Whereas incidents and accidents are inevitable in any fast-paced modern society, the severity of attendant injuries, trauma, deaths and disabilities is highly manageable. In between is the primacy of prompt, coordinated, and efficient emergency response and trauma care – a basic public good in civilised settings. The contrary in the Nigerian setting is the routine absence of a functional emergency medical service, uninformed ‘first-responders’ in the mode of residents and passersby, inactive emergency helplines, hospitals and health workers without trauma-specific resources – all of which culminate in ruining the ‘Golden Hour’ rule in life-or-death moments. Apparently alarmed by the deficits, stakeholders are unanimous that until the government thoroughly addresses these and sundry challenges, the country would continue to record needless loss of lives at emergency scenes, BERTRAM NWANNEKANMA and NKECHI ONYEDIKA-UGOEZE report.
Amid claims of professional negligence occasioned by poor emergency and trauma care services, Mrs Charity Unachukwu gave up the ghost on 20th September 2025, at the University of Nsukka Teaching Hospital (UNTH), Enugu State.
The deceased’s sister, Phina Ezeagwu, at the height of the pathetic drama, alleged that Unachukwu’s death, which stemmed from a vehicle accident, would have been averted if the hospital had not dilly-dallied for over 12 hours before treatment fully commenced.
Even though the hospital claimed that most of the allegations levelled against it were either inaccurate or unsubstantiated, it nevertheless acknowledged communication and coordination gaps in the entire episode, which it maintained have led to immediate and long-term actions that will further strengthen its service delivery and accountability mechanisms.
Unachukwu’s death is not a one-off incident in the milieu, but one of the many that happen daily nationwide. Adetunji Opayele, also known as “Teejay,” and Greatness Olorunfemi suffered similar fates due to the subpar emergency care services available in their country.
Opayele, a brilliant mind who was the co-founder and chief technical officer (CTO) of Bumpa, a retail automation startup, died on March 5, 2025, after being knocked down by Biola Adams-Odutayo, along with Ozumba Mbadiwe, in Lagos. She also allegedly failed to assist the critically injured Opaleye, reportedly citing concerns about staining her car.
By the time bystanders moved in to find medical help, several hospitals allegedly refused to provide him treatment. The absence of prompt emergency care led to his untimely death.
Olorunfemi, a ‘one-chance’ victim, who was attacked along the Katampe-Kubwa Road in September last year, reportedly died before making it to the Maitama Hospital, where she was rushed to for emergency care by passersby.
As millions savoured the New Year’s Day, life’s journey abruptly ended for eight people, including two toddlers, who were involved in a ghastly motor accident at about 3:00 p.m., along the Lagos-Ibadan Expressway.
In that tragic encounter that involved an 18-seater Mazda bus (with registration number APP 943 XP) and a Volvo truck (with registration number AKM 547 YQ), at the NASFAT turn along the expressway, 11 others sustained injuries.
The casualty figures could have been higher, but a quick emergency response from operatives of Ogun State-based Traffic Compliance and Enforcement Agency (TRACE), the Nigerian Police, and the Federal Road Safety Corps (FRSC), who arrived at the scene well within the “Golden Hour,” saved the day for the injured.
This incident occurred barely three days after boxing icon, Anthony Joshua and his friends, Sina Ghami and Latif “Latz” Ayodele, were also involved in an auto-crash within the Makun axis of the busy Lagos-Ibadan Expressway, in Ogun State, while travelling from Lagos to Sagamu.
Saving lives, making ‘Golden Hour’ count
WHEN accidents occur, timely interventions and actions taken by the first responders/emergency workers in the first 60 minutes of trauma go a great length in determining whether lives are lost or saved.
According to experts, the Golden Hour refers to the first hour after a serious injury, such as a road accident, fall, burn, or major trauma to the head or chest. During this time, the body is under extreme stress. Bleeding, breathing problems, or internal damage can quietly become life-threatening if not treated quickly.
While marking the official flag-off of the 2025 Ember Months Public Enlightenment and Sensitisation Campaign in Abuja, last October, the Federal Road Safety Corps (FRSC) revealed that no fewer than 3,400 people died in road crashes countrywide between January and September 2025.
According to the Corps Marshal Shehu Mohammed, during the same period, 22,162 others sustained injuries in a total of 6,858 reported crashes.
Without a doubt, the number of deaths recorded within the period would have been way lower if the country’s emergency response and trauma care were functional, responsive and effective. It would have been even lower if citizens were sufficiently sensitised to call the national emergency helpline for prompt medical attention.
That said, the international dimension of Joshua’s accident drew a lot of criticism from Nigerians and foreigners alike. For instance, Prof. Grace Ayensu-Danquah, a Ghanaian surgeon and politician, writing on her Facebook page, said: “As a surgeon specialist, I am watching the Anthony Joshua accident in Nigeria, and so many issues come to mind… sad indeed.
Lacing it with several sad emojis, she listed some of the issues that were assailing her mind, including trauma, accident, first responders, pre-hospital care, overall road safety and safety of the evacuated injured persons.
She added: “How we evacuate the injured; how we safely transport accident victims; patient confidentiality, and many issues! Latching on to the bandwagon to condemn the poor emergency response system in the country, medical doctor and Co-founder @tryprivhealth, who tweets via his verified X handle, @the_beardedsina, wrote: “There’s a health crisis in Nigeria. Anthony Joshua’s case is a typical example of what happens when you have a poor emergency response system and a failed health sector. To date, there’s a strike ongoing, which has been on for months in Nigeria. No one is safe!!”
In many parts of the country, the emergency units of medical facilities are overcrowded, and as multiple critical cases scavenge for spaces, temporary shortages of beds and trolleys are routinely created. Delays in blood transfusion are routine, and many other oddities take place due to infrastructure constraints, communication and logistical challenges. Gaps in coordination and communication also contribute to delays in service delivery, as well as expose the country’s weak emergency and trauma care systems.
State of trauma, emergency centres in Nigeria
EFFECTIVE emergency management requires a well-funded, staffed system that operates 24/7, but the near absence of this is responsible for the needless death of countless Nigerians due to the failure of basic services like ambulances, fire response, and a dependable national 112 helpline, despite repeated government assurances and billions allocated to emergency response infrastructure.
The Guardian’s visit to the emergency units of some hospitals in the Federal Capital Territory (FCT) revealed an overwhelmed health system grappling with severe manpower shortages, unmotivated and overworked staff, and poor infrastructure.
Most of the hospitals had a maximum of 11 bed spaces with only two nurses on each shift. From the Federal Medical Centre Jabi, Maitama Hospital, and the Asokoro District Hospital, the story is the same.
Nurses at the Asokoro District Hospital shared their challenges, citing the Japa syndrome as the major reason why the situation is getting worse. The situation, health workers said, has led to units being merged and essential services being compromised.
Many health workers in these facilities, who spoke anonymously for obvious reasons, expressed concerns about the heavy workloads, burnout, and lack of motivation due to poor pay packages.
At the National Hospital, the Trauma Centre caters to accident and gunshot victims; the Emergency Paediatric Unit (EPU) caters to children below 12 years, while medical emergencies and surgical emergencies are handled elsewhere.
However, The Guardian discovered that due to limited bed space, some patients at the Accident and Emergency Unit, located next to the hospital’s Administrative Block, were being attended to at the triage within one of the hospital pharmacies, raising privacy and safety concerns considering the high volume of movement within the area.
A caregiver at the Federal Medical Centre, Jabi, Tabitha Abubakar, who was taking care of her nephew, who was stabbed in the chest during a fight at their residence in Galadimawa, told The Guardian that the health workers handling the case have shown both empathy and expertise, making the recovery process very fast.
She said, “My nephew was bleeding profusely when he was brought to the hospital after a fight. He complained of severe pain, and his speech was slurred. But right now, there has been a remarkable improvement. He has started talking well, and the nurses have been so nice and professional.”
Another patient at the National Hospital, who simply identified himself as security personnel, told The Guardian that he sustained a gunshot injury during an operation, adding that as soon as he arrived at the National Hospital, workers on duty swung into action.
“They have tried. I knew how I was when they brought me here. I was referred to this place from another hospital. I must confess, the nurses and doctors here are good.”
The situation is no different from what is happening in other parts of the country, such as Port Harcourt, Calabar, and Kano. In the South-East, specifically at the Federal Teaching Hospital, Owerri, there is presently no trauma centre, but one is under construction.
According to the public relations officer of the hospital, Ikechukwu Anyaegbu, the ultramodern trauma centre is the only one in the South-East.
The Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, is now one of only 10 recognised emergency medicine training centres in the country. The hospital, established in 2011, has gained full accreditation from the National Emergency Medical Services and Ambulance System (NEMSA).
According to the Chief Medical Director (CMD), Prof. Robinson Chukwudi Onoh, the hospital’s collaboration with the Irish and Royal Colleges of Emergency Medicine is underway, with training missions already conducted and another set to take place in August this year.
Slow response time, poor network connectivity, ignorance as limiting factors
IT is an undeniable fact that most parts of the country are bereft of emergency and trauma care, hence the high rate of needless and avoidable deaths from emergencies.
A recent study published by the Journal of Public Health and Emergency indicates that only 21 per cent of Nigerians involved in road crashes used emergency services, with an average 30-minute response time.
Also, according to the National Bureau of Statistics (NBS), Nigeria records a yearly death rate of 2.4 million, and 50 per cent of the deaths could be avoided with effective emergency medical service.
While emergency medical services in the country face numerous challenges, including limited infrastructure, bed space in the emergency units, and a shortage of personnel, leading to a small number of staff on duty despite a high patient load, there is also a glaring disregard for the golden hour across board, despite timely medical assistance within this critical time frame significantly enhancing the chances of survival for victims.
It was to enhance medical emergency service delivery, especially in rural and underserved vulnerable populations, and to provide timely and efficient medical response during emergencies that the federal government launched the National Emergency Medical Services and Ambulance System (NEMSAS) in 2022.
Sadly, however, after more than three years of its establishment, its operations have been suboptimal due to low awareness, a lack of an effective communication system for emergency notification affecting response time, a lack of capacity among ambulance staff (nurses and paramedics), and a shortage of well-equipped ambulances, among other issues.
Indeed, investigations by The Guardian revealed that despite having the 112 National Emergency code, many Nigerians in need of emergency services do not utilise it due to ignorance of its existence or use.
The Guardian learnt from the Federal Ministry of Health and Social Welfare that NEMSAS is a missing link in the Nigerian health sector, operating as a government-owned programme of the ministry, driven by a partnership with the private sector.
Its goal is to improve emergency care service delivery, particularly in rural and underserved vulnerable populations, by providing timely and efficient medical response during emergencies.
NEMSAS’s National Programme Manager, Dr Emuren Doubra, informed The Guardian that the programme is part of the country’s commitment to Universal Health Coverage (UHC) embedded in the National Health Act of 2014.
According to Doubra, NEMSAS has three key features: the provision of emergency medical services at no cost to patients for the first 48 hours; ambulance services to transport patients to healthcare facilities using public and private registered and accredited ambulances; and rural emergency services prioritising rural areas to bridge the gap in healthcare access for rural populations.
Access to these services by Nigerians, he said, is through the National Emergency Number – 112, managed by the Nigerian Communications Commission (NCC).
The ministry regretted that although the toll-free number has covered about 24 states, it is fully functional in some of them, while it faces challenges in others. These challenges range from connectivity disruptions, particularly during heavy rainfall, to administrative and capacity-related issues that intermittently hinder its overall efficiency.
Doubra explained that in states with no functional national emergency number, or in those experiencing connectivity disruptions, an eleven-digit number or state-owned short code serves as an alternate number to ensure efficiency even as he also highlighted other key challenges facing emergency medical services in the country to include a lack of an effective communication system for emergency notification, which hinders response time; low private sector participation due to low reimbursement fees; a lack of capacity among ambulance staff (nurses and paramedics), inadequate ambulances; a shortage of well-equipped ambulances and a lack of awareness for even the existing service.
For the Director of Safety Beyond Borders, Adenusi Patrick, while the response time in Joshua’s case was manageable, the process of evacuation was not the best, as victims should, ideally, be conveyed in an ambulance, on a stretcher, to ensure prompt treatment that saves lives.
He emphasised that the number of ambulances for emergency evacuation in the country was extremely low, considering the country’s population.
“A lot of things are wrong in Nigeria, and Anthony Joshua’s case is bringing them to the fore now. If you sample the views of 100 Nigerians regarding emergency numbers, 99 of them will not know it. When an incident happens anywhere in the world, the first thing they do is call the emergency number, but in our case, we don’t readily have an emergency number that covers the entire country. In Lagos, there are 112 and 767, but most of the time, when incidents like this occur, the crowd simply mills around and creates an unsafe environment,” he said.
The Corps Public Education Officer (CPEO), who heads the public enlightenment arm of the Federal Road Safety Corps (FRSC), Assistant Corps Marshal (ACM) Olusegun Ogungbemide, disagrees with Patrick.
According to him, the FRSC has been operating a very active toll-free line, 122, which operates 24 hours a day, stressing that temporary network failures are sometimes a global challenge that is not limited to Nigeria. “No technology is 100 per cent perfect…”
Ogungbemide charged Nigerians to make use of 122 maintained by FRSC, and the national emergency helpline, as all rescue operations are functions of emergency number calls.
The same sentiment is shared by a senior official of Lagos State Emergency Management Authority (LASEMA), who added that Lagos is the only state that has two emergency numbers, the national helpline- 112 and 767, which is also toll-free. This is so because the state had already commenced with its emergency number before the Federal Government introduced the national helpline.
The official, who asked not to be named, explained that while 112 is the national emergency number for the whole of Nigeria, 767 is the first digital toll-free emergency number in Nigeria.
Multi-sectoral failures hold emergency, trauma care systems hostage
FROM the foregoing, the emergency and trauma care system is bogged down by dire systemic challenges that ultimately lead to soaring preventable morbidity and mortality. For instance, while weak infrastructure is a key factor in the lineup of challenges, poor governance and poor funding contribute to making the situation complex.
The near absence of a formal ambulance service/emergency medical service, a dearth of adequately equipped trauma and emergency centres (as most emergency care services are provided in general emergency rooms in public hospitals that lack trauma-specific resources), as well as massive shortages of essential life-saving equipment and even a steady electricity supply, are major barriers to emergency care.
This explains why some experts say that Nigeria is not yet fully prepared to provide the best care for medical emergencies. The Second Vice President of the Nigerian Association of Resident Doctors (NARD), Dr Kwarshak Kevin Yakubu, who emphasised the urgent need to improve diagnostics and the staffing of accident and emergency units, noted that the response time to emergencies in hospitals across the country is suboptimal due to a lack of adequate doctors, with a concerning shortage ratio of one to over 1,900.
Yakubu stressed the importance of motivating healthcare workers for quality service delivery, stating that equipment alone is not enough. He said: “If you have all the equipment but don’t have a motivated workforce, it amounts to a waste of time. So, first things first, motivate the doctors, the nurses and all the healthcare workers. If you motivate and give Nigerian doctors the needed equipment, they will become one of the best in the world. Many of the doctors, who are doing very well outside this country, are Nigerians, after all, so what’s the difference? Condition of service and working environment. They are well paid, they are well motivated, and they have all the equipment at their disposal to use.”
He, however, noted that the present government has made some improvements in the health sector and introduced initiatives on emergency, such as the National Emergency Medical Service and Ambulance System (NEMSAS).
Yakubu, who claimed not to be aware of any number designated for emergencies in the country, said: “I am not sure that we have an emergency line that people can quickly reach out to dispatch an ambulance during an emergency. Maybe it happens in Lekki, maybe it happens in Lagos, you know that Lagos is a different world altogether. But outside that, I’m not aware.”
In Lagos State, which is miles ahead of many states in emergency and trauma care, traffic congestion and motorists’ refusal to yield to ambulances constitute major obstacles to life-saving endeavours.
But to circumvent this traffic challenge, the state has introduced ambulance bikes to navigate congested areas and deliver prompt care before regular ambulances arrive.
“An ambulance might be going to pick up a patient, get a surgeon, or collect blood. These are critical emergencies, so people must give way. However, we now have ten brand new ambulance bikes to reach patients faster, especially in areas inaccessible to vehicles,” the Director of the Lagos State Ambulance Services (LASAMBUS), Beatrice Makinde, told The Guardian.
Apart from this innovation, the agency currently operates five ambulance bases, which are spread strategically across its length and breadth to provide swift assistance to accident victims.
The bases are situated at the General Hospital, Lagos; Lagos State University Teaching Hospital; Federal Medical Centre, Epe; Badagry General Hospital, and Ikorodu General Hospital.
Several ambulance points were vandalised during the #EndSARS protests, but the state government has renovated 15 out of 28 facilities, with Governor Babajide Sanwo-Olu approving the refurbishment of 10 and partners handling five.
Staff retraining critical to improving emergency care standards
WHILE Joshua and his driver survived the ghastly accident, enormous gaps were noticed in the intervention of rescuers and emergency responders, a development that shifted the nation’s attention to the parlous state of emergency and trauma care in the country.
This unprofessional manner of executing emergency services is the reason that safety advocate and Convener of Strap and Safe Child Foundation, Bolanle Edwards, is calling for training and retraining for emergency personnel.
According to her, even if an accident survivor appears fine, there is a need to ensure that the airway is clear, followed by checking the breathing rate and oxygen levels, as well as checking pulse, bleeding, and skin colour.
Edwards also stressed the importance of assuming spinal injury until proven otherwise, followed by keeping the survivor still, applying a cervical collar if available and avoiding unnecessary movement or self-extraction unless there’s fire or imminent danger.
She also emphasised the need to check for internal bleeding, concussion or traumatic brain injury, chest or abdominal trauma, fractures or soft tissue injuries, as well as monitor vital signs continuously.
If controlled extrication is required, Edwards said trained responders should use rescue tools to remove doors/roof only if necessary and maintain spinal alignment throughout.
“Afterwards, there is a need for immediate medical transport of the survivor to a Level I or II trauma centre, even if injuries seem minor, because high-impact crashes always require hospital evaluation.
For psychological and shock management, the survivor should be kept calm and warm, while the rescuers watch for delayed shock symptoms with limited crowd, media, or bystander pressure, especially for public figures.
A security expert and retired Director of Public Safety and Wellbeing at the Lagos State Safety Commission, Adeyinka Adebiyi, stated that since emergency response worldwide is a professional vocation, there is a compelling need for the training and retraining of emergency responders to constantly equip them to respond to emergencies at all times.
According to him, accidents and emergencies do not give notice before they happen; therefore, preparedness and swift, quick responses to save lives are essential.
