‘Paramedics Close The Gap Between Doctors And Nurses’

Dr Nnamdi Nwauwa is the National Chairman of the Society of Emergency Management Practitioners of Nigeria (SEMPON); Chairman of Emergency Response Group, Chairman of the Advanced Trauma Life Support (ATLS) and Advanced Life Support Providers Association in Nigeria.

Popularly known as the father of emergency response management and services in Nigeria, Nwauwa has been an advocate of emergency management for the past 25 years.

In this Interview with LAOLU ADEYEMI and KEMI OBADIMEJI; Nwauwa, the former Pro-Chancellor, University of Ilorin, bares his mind on improving the state of emergency management, his proposed Institute of Emergency and Paramedics which starts admission in September, and other issues.  

CONSIDERING your background as a doctor and as a former Pro-chancellor, what informed your choice of emergency management business?   When I was in charge of a general hospital in Imo State those days, we had lot of trauma cases.

Many of the patients were usually at the point of death before getting to my hospital and I was the only doctor in the area. Since the job was pretty much for me, I had to arrange and show people what to do whenever emergency occurs.

I started teaching my patients and those who came in contact with me. I even produced improvised scripts and gave it to the villagers. From there, I developed interest in treating emergency victims.

Alongside, some oil companies invited me to help handle their emergency units. And from there, the interest grew and I began to get links from international organisations.

Since I started this, I have never done any other thing outside emergency. When did you begin your emergency service crusade?   After my training abroad, I came back and introduced the first emergency service in Nigeria in 1990.

I had training in Medicines Sans Frontières (MSF) International, American College of Surgeons, American College of Emergency Physicians, among others. I then became a member of many other bodies.

In Nigeria, I have been able to spread the gospel of emergency and it has become a known area of medicine. The development we’ve recorded in the sector is because of God, my ability and that of my staff. We have also brought in lot of training programmes. My company brought in over 90 per cent of training programmes in emergency management in Nigeria.

We have sensitised the medical society and the general public on the importance of emergency. Today, areas like Basic Life Support, Advanced Life Support and others have become very essential and widespread.

But when we started, nobody gave us a chance. At present, almost all institutions want their doctors and nurses to be certified in these areas of emergency. So, that is a major achievement.

We brought in ATLS to the country in 2010 and we worked hard to get the government key into it. Without ATLS, we cannot be talking about good emergency sector. The implication is that organisations such as NEMA, Road Safety among others are yet to be well- equipped or trained in the latest emergency programmes.

We have been pleading with the government that every emergency department must adopt this. A few months ago, the Federal Ministry of Health directed all the emergency departments to make sure that doctors and nurses are certified in these programmes.

The mandate was issued late last year, but it has been very slow in practice. How would you rate the level of emergency preparedness in Nigeria?   I would answer this by making reference to a study my group did recently.

In that study, we wanted to see the factors affecting emergency response in Nigeria. We don’t have paramedics and the emergency departments of many hospitals are poorly equipped. We went round hospitals and discovered that if anything happens in the country, we are in trouble.

There is apathy to things like this until it affects somebody close to the authorities before we make a move. If any disaster happens now, it would attract attention from the public, but as soon as the case dies down, everything goes under the carpet.

For instance, nobody is talking about the aviation sector again since the last aircraft crash but if disaster happens now, people would start lamenting.

How many of our airports have ambulances? So, pre-hospital is so crucial in this country and that is why paramedic school is invaluable. Government should encourage these people and give them very good benefit because they risk their lives every day. They are the ones that get in touch with the situation when it is very intense.

Lives lost to disasters have been on the increase in Nigeria. How do we reduce casualties whenever disasters happen?   Emergency management and preparedness is best done when there is no emergency.

When it occurs, the situation, anxiety, among others, would not allow you to think. If you’ve not rehearsed, you cannot apply the skills very well.

This means we must tackle situations by prevention. Since the emergency situations don’t occur in the hospital, doctors are out of it. When there is a serious casualty while people are running away, it is only the paramedics that stay. Bystanders are not trained, so why would they want to intervene? Many people would have been saved if people around could only help.

In some countries, the government says each institution must train their staff on basic things in emergency. It is mandatory. So, when there is a disaster, everybody around knows what to do.

As a banker or lawyer, you must have a basic knowledge of emergency because it might be too late before help comes. In every 10 people, one person must be emergency certified and paramedics should be given priority.

There should be adequate and effective communication too. There might be a bomb blast somewhere but if people around are inexperienced; more lives would be lost.

The fact that no doctor heals death makes it imperative for government to raise awareness on pre-hospital emergency management training. At least two people should be trained on emergency management in every single family in Nigeria.

I sincerely want to appreciate the last administration that put up a curriculum which enables us to run an institution saddled with responsibility of providing pre-hospital training to people.

Our institute will be admitting the first batch of his students come September.  The last administration put up a curriculum and went ahead to approve institutions that will start paramedic emergency schools.

Of course, we were at the forefront and that was how we got the federal government’s approval. In September, we would be admitting the first set of students in our College of Emergency and Paramedics.

This is the first in Nigeria and it is one of the major achievements we’ve recorded too. After 15 years of making the government to recognize the needs, these schools are now emerging.  What do you hope to achieve with the college?   I think I would start by talking about the pre-hospital emergency services in the paramedic.

We have many situations where people die just because they didn’t rescue the situation fast. If anything happens to us, we are all alone. Transportation is always a challenge too, as many families don’t have vehicles or the person who knows how to drive could be the victim. At times, when patients get to the hospital, it takes time before they are attended to, until the condition becomes inescapable.

I had a case where one of my staff members was bleeding seriously and the medical practitioners on duty insisted he got a card. There is no sense of urgency or emergency in our system.

Paramedic system would have said leave that patient and go take care of the one in terrible situation. This is what we call training and attitude changes in emergency.

It is a bit different from the normal health training. An emergency physician could even start treatment without hearing from you or without an identity. But a normal physician would have to take your history among others before administering treatment. In emergency, you have to secure life first. The emergency physician would first see the patient, stabilize him and then allow the various medical practitioners to take over.

So, this is where the job of the paramedic comes in. In some countries, when you call an ambulance, it gets to you in three minutes. The critical rescue period of those countries have been reduced drastically.

All you need to do during a disaster is to make call and you would see the whole “nation” in your house to assist. There is nothing like that here. Paramedics are there to fill this gap. They move any time, but doctors cannot. If the paramedics’ ambulance is in use, they would stabilize the patient.

On the way, the patient could be in serious reparatory distress condition that would mandate them to put him in oxygen or to introduce mechanical breathing.

The patient could also be in shock and they would quickly respond to the situation at that instance. They don’t even handover until the doctor comes and they ensure the transfer.

So, you can see the smooth advantage of having a paramedic school. It is a missing gap in our health system and that is the reason we have been campaigning all these years.

We thank God that it is on now and the schools are gradually being opened by the Federal Ministry of Health. It is a four-year programme and a year internship. It is an HND programme and you need to see them in action.

While the job of a doctor is to sustain the life of a patient, the job of a paramedic is to make sure the doctor sees a live patient. They are well trained and the admission process requires physics, chemistry, biology and mathematics.

They also work under the medical director. How about the fear that your certificate might not be recognised by all and sundry?  No, it cannot happen in this case. This is a Federal Government-approved course and the curriculum is adopted from other countries. The team of experts was selected to see through it and it was approved by the various levels of the medical profession.

So, it passed through all the various stages and they joined civil service at a good grade. But before the approval, we’ve been training people in affiliation with international schools.  When you train with us, you have HND and you are also certified to work abroad.

HND is Nigeria while the other certificate we give is internationally accepted. It is acceptable in the whole of Europe, Asia among others. The paramedics are highly needed in the emergency department and they close the gap between doctors and nurses.

By the time the ambulance legislature comes in, it would be impossible to have an ambulance without having a trained paramedic. In India and other developed countries, an ambulance must contain certain things. You must also be able to differentiate between an ambulance service and emergency service.

Ambulance service is more of transportation and what they do is to pick up the patient and transport him or her to the hospital. But emergency medical service stabilizes the patient, rescues and delivers him or her to the hospital. So, all what you see often is just ambulance service. If anything happens before they get to the hospital, you are on your own.