Beyond band-aids: Institutionalising emergency medical care in post-Hasina Bangladesh

As defined by the World Health Organisation, an Emergency Medical Services System (EMSS) is a critical component of a country’s healthcare framework.It encompasses the entire network of services, personnel, and infrastructure dedicated to providing emergency medical care, from the moment an emergency occurs to the patient’s arrival at a healthcare facility.
A well-functioning EMSS ensures timely and effective response to medical emergencies, including triage, stabilisation, transportation, and communication. It also involves coordination with other emergency services, like fire and police departments, to provide a comprehensive response to emergencies. The WHO emphasises that a strong EMSS is essential for reducing mortality and morbidity, and improving health outcomes, particularly in resource-limited settings such as Bangladesh.
The number of patients visiting emergency departments worldwide is increasing. In the United States, the number of emergency department visits was 353 per 1,000 people in 1997, but it was 411 per 1000 population in 2020, reaching 131 million a year, more than double the rate of population growth. In Korea, the number of emergency patients, which was 2.4 million in 2002, increased steeply from 1,0 million in 2018.
In Bangladesh, it is difficult to identify the exact emergency patient demand because of severe data gaps. Also, most patients who come to hospitals are triaged and then divided into outpatient department, inpatient department, emergency department, and intensive care units. The EMSS, including its referral and transportation systems, has yet to be recognized as a vital component of the healthcare system.
By integrating a well-functioning EMSS into Bangladesh’s health sector, the country can reduce the impact of accidental injuries, prevent disabilities, and save lives. A recent example of the need for this is the crackdown on student protesters between July 15 and August 5. The government’s violent suppression of the student-led movement demanding reforms in the quota system resulted in a significant number of deaths and injuries. Although the exact numbers are unclear, reports suggest a devastating toll. The presence of a functional EMSS in Bangladesh could have prevented many of these deaths and permanent disabilities. By prioritising EMSS development, the post Hasina Bangladesh can better protect its citizens and ensure more effective emergency care.
Over the past 15 years, Bangladesh has faced significant challenges under Sheikh Hasina’s authoritarian rule, including human rights violations and the deterioration of public institutions. The health sector has not been spared, with inept leadership, widespread corruption, and politicisation exacerbating the fragmentation of already fragmented emergency medical services. This has resulted in denied services, medical negligence, and increased healthcare disparities, disproportionately affecting the poor and marginalised populations. Many victims of the regime’s violent oppression have faced financial hardship due to exorbitant emergency medical costs, leading to catastrophic expenditures.
Furthermore, in Bangladesh the current health system challenges including limited access, inadequate infrastructure, shortage of skilled professionalsand high out-of-pocket expensesare compounded by skyrocketing increase of accidental injuries which are now estimated to account for higher number of deaths than infectious diseases. According to limited information that is publicly available, accidental injuries account for around 12 per cent of all deaths, and by 2030, this acute condition will become a top leading cause of death in Bangladesh.
Integration of EMSS in Bangladesh’s health systems will reduce the risk of further injury or complications during transportation, ensure timely arrival at hospitals for proper treatment, promote the provision of life saving interventions by trained paramedics and emergency medical technicians, strengthen coordination with hospitals for
emergency preparedness and response, and on the top of everything, it will raise public awareness about accident prevention and safety measures.
To improve EMSS, we need high level policy attention, a legal framework, policy reforms, increased investment, expert human resource and collaboration between public and private stakeholders. The US and Canada’s 911 system is a great example of a well-functioning EMSS that can inspire us.
The number “911” is the universal emergency number for everyone in the United States. However, prior to 1968, there was no standard emergency number. So how did 911 become one of the most recognizable numbers in the United States? In 1967, the Federal Communications Commission (FCC) met with AT&T to establish such an emergency number. They wanted a number that was short and easy to remember. More importantly, they needed a unique number, and since 911 had never been designated for an office code, area code or service code, that was the number they chose.
Soon after, the US Congress agreed to support 911 as the emergency number standard for the nation and passed legislation making 911 the exclusive number for any emergency calling service. A central office was set up by the Bell System to develop the infrastructure for the system.
On February 16, 1968, Alabama Senator Rankin Fite made the first 911 call in the United States in Haleyville, Alabama. In 1973, the White House’s Office of Telecommunication issued a national statement supporting the use of 911 and pushed for the establishment of a Federal Information Center to assist government agencies in implementing the system.
By 1979, about 26 per cent of the United States population had 911 Service, and nine states had passed legislation for a statewide 911 system. Through the latter part of the 1970s, 911 Service grew at a rate of 70 new local systems per year. Approximately 50 per cent of the US population had 911 Service by 1987. In 1999, about 93 percent of the US population was covered by 911 Service. Canada adopted 911 in 1972, and the first city to implement the system was London, Ontario, in 1974.
Bangladesh can draw inspiration from this unique example to institutionalise EMSS within its health systems. To enhance EMSS, it’s crucial to identify existing resources, understand demand, and develop a comprehensive improvement plan for each EMSS component. With increased political will and ambition for health sector reforms, the post-Hasina era presents a significant opportunity for Bangladesh to establish a comprehensive EMSS. This will be a vital milestone in achieving universal health coverage in Bangladesh, ensuring that all people have access to quality health services without denial and financial hardship.