17 November 2009Fairview Hotel, Nairobi, Kenya

Emergency Medical System Development PilotStakeholders Conference

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role Africa Collaborative for EMS

EMS Development Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps

Welcome

Asante Sana

Many Thanks

Merci Beaucoup

Setting the foundation for action

Why are we here?

Why are you

here?

Why now?

The journey

We Share the Same Dream...

...You Have the Same Passion...

...A Window of Opportunity

Life-Long for many, a 3 year labor of love for the UCLA Team

Healthcare - The Most Basic Commitment of a Society to its Fellow Citizens

Emergency Healthcare- The Most Vulnerable Stage

Introductions - Building bonds to overcome challenges

Please share your• Name• Organization• Role

Vision for today

There are risks and costs to a program of action. But they are far less than the long range risks and costs of comfortable inaction

John F. Kennedy

Let us reflect throughout today on how to create a foundation for practical and united action

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role Africa Collaborative for EMS

EMS Development Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps

This section WIPThis section WIP

A new model of health care needs to be developed

Silo approach to health care has failed us

Care coordination is needed at every level and every transition point• Pre-Hospital (Emergency Care)• Hospital• Rehab• Chronic & Long-Term Care

Current system prevents comprehensive care coordination: This is a global problem

What are alternate approaches?

Sustainable change requires systems thinking and the collaboration of three groups

Academia

GovernmentPrivate

Sector & NGOs

Working together in a balanced and collaborative manner is key

Emergency medicine is a consistent challenge globally

Emergency Medical System- A Global Problem

The Continuous Improvement Challenge in Developed Nations

A “Silent Killer” in Developing Nations• Sub Saharan Africa, South America, MENA, U.S. (Underserved)

Role of academia is valuable as a facilitator and developer of insights

Relative Independence

U.S. Universities: University of California, Stanford University, (Duke, UNC, etc)

Local Universities: TBD

Multi-Level, Multi-Profession Systems Thinking• School of Medicine• School of Management• School of Nursing• School of Education

Review of pilots

Africa Pilots

Nigeria, South Africa, Kenya,

Why Kenya?

East Africa- Kenya, Tanzania, Nairobi Pilot(s):• Phase I- Initial 2 sites, Consult & Consensus- • FAST (NO WRONG DOOR)

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role Africa Collaborative for EMS

EMS Development Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role Africa Collaborative for EMS

EMS Development Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps

International EM – A Case Study

India – GVK Emergency Management and Research Institute (EMRI) Collaboration with Stanford University, USA.• Dr. S Mahadevan, Stanford Emergency Medicine

Developed a successful Emergency Medical Services System in several states in India

Overview of this system

GVK EMRI

Started in August 2005

Not-for-profit professional organization operating in the PPP mode• Private entrepreneur funded initial startup costs• Government provided 108 emergency service and legislation

Only professional emergency service provider in India today

Handles medical, police and fire emergencies through the "1-0-8 Emergency service”

Quick Facts

Over 1900 Ambulances and 15 Prime Responder Vehicles across 9 states

Ambulance reaching in 14 minutes in urban areas and 22 minutes in rural areas

100% Virtual handholding by Paramedic and Physician in critical cases

Medical Emergencies (Vehicular Trauma 18%, Maternal Complications 22%, Suicidal attempts 6%, Cardiac 4%, etc)

46,000 + Lives saved

12,000+ Associates – Ambulance (90%), ERC (5%), Support (5%) Source: http://www.pressreleasepoint.com/node/165826/pdf

EMRI EMS Project

Emergency Medical Technician (EMT) Training program• Extensive education initially provided by Stanford, trained Indian

instructors who now train future EMTs.

Universal toll-free number

Call Center that dispatches ambulance

Provided jobs for community

EMRI EMS Project

Improves healthcare

Created public demand

When private funding reduced, public implemented policy for EMS

Now funded by Indian Government and private sources

Expanded to several other Districts

Key Points for an EMS System

Learning from India’s EMRI EMS project, sustainability is the TOP priority in design

Infrastructure• Emergency Number• Call Center• Employees (Nurses, EMT, Doctors)• Hospital Emergency Departments

Key Points for an EMS System

Education• Community Emergency education• EMT, ER Nurse, Emergency Doctor

Cooperation/Dedication• from Stakeholders

Public Health

In response to resolution WHA60.22 on emergency-care systems, adopted by the World Health Assembly, May 2007, WHO/Europe actively contributes in the following aspects:• Devising standardized tools and techniques for assessing need for pre-

hospital and facility-based capacity in trauma and emergency care• Reviewing legislation • Determining standards of essential trauma and emergency care• Providing guidance for the creation mass-casualty management systems• Encouraging research

International EM – Emerging Areas

Will Kenya have the first Comprehensive Emergency System in Sub-Saharan Africa?

A chance to be a leader amongst Sub-Saharan African nations?

Thank You

Acknowledgements (to name a few)• UCLA EMPH, Fred Hagigi DrPH, MBA, MPH• Charles Otieno, M.D., MPH, Jonathan Crisp, M.D.• Shubha Kumar, DrPH, Julie Elginer, DrPH MBA• Nanette Ramzan, Edith Omwami PhD• S. Mahadevan, M.D.• Jerome Hoffman M.D., Scott Votey M.D., Seve Rottman M.D., Marshall

Morgan M.D.• UCLA Emergency Medicine residency• Luis R. Goldfrank, M.D.

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role - Africa Collaborative for EMS

EMS Development: Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Set the foundation for today's conference

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps and preparation for Thursday

This section WIPThis section WIP

Today's agenda

TopicTopic

Welcome & Introductions

Opening and Keynote Address

Academic role - Africa Collaborative for EMS

EMS Development: Nairobi Pilot Project

Required Elements of an EMS System

The Call to Action

Identification of Next Steps

ObjectiveObjective

Set the foundation for today's conference

Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda

Review the role of universities and researchers in facilitating this process

Set the foundation for the pilot project

Review lessons learned from India’s EMRI Program

Stakeholders group discussion to align on practical action

Outline immediate next steps and preparation for Thursday

This section WIPThis section WIP