Prehospital trauma care systems - World Health Organization

3. DESIGNING AND ADMINISTERING THE SYSTEM
Box 4. Case study: Thailand
Developing and implementing a prehospital care system
Each year, there are more than 12 million visits to Thailand’s emergency departments; these
are the result of acute trauma and emergency medical conditions. In 1994, the Ministry of Public
Health recognized the importance of developing an effective prehospital care system to address
this need and improve care. A long-term strategic plan was subsequently adopted and
implemented in three phases.
● Phase I lasted from 1994–2000 and focused on developing the model.This phase addressed
four important components: administration and management (establishing provincial
boards, regulations and standards of practice, and developing a system of evaluation),
personnel (designating prehospital personnel as nurse paramedics, intermediate-level
emergency medical technicians, basic-level emergency medical technicians, and first
responders; and developing job descriptions, clinical practice guidelines and evaluation
systems), ambulance standards (establishing required equipment and maintenance
standards), and communication systems (establishing an emergency call system using a
nationwide number, delivering public education and developing the rescue network).
● During phase 2 (2000–2004), an organization (known as the National Board) was created
to develop a master plan for implementing the prehospital care system and to formulate
a budget (approved by the Ministry of Public Health at a cost of 10 Thai baht per person;
1 Thai baht = approximately 0.02 euros).
● During phase 3 (2004) the focus was on analysing the implementation of the model at
the provincial level.An initial review of data from Khon Kaen Province (with a population
of 1.7 million people) from 2003 showed that there were 1000 prehospital care personnel
and 80 ambulances and that 7835 emergency calls had been answered.Altogether, 90%
of responses had been performed in less than 10 minutes, and 90% had a scene time
(time spent at the scene of an event, after arrival and prior to transport) of less than
10 minutes.
● This process is continuing, and prehospital care continues to develop in Thailand. However,
four issues remain for further consideration: the establishment of national prehospital
care legislation, further development of the national central alarm centre, the establishment
of national standards and direction for personnel development and implementation of
a sustainable budget system.
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