The situation in Ambulansyang de Paa provides a glimpse into a system with multiple problems of pre-hospital care, particularly, the lack manpower, the lack of proper transportation and roads, the lack of facilities and equipment, the lack of protocols and systems in addressing disease burden. Transportation and access to facilities are factors of timely disease management, while manpower and equipment are factors of appropriate and effective healthcare. Protocols, meanwhile are factors for the efficiency and accuracy health care delivery. All of these together contribute to the treatment of life threatening conditions, since these conditions are often time-sensitive, and require expertise as well as specific resources.
For example, for the case of Lowen, the journey required traversing uneven terrain as well as exposure to the elements. In the middle of the journey, several people huddled around Lowen without regard to his contagious disease. Upon arrival to the Health Center, Lowen was given medication for his tuberculosis (the documentary did not show what procedures, i.e., Hx/PE, were performed on Lowen at the Health Center, but we will assume that the decision to provide medicine was based only on clinical findings). There are numerous problems in this case. Firstly, there were no trained personnel to assist Lowen prior to beginning the journey. There was no documentation of important data such as subjective and objective findings such as history or vital signs performed prior to beginning the journey. There was no communication to the Health Center that there would be a patient arriving. The patient was not stabilized nor monitored for vital signs during the journey. Exposure of both volunteers and the patient to each other may have contributed to spread of disease. Upon arrival to the Health Center there was no proper handoff. At the Health Center, the doctor was not able to order necessary diagnostic procedures such as
GeneXpert or X-ray due to the lack of resources. There did not appear to be any documentation performed at the Health Center (although perhaps this was simply not shown in the documentary but otherwise performed). Lastly, a less than ideal management plan was decided for the patient, again due to the lack of resources (given the patient’s appearance and history, he should at least be classified as an ESI 2 case and should be admitted to a hospital and screened for other health problems, e.g., malnutrition, psychological disease such as depression, extrapulmonary TB, other infections such as intestinal parasites/ head lice, etc.) If all the important pre-hospital care elements were in place, many of the above problems would be avoided, and the patient would have received better care with improved outcomes.
The situation shown in Ambulansyang de Paa is rather extreme and requires multi sectoral improvement for there to be any real outcome. Even if transportation were improved, trained manpower increased, and facilities built and equipped with resources and with protocols to guide procedures, the disease burden will still likely be the same. I.e., the population will still have the same burden of trauma, infectious, and nutritional diseases. To address this aspect of health care, a strong intersectoral collaboration in the management and promotion of health must be developed. Communities must be empowered, educated, as well as provided with the basic necessities of life such as shelter, and clean food and water. This, in combination with improved prehospital care is an important step toward improved outcomes for all patients.