Ambulances are the greatest billboard never used: they have lights, sirens, move on four wheels, and every time the community sees them in action, they are going to help people who could really need it. They give citizens a sense of assurance that something is being done, that someone is looking out for them, because everyone realizes that the ambulance could be coming for them. This fact is often best understood by politicians in developing countries, where the need for emergency medical care is most needed. According to the World Health Organization (WHO), developing countries spend 1-5 percent of their gross national product on care for the injured. Yet at the same time, WHO also reports that less than 60 countries worldwide can provide reliable ambulance transport to a wide majority of the population. Such a lack of emergency transport is likely one of the reasons why 80 percent of all road traffic fatalities in low-income countries occur in the prehospital setting: there’s no reliable way to get help when and where it’s needed. Emergency medical services is a very ripe area for CSR programs to find new innovation in positively impacting the triple bottom line.
However, before we can start shipping more full-body ambulances to emerging markets and decking them out in logos like NASCARs – and it happens often – it’s good to understand why there aren’t many ambulances in developing countries to begin with: conventional ambulances often just don’t belong. A quick ride past the hillside shantytowns in Rio de Janeiro, or along a washboard road in Panama will make it clear that there are some communities that ambulances simply cannot access. In fact, in some countries where western-style ambulance services have been rolled out, the community doesn’t even bother calling when they’re needed because they know the ambulances will never arrive in time; discerning public servants who understand this have been known to use ambulances for better use, by making air conditioned offices out of them.
Nonetheless, emergency medical care is still needed in the developing world, and urgently, and solutions exist to improve public services through a range of innovative corporate social responsibility programs. Using low-cost / high-impact interventions, public-private health partnerships can improve access to basic emergency care while making significant improvements to the triple bottom line.
The concept is really quite simple: emergency medical systems contribute to healthy and safe communities by reducing healthcare costs, mitigating productivity losses, and improving community relations. If this last part seems a stretch, consider for a moment what your reaction might be like if your mayor published an announcement in the newspaper stating that due to budget shortfalls, 911 services were being cancelled for the next year. Then, consider what it would be like if no 911 services had been the norm, and your mayor then announced that 911 services were now available, thanks to him and his team. EMS services in affluent countries are a given.
The trick, of course, is making sure the ambulance arrives when it’s called, because when an ambulance can’t respond after being, it is easy to see how the public’s faith in their leadership could be compromised. This may help to explain, in part at least, why governments and ambulances have such short lives in many developing countries.
Improving access to emergency care doesn’t have to be viewed with so much suspicion of liability, either. The WHO data mentioned above are another way of saying that it is more expensive for governments and corporations to do nothing, than to even make the most incremental improvements. And perhaps the most compelling reason for taking a closer look at improving emergency medical care is simply due to the fact that everyone drives the same roads: car wrecks do not discriminate. There is the classic case of the bourgeois baron in his slum empire who was too dignified to consider pick-up trucks as a legitimate form of emergency transport; fortunately for him he was unconscious when the street kids pulled him from his crumpled SUV and threw him in the back of a Daihatsu.
That’s exactly how such systems can be improved through CSR programs: engage the community to improve their own emergency response systems by starting from where they’re at. Simply strengthening the systems that already exist, whether formal or informal, is an innovative way to improve the triple bottom line while also benefiting from substantive consumer-facing marketing initiatives. Here are the insights my organization, Trek Medics International, can offer from our own experiences, though many more are certainly possible:
- Training: millions of able-bodied, unemployed, and potentially at-risk youth are right now collected on street corners across the globe, looking for something to do. When they hear of a car wreck or a sick person, they will go and watch, simply to see what’s going on. Pluck out the ones who actually have the courage – or the bravado – to get in and help, and we have the first round of candidates for leadership and community instructor positions. How do you pay them? Depends on the call volume: can they make a full-time job out of emergency response, or is this an every-once-in-awhile opportunity? Give them a uniform with a badge and they will band together. Put your logo on it and back it up with tangible support and accountability and they will respond to that, too. If they don’t, let them go – their friends will be eager to replace them.
- Transportation: I wasn’t kidding earlier about the NASCAR thing, and full-size ambulances do have a place in developing community-based EMS systems, albeit a limited one. The roads are already full of appropriate vehicles that can provide safe transportation. If we train those who drive them – including the taxis, commercials vehicles, motorcycles and rickshaws, among many others – and if we make it visible to the public that they have been approved and can be held accountable for transport, the drivers and community will respond to that. But who will pay for it? Depends on the call volume, but nobody’s leaving a full-time job for a once-in-awhile opportunity. And in either case, they are already charging people for transportation to the hospital – sometimes so much so that people will forego transportation and end up with problems that are exponentially more expensive. But by approving transport that’s already being used, you can certainly regulate it.
- Communications: If we have people who are willing to help, there are plenty of people willing to transport, and nearly everyone is carrying a cellphone, how come there’s no way to call for help when and where it’s needed? Crowd-source it. Instead of sending an ambulance out to fetch patients and return to the hospital like a boomerang, as we do in rich countries, send word out by text message to everyone you’ve trained and find out who’s closest. This is what volunteer fire departments across the US have been doing for decades, and like we are now doing with our software BEACON, an SMS-based dispatching software developed specifically for communities that will never afford advanced 911 technologies. How do we pay for dispatch? To begin with ,text messages are cheap. And just like politicians, telecom providers have very compelling incentives to be the emergency telecommunications provider in countries that don’t have dispatch available. If existing companies don’t want to, others likely will.
If there is still skepticism, my final attempt to make you a believer would be that these systems already exist, and have for as long as there’s been hospitals for treatment, or homes for hospice. Once we reject the thinking that it’s the western-style EMS or nothing, then it’s easy to see how a few dollars for a youth development program and some smart public service announcements could go a long way. But if you’re still not convinced that it’s worth the pain and effort and cost, then the best advice I can give is to buckle your seatbelt and make sure you know where the nearest pick-up trucks are. There are millions of young adults around the world who are just dying to find an opportunity to be a part of something bigger, and they’d wear that generosity like a badge of honor.
J. Friesen, MPH, EMT-P, is a paramedic and the founder of Trek Medics International, a nonprofit organization that improves emergency medical systems in developing countries. Trek Medics is currently seeking funding to complete testing of the BEACON dispatching software on IndieGoGo.com through Oct. 6, 2013.