Emergency services play a vital role in the health sector, providing immediate medical attention to patients with acute injuries or illnesses. These services are essential for saving lives, preventing further harm, and improving health outcomes. Timely intervention is critical in emergency situations, where every minute counts. Emergency services offer life-saving interventions, such as cardiopulmonary resuscitation (CPR), defibrillation, and advanced trauma care.
The importance of emergency services in the healthcare system cannot be overstated. They are an essential component, providing a safety net for patients in need of urgent care. Emergency services are expected to be available 24 hours a day, 7 days a week, ensuring that patients receive timely care regardless of the time of day or night. It can be categorized into out-of-hospital and in-hospital settings. Out-of-hospital emergency services, delivered by Emergency medical Technicians (EMTs), paramedics, or responders, include ambulance services, emergency response teams, and first aid. In-hospital emergency services, provided by emergency physicians and nurses, include emergency departments, trauma centers, ICUs, and code blue teams. Both settings play critical roles in delivering timely and effective care to patients in need. A multidisciplinary team of healthcare professionals, including doctors, nurses, and other specialists, work together to provide comprehensive care. It utilize a range of equipment and modalities, including defibrillators, ventilators, ECG monitors, pulse oximeters, and infusion pumps, as well as advanced life support technologies like ultrasound and point-of-care testing. Other essential equipment includes Ambulance services, stretchers, splints, and immobilization devices for patient transport and stabilization, as well as communication devices to facilitate coordination with other healthcare teams.
In Nigeria, emergency services are designed to be managed by various organizations, with the National Emergency Management Agency (NEMA) being the primary agency responsible for disaster prevention, preparedness, mitigation, and response. NEMA operates a 24/7 emergency hotline, 112, which connects callers to trained operators who can coordinate immediate assistance during natural disasters, accidents, or other crises. In addition to NEMA, other emergency services in Nigeria include the police, fire service, and ambulance services. Each of these services has its own emergency contact numbers, which can vary by state. For instance, the police emergency numbers differ across states, while the Federal Road Safety Corps (FRSC) has a national emergency line, 122. The Nigerian Red Cross Society (NRCS) also provides emergency assistance and has its own contact numbers.
Despite the existence of these emergency services, Nigeria still faces significant challenges in providing effective emergency response. This can be attributed to myriads of factors ranging from limited infrastructure, inadequate funding, and insufficient training which hinder response times and the quality of care provided. The absence of a well-structured and operational emergency care system in Nigeria, the continent’s most populous nation and largest economy should raise serious concerns.
According to the World Health Organization (WHO), Africa, including Nigeria, has one of the highest road fatality rates globally, Nigeria records around 39,000-40,000 road traffic deaths annually, with a fatality rate of 21.4 per 100 million vehicle-kilometers. Additionally, Cardiac arrest mortality rates in Nigeria are alarmingly high, studies reveal varying outcomes with approximately 8.1% in-hospital mortality for acute coronary events, while 86.1% of sudden cardiac death cases were brought dead to hospitals. Hypertensive heart disease accounts for 82% of sudden unexpected cardiac deaths. This alarming figures in mortality before hospital care attest the limitation of emergency response in the country.
It’s imperative to note that most Nigerian public places, such as stadiums, airports, schools, markets, and offices, lack defibrillators. Moreover, many Nigerians are unaware of proper resuscitation techniques, let alone performing them adequately. A study among students revealed that 63.6% demonstrated poor to average knowledge of CPR, with only 25% knowing the correct compression-to-ventilation ratio, 20.7% aware of the correct CPR sequence, and 18.6% familiar with the proper chest compression landmark. These figures would likely be worse if the study were conducted among the general population.
Additionally, in-hospital factors significantly contribute to mortality rates in emergency situations and cardiac arrests. One major challenge is the limited availability of critical care resources, including ICU beds, ventilators, and other life-saving equipment. This scarcity can lead to delayed or inadequate treatment, ultimately affecting patient outcomes. Inadequate equipment, such as defibrillators, is also a significant concern. Defibrillators are essential for treating cardiac arrests, and their absence can prove fatal. Moreover, delays in response times can make a significant difference in patient outcomes. When healthcare providers take too long to respond to emergencies, patients can suffer irreversible damage.
Insufficient staff training in emergency procedures is another critical issue. Healthcare providers may not be adequately equipped to respond to cardiac arrests or other emergencies, leading to mistakes and delayed interventions. Regular training and drills can help mitigate this issue, but these opportunities are not always available or prioritized in Nigeria health care.
Variability in the quality of care provided is another factor that can impact patient outcomes. Differences in training, experience, and expertise among healthcare providers can lead to inconsistent care, which can be detrimental in high-stakes emergency situations. Standardizing emergency care protocols and ensuring that all patients receive a high level of care can help mitigate this issue. Addressing these in-hospital factors is crucial to improving patient outcomes in emergency situations and cardiac arrests. By investing in critical care resources, staff training, and equipment, hospitals can better prepare themselves to handle emergencies. Implementing standardized emergency care protocols can also help ensure that all patients receive high-quality care, regardless of the circumstances.
Nigeria’s healthcare budget allocation has fluctuated over the years, ranging from 3.5% to 6.24% of the national budget between 2015 and 2025. This inconsistent funding falls significantly short of the World Health Organization’s recommended 15%. The underfunding has serious implications for the country’s healthcare system, infrastructure, and public health outcomes, hindering efforts to provide quality healthcare services to its citizens.
To address the challenges facing Nigeria’s emergency services, the following recommendations are proposed. Firstly, increasing healthcare funding to at least 15% of the national budget, as recommended by the World Health Organization, would significantly improve infrastructure, staffing, and equipment. Equipping healthcare facilities with essential life-saving equipment, such as defibrillators, ventilators, and ECG monitors, would enable healthcare facilities to provide quality emergency care and respond effectively to critical situations.
Developing a well-structured emergency care system is also crucial. Standardizing emergency care protocols and ensuring their implementation across all healthcare facilities would help ensure consistent, high-quality care. Additionally, providing regular training and drills for healthcare providers on emergency procedures, including CPR and defibrillation, would enhance their capacity to respond to emergencies.
Furthermore, launching public awareness campaigns to educate citizens on basic life-saving techniques, such as CPR, would empower them to respond to emergencies. The Federal Government should also take it as a responsibility to strengthening emergency response systems. Enhancing the capacity of emergency response agencies, including NEMA, police, fire service, and ambulance services, through improved funding, staffing, and equipment, would enable them to respond more effectively to emergencies.
Finally, increasing access to defibrillators in public places, such as stadiums, airports, schools, and markets, would help save lives. This should be done alongside developing a national emergency response plan, outlining roles, responsibilities, and protocols for emergency situations, to improve coordination and response. Regular monitoring and evaluation of the effectiveness of emergency services would enable data-driven decisions to improve the system.
Nigeria can strengthen its emergency care system, improve patient outcomes, and save lives by increasing budget for healthcare, standardizing emergency care protocols and equipment, as well as enhanced staff training which are crucial steps towards achieving this goal. By prioritizing emergency care, Nigeria can build a more resilient healthcare system and better respond to the needs of its citizens.
Dr. Aiwuyo is a cardiologist and physician-researcher in internal medicine who currently works at One Brooklyn Health/Brookdale Hospital Medical Center, Brooklyn, New York, USA. (Email: [email protected] )
Dr. Kenneth is a researcher and also a Resident Doctor in the Department of Anaesthesia and ICU at the Delta State University Teaching Hospital, Oghara, Delta State, Nigeria. (Email : [email protected] )
