Integrated Clinical Clerkship in Emergency Medicine AY 2021- 2022

Pre-hospital care is an essential part of a responsive and well-functioning emergency care system. According to the WHO Emergency Care System Framework, facility or hospital care is just one part of emergency care; the function of a responsive system starts at the scene, which involves the bystander response, dispatch, and provider response. This is where the system is activated, and the time to dispatch and time to scene are crucial so that proper onsite care may be given. The next function is transport, which involves patient transport to the facility and transport care. This usually involves an ambulance where the destination triage and transport care may be performed. Faster transport time and time to provider are also crucial to achieve in an emergency care system. However, as seen in the documentary Ambulansyang de Paa, the reality of pre-hospital care in the secluded areas of our country cannot be any more different. Because of multiple compounding factors, including but not limited to lack of proper road access and scarcity of healthcare facilities, people in these geographically disadvantaged areas are forced to utilize unconventional means to transport those in need of medical care. Due to the lack of roads, dispatching providers to the scene is simply not possible, and thus patient transport becomes the first step of the system. Relying on willing people from their community, patients are transported on foot in hammocks through a 3-4 hour hike along precarious terrain just to get them seen by a doctor in town. But even if they get them to the closest facility, the municipal health center is only equipped to handle basic cases, and may still need to transfer to a bigger hospital if they will not be able to manage the patient adequately. This current system is definitely inadequate and unsustainable, and will inevitably collapse when a bigger emergency occurs. However, the solution is not solely on the part of the healthcare system, but the burden must also be put on other agencies. Health truly is multifactorial, and needs the cooperation of all sectors of the country to ensure that health for all, especially emergency care, is achieved, even for those in the most hidden places of our country.