EMS IN SRI LANKA
SUPPORT FROM INDIA
According to the World Health Organization
( WHO), emergency care requires three main
components: 1) community care; 2) care in
health facilities; and 3) care en route from one
location to another location. 9 A lack of centralized communication, inconsistent EMT
training standards and a lack of public awareness about appropriate use of ambulances were
some of the factors that presented obstacles
to care during transport. 10
Against a historical patchwork of volunteer
services, commercial ambulance companies,
hospital-based services, and an underutilized
fire department service that responded primarily to trauma, Sri Lanka was clearly in need
of a more effective EMS system.
In July 2016, ambulance services commenced in three provinces—a groundbreaking
initiative that was the result of intervention by
Indian Prime Minister Narendra Modi. With
a personal interest in emergency response,
Modi was well aware of the successful track
record the GVK Emergency Management
and Research Institute (EMRI) Company
had in his country. EMRI, assisted by Stanford University Emergency Medicine International, had begun operating in India in 2005.
Its ambulances now provide emergency care to
three-quarters of India’s population. EMRI’s
expertise was ideal for expansion to India’s
southern neighbor. 11
In Sri Lanka, the major change agent has
been Deputy Minister of Foreign Affairs
Dr. Harsha de Silva. While recognizing the
high status of Sri Lankan healthcare in the
region, he acknowledged that “the only lacuna
that existed was in gaining timely access to
emergency ambulances with trained para-
medical staff.” 12
The Indian grant of US $7.6 million provided for 88 ambulances, as well as training, at GVK EMRI in Hyderabad, India,
for Sri Lankan emergency providers: 250
EMTs, 250 pilots and drivers, and 50 call
center operators. 12
EMS IN SRI LANKA TODAY
Citizens may now call 1-9-9-0 to access free
care. Public awareness of this new service has
been promoted by print, radio, television media
and via blanket texts from the major cellular
The new, modern ambulances, stationed
at police stations, are now coordinated by a
state-of-the-art command and control center located in the Rajegiriya area of Colombo.
Vehicles can be tracked throughout the course
of a transport. Medical control and advice
is available at the center by trained physicians. Ambulance services, which began in
the southern and western provinces, are provided free of charge.
The Sri Lankan Society of Critical Care
and Emergency Medicine, which guided the
development of emergency medicine, has taken
on the responsibility of maintaining EMT
training for the program.
Phase two of the undertaking, scheduled
for early 2018, calls for more than 200 additional ambulances to be deployed in the rest
of the country. JEMS
Nuwan Chamara Ekanayaka, EM T-I, is director of training
and development for MediAsia.
Ken Elam, MD, MPH, is medical advisor for American Medical
Response (AMR) Pierce County, Wash.
1. Peiris, GH, Arasaratnam S. Sri Lanka. (Sept. 13, 2017.) Britan-nica. Retrieved Sept. 26, 2017, from www.britannica.com/
2. Perera C. Legal aspects of motor traffic trauma in Sri Lanka.
Egyptian J Forensic Sciences. 2016; 6( 4):341–346.
3. Sri Lanka: Life expectancy at birth. (n.d.) CountryEconomy.com.
Retrieved June 25, 2017, from www.countryeconomy.com/
4. Sri Lanka Ministry of Healthcare and Nutrition. EMS. (n.d.) Trauma
Secretariat. Retrieved June 24, 2017, from www.traumaseclanka.
5. Moore M, Ritcie M. (Dec. 23, 2014.) How the Boxing Day tsunami unfolded, hour by hour. The Telegraph. Retrieved Sept.
26, 2017, from www.telegraph.co.uk/news/worldnews/
6. Sirimanna B. (Aug. 19, 2012.) Speedy emergency medical
service launched. Sunday Times. Retrieved Sept. 26, 2017,
7. EMS provider Falck exits citing commercial unviabil-ity. (June 10, 2015.) Daily Mirror. Retrieved June 23,
2017, from www.dailymirror.lk/90137/ems-provider-
8. Zimmerman JR, Bertermann KM, Bollinger PJ, et al. Prehospital
system development in Jaffna, Sri Lanka. Prehosp Disaster Med.
2013; 28( 5):509–516.
9. Razzak J, Kellerman A. Emergency medical care in developing countries: Is it worthwhile? Bulletin of the WHO.
10. Wimalaratne K, Lee JI, Lee KH, et al. Emergency medical service
systems in Sri Lanka: Problems of the past, challenges of the
future. Int J of Emergency Med. 2017; 10( 10): 1–6.
11. Sri Lanka starts emergency paramedic service backed by India.
(Aug. 12, 2015.) Economy Next. Retrieved June 22, 2017, from
12. Sri Lanka launch first free pre-hospital care ambulance service with Indian grant. (July 28, 2016.) Lanka Business Online.
Retrieved Sept. 26, 2017, from www.lankabusinessonline.com/
Med1 Ltd., later purchased by Falck, pioneered these motorcycle-based first responders in Sri Lanka.
Photo courtesy Nuwan Chamara Ekanayaka
Sri Lanka’s Deputy Minister of Foreign Affairs, Harsha
de Silva, PhD, was instrumental in starting the 1-9-9-0
EMS system in 2016. AP Photo/Eranga Jayawardena