Calling An Ambulance - How To?

[gpdjohn]

Hi,

Sorry for the morbid topic. How would one call an ambulance in an emergency in Chiang Mai? I.e. The equivalent of 999 in England.

I heard that if you don't speak Thai you can call the Tourist Police. Not sure whether you can only call them from a public phone box (or from a mobile), whether you need money to make the call, and whether they answer 24 x 7 or not.

Any pointers would be appreciated.

Thanks.

I have already posted that I had inspected an ambulance at Ram hospital and was impressed by the fact that there was a complement of 4 persons on their emergency ambulances. I live very close to that hospital and my wife and I have used their services for surgery etc with complete satisfaction over a number of years. (I know that there are some TV members who just will not be able to wait to tell me that the service I am totally satisfied with is , in fact, not satisfactory !!!!! ) - but back to your question. If you satisfy yourself that Ram 1 hospital is where you want to be taken thou can do this :-

Phone 053- 895001 - ( double check this yourself ).

This number will connect you directly to the Emergency Department ( 24 hrs. ) and it is from there that the ambulance is despatched.

Now if you feel that this is not the hospital you wish to be taken to or that the ambulance provided might not be up to your standard then I recommend that you speak to other hospitals providing an ambulance service and get their emergency room telephone numbers.

BTW I served in the Emergency ambulance service in Australia for 19 years up to paramedic grade - so I have a fair idea of what's what.

Good luck. Good choice.

Cheers

Yep, good luck. My previous post of the level of care I got in my ambulance adventure was the CM Ram 1 ambulance.

I had good care at the hospital, but the so called ambulance was, well...something I'd rather not experience if I was in dire straights, again.

[Blinky Bill]

Well, just explained the differences between medical emergencies and accident emergencies (trauma).

In Chiangmai, when dialing 1669, it will route you to Viengping EMS Command and Control Center at Nakornping Hospital. They just opened its new 1669 headquater last year, it's equipped for the first time, camera system that can transmit video live from emergency scenes to 1669 center through CDMA network.

I'm glad we have this system in Thailand, for helping the ones who need.

Well, as primitive as it is, I guess it is better than nothing (or the dreaded meat wagons).

[Golfja]

Well, just explained the differences between medical emergencies and accident emergencies (trauma).

In Chiangmai, when dialing 1669, it will route you to Viengping EMS Command and Control Center at Nakornping Hospital. They just opened its new 1669 headquater last year, it's equipped for the first time, camera system that can transmit video live from emergency scenes to 1669 center through CDMA network.

I'm glad we have this system in Thailand, for helping the ones who need.

Well, as primitive as it is, I guess it is better than nothing (or the dreaded meat wagons).

I guess it's better than paying 600 USD just for riding on a "paramedic unit" around street corner to hospital's emergency room. And if Thailand can collect that amount of money from every patient (or insurance company), Thailand should have a lot better services.

[gpdjohn]

Well, just explained the differences between medical emergencies and accident emergencies (trauma).

In Chiangmai, when dialing 1669, it will route you to Viengping EMS Command and Control Center at Nakornping Hospital. They just opened its new 1669 headquater last year, it's equipped for the first time, camera system that can transmit video live from emergency scenes to 1669 center through CDMA network.

I'm glad we have this system in Thailand, for helping the ones who need.

Well, as primitive as it is, I guess it is better than nothing (or the dreaded meat wagons).

I guess it's better than paying 600 USD just for riding on a "paramedic unit" around street corner to hospital's emergency room. And if Thailand can collect that amount of money from every patient (or insurance company), Thailand should have a lot better services.

If the government really did care, they would. It must put money into the right pocket before that's going to happen, or until the Thai people have had enough of this crap and stand up for what they deserve.

[Golfja]

If the government really did care, they would. It must put money into the right pocket before that's going to happen, or until the Thai people have had enough of this crap and stand up for what they deserve.

I guess they have not much idea, money is one thing that i agree is insufficient (just over 500 million baht per year for Emegency Medical System), but there are other things. Once a Paramedic from U.K. said that Bangkok has more ambulances than the whole England, many are surprised, but EMS people knows exactly what's the problem since these ambulances traditionally are not used in pre-hospital care, so what we have been trying to do in the last 14 years is to organize these available resources in community to be used in Emergency Medical System as much as possible, and in proper way, so it's rather about management than money alone to get things implemented in Thailand.

Last year the cabinet passed Emergency Medical System Act and it's in effect since March, 2008 click here (in Thai) . Also, last year, the number of newly graduated Emergency Physician (EP) is 147 souls, and it's among the fastest growth medical field in the market. And with over 700,000 patients got proper and free pre-hospital care last year up from 400,000 patients in 2007 (estimated to 1 million this year), no one disagree we are not success, even the budget buraeu officers were surprised on these figures.

Next time if you involve or witness in an accident or experience what you think it's a medical emergency, try to call 1669.

[ScubaBuddha]

prehistoric ?? well, take a look...

This is public ALS ambulance service (EMS) in service since 1995 or 14 years ago. At that time the service cover only a few area but today it's cover every provinces, and it's still a free service (subsidized by government budget) for emergency patients only. If you are lucky to live in high response area such as Khon Kaen, Lampang, Nakornsawan, the service covers over 50%, but other places the figure is below that, because people don't dial 1669 fast or suffer from less cooperation from the police and rescue volunteers.

For BLS ambulances, they are mostly pick-up trucks manned by EMT-Basic (110 hours of training), most accident victims are scooped and run by these units since advanced care is more effective in medical emergencies rather than accident.

I'm sorry, I do not understand this.

Is an accident not considered a "medical emergency"?

Sprained ankle, ok..I agree, but what are you defining as a "accident" ?

I think Golfja is trying to differentiate between a "medical problem" such as illness, heart attack stc, and a trauma, which Golfja is also calling an "accident". It is confusing. This is how EMT's and Paramedics are trained. They determine which type of call for service it is, trauma or illness, and that leads us to a course of action. It is a difficult concept to explain if you aren't in the field of emergency medicine, and especially difficult of English is your second language. No offense meant to Golfja, I admire the fact that he/she is willing to come one here to help us farang understand the Thai EMS system better. In Thailand ALS (Advanced Life Support)= Paramedic/ER Nurse/ER doctor (higher level of training than in the the staes!). BLS (Basic Life Support)= First Responder or EMT 1. I will say that although these responders may hold the titles does not necessarily make them good clinicians in the field.

I disagree with Golja's statement about the pick-up trucks being BLS trained. Maybe some of them have some training, but EMT? No way. It varies area to area, but most either aren't trained at all, or they don't utilize the training in the field. Maybe laws mandate they are BLS, but that doesn't make it so. Golfja is trying to be optomisitc and in doing so is looking through some very rose tinted glasses.

Edited July 15, 2009 by Scubabuddha

[ScubaBuddha]

BLS ambulances (?), I guess are the meat wagons we often see driving recklessly with lights flashing, sirens blaring and young guys at the helm. I've seen these guys cause accidents by the way they drive on more than a few occasions.

Anyway..........

Getting there is one thing (although I doubt very much that the response is as quick as you say Golfja, very occasionally yes, but normally no). But then getting proper first aid administered and transporting the patient (victim) to the nearest hospital is another situation altogether.

I don't mean to sound negative but I agree with my friend gpdjohn, the system in Thailand is prehistoric. But on a brighter note, it is a lot better than in many of the countries I've had the displeasure to work in over the years.

It's not prehistoric, it is, however, a dual system. You either get the meat wagon (pick-up trucks with no training or pre-hospital care given, ie.e transport only) or BLS (EMT) ALS (Paramedic/Nurse/ER Doc). Which can perform fairly invasive life saving procedures in the field. Having ER nurses and doctors on board exceeds even that of U.S. ambulances. But that says nothing about whether they are properly trained or can perform adequetly in the field. At least where I live, the meat wagon is dispatched to ferry the injured Thai and the BLS/ALS/Mobile ICU's come only if it's a farang.

[ScubaBuddha]

Back in the previous life as a cop in the west many years ago my experience of doctors at accident/trauma scenes was not good. From my experience doctors do very well in their own environment, ie. the hospital and ER where everything is set up for them, they know what they are doing and how to go about putting people back together and maintaining life.

The guys and gals who do the work well on the street are the trained paramedics who are specialists in working in wrecks and very difficult situations.

Thailand has a few specialist paramedics but fortunately for some accident victims the situation is changing, but ever so slowly.

There are also some training of EMS ambulance personal in thailand.

1. Paramedic Nurse: registered nurse with 14 days of ambulance operation training.

2. Emergency Medical Technician - Intermediate: 2 years of pre-hospital care training at Khon Khaen, Chiangmai.

3. Emergency Medical Technician - basic: 1 month of training by provincial hospital.

4. First Responder: 16 hours of training by provincial hospital.

Not wanting to criticize Golfja, but this amount of training is extremely basic. One could barely learn to properly administer EAR or CPR in this time frame.

I am confused by your post Bill. Which time frame are you referring to in which someone can't learn CPR? There are 4 to choose from: 1)Years of nursing school; 2)Two years for EMT I; 3) 1 month for EMT B; 4) 16 hours for First Responder. This is absolutely NOT basic. It is, in many cases, beyond the training in the west. You have seen registered Nurses on ambulances in America? Never. Air ambulances yes, sometimes. In terms of the amount of time Nurses, EMT Intermediate and EMT basic and First Responder receives, it's on par with the west.

[caf]

I'm sorry, I do not understand this.

Is an accident not considered a "medical emergency"?

Sprained ankle, ok..I agree, but what are you defining as a "accident" ?

I'm no expert about this but "advanced care" (a.k.a. stay and play) in pre-hospital setting use much more time than "basic care" (a.k.a scoop and run). In an accident, victim needs to get to operation room as fast as possible, of course with proper care to airway and immobilization, but in medical emergencies such as heart attack or strokes, advanced care such as intubation, IVs, emergency medications prove more effective in saving lives. The most famous debate one was the accident of princes Diana, the responded SAMUR (French EMS) unit "stayed and played" with Diana over a few hours at scene and during transport, the ambulance traveled 20 KM/hr to the hospital and stopped several times along the route for treatment. The French EMS system is the concept of bringing mobile hospital to the patient, however, it delays the time it takes the patient to get operated.

What are you on about Golfja?

I feel that you are a little confused, well I sure am at least, I'm trying to make sense of your theories but it isn't quite working.

I think everyone is confused by Golfja, particularly on his estimates of timings to get from scene to hospital.

The Princess Diana comparison of "stay and play" and stopping several times was rubbished by barristers at the coroner's hearing. It was not "stay and play" it was shown the delays were caused by calls between doctors and hospitals not being relayed by the agencies involved. Golfja, read the inquest transcripts

[ScubaBuddha]

I'm sorry, I do not understand this.

Is an accident not considered a "medical emergency"?

Sprained ankle, ok..I agree, but what are you defining as a "accident" ?

I'm no expert about this but "advanced care" (a.k.a. stay and play) in pre-hospital setting use much more time than "basic care" (a.k.a scoop and run). In an accident, victim needs to get to operation room as fast as possible, of course with proper care to airway and immobilization, but in medical emergencies such as heart attack or strokes, advanced care such as intubation, IVs, emergency medications prove more effective in saving lives. The most famous debate one was the accident of princes Diana, the responded SAMUR (French EMS) unit "stayed and played" with Diana over a few hours at scene and during transport, the ambulance traveled 20 KM/hr to the hospital and stopped several times along the route for treatment. The French EMS system is the concept of bringing mobile hospital to the patient, however, it delays the time it takes the patient to get operated.

What are you on about Golfja?

I feel that you are a little confused, well I sure am at least, I'm trying to make sense of your theories but it isn't quite working.

Ok, I think I understand what Golfja is trying to say in this post and the previous one, so I'll take a stab at it.

He's using EMT speak to try to articulate the difference between BLS (Basic Life Support) ambulances and ALS (Advanced life support) ambulances and how those differences affect response times as well as the decision by clinicians in the field whether they should transport immediately to and ER ("scoop and run" or "load and go" which is the term I am familiar with) or treat the patient on scene (stay and play.) BLS ambulances tend to be dispatched to accident scenes where the MOI (mode of injury, sorry more EMT speak) is caused by a trauma of some kind, like a car accident, rather than by an illness (disease, infection, heart attakes, stroke, etc). Calls in which the MOI is trauma usually require EMT's and/or paramedics to "load and go". I.E a minimal amount of time is spent stabilizing the patient on scene. They will imobilizing C-spine, secure an airway, provide oxygen, CPR if needed, or other non-invasive treatment. Traumas can be handled by the BLS ambulances because they are relatively simple. BLS ambulances are less expensive to operate (1 month of training, less equipment) and therefore there are more of them, hence response times are faster. ALS ambulances, if available, are more likely to be dispatched when the MOI is something other than trauma, such as the illnesses mentioned above. Because they more expensive to operate, at least according to Golfja, there are less of them therefore they often have longer response times. Because they have staff that is (theoretically) trained to a much higher level than EMT's (full doctors and ER nurses/paramedics in the case of Thailand, Paramedics in most cases in the US) there is much more they can do in the field, such as administer emergency medications, intubate, IV, hence the term "stay and play." As mentioned previously by someone in this thread, Doctors aren't the best clinicians when it comes to traumas, but EMT's and Paramedics are because they deal with it everyday. Doctors are better diagnosticians.

Golfja then uses the example of a very famous trauma victim (Princess Diana) in which ALS responded and "stayed and played" when some people thought a "load and go" was more appropriate in order to get her critical care the ambulance couldn't provide in the field.

Again, his is point to all this, I think, was to illustrate the differing response times due the the differences between BLS and ALS ambulances.

And I believe SAMUR is Spainish, not French. (Servicio de Asistencia Municipal de Urgencia y Rescate= Madrid's ambulance service.) Princess Diana died in Paris.

SB

Edited July 16, 2009 by Scubabuddha

[slapout]

What ever training they have the utilization of emergency vehicles in CM is at best suspect.

Recent observations: Motorcycle jumps curb/footpath on moat, driver bales off unhurt, bike in moat, over next 30 minutes 3 emergency vehicles show up, block traffic, visit with bystanders/police, verify bike under water, discuss how mishap occurred, laugh, have snack.

Monks on alms quest (0830) about 20 in number, with EMS vehicle leading and following the procession along Chang Klan.

EMS vehicle leading caravan (6 in number) of vans around moat road.

Meat wagon (pickup) lights flashing stop (double park) at noodle shop on Hang Dong road for order to go (1900). The noodle shop does not have call in order.

Just my observations over the past 3 weeks

[ScubaBuddha]

After my accident last year and the day I was released from the hospital, my right lung collapsed. Needless to say breathing became somewhat of a problem, a real problem.

Wife called the emergency number and informed them of our address.

20 minutes and still a no show.

Wife called again ( Thai speaker ) and again informed them where to go.

Another 10 minutes.

Wife at this point was frantic, I was holding myself up at the fence fighting for breath.

She calls again. Still no ambulance.

Few more minutes pass..

I see the flashing blue light on top of the "meat wagon" parking down the street.

I had to walk to the ambulance so they could find me.

Climbed in without any assistance, the nurse stood there looking at me and saying that I did indeed look like I was having some problems.. duh.

Off we go...the nurse telling me it was alright, me fighting for some O2.

Then she began the advanced life support..

She gently took me by the hand.

I'm confused by your post. If it was a "meat wagon" how could it have a nurse and emergency oxygen inside? your quite lucky to have that in Thailand. I'm not sure I really agree with the level of lack of care you feel you were given here, apart maybe from them not being able to find you. If you have breathing difficulties but are upright and walking, you are considered stable. The most any responder would do is give you O2 and observe you while transporting. A nurse has much more training even than the paramedics we normally get in the west. If you "crashed" on the way, I'm sure she would have provided further care/treatment.

[Blinky Bill]

I'm confused by your post. If it was a "meat wagon" how could it have a nurse and emergency oxygen inside? your quite lucky to have that in Thailand. I'm not sure I really agree with the level of lack of care you feel you were given here, apart maybe from them not being able to find you. If you have breathing difficulties but are upright and walking, you are considered stable. The most any responder would do is give you O2 and observe you while transporting. A nurse has much more training even than the paramedics we normally get in the west. If you "crashed" on the way, I'm sure she would have provided further care/treatment.

Scuba, I don't mean to rude , but your post seems to me to be little bit of guess work or perhaps just uninformed.

Most of the foundation meat wagons that I've seen in recent years are equipped with O2 bottles, whether or not they are charged is anyone's guess.

Your comment about upright and walking does not make one stable. In my earlier daze as a young cop, I attended accidents where the victim/injured were walking about, mostly in a state of shock, the next day many were either in the ICU or the morgue.

[gpdjohn]

After my accident last year and the day I was released from the hospital, my right lung collapsed. Needless to say breathing became somewhat of a problem, a real problem.

Wife called the emergency number and informed them of our address.

20 minutes and still a no show.

Wife called again ( Thai speaker ) and again informed them where to go.

Another 10 minutes.

Wife at this point was frantic, I was holding myself up at the fence fighting for breath.

She calls again. Still no ambulance.

Few more minutes pass..

I see the flashing blue light on top of the "meat wagon" parking down the street.

I had to walk to the ambulance so they could find me.

Climbed in without any assistance, the nurse stood there looking at me and saying that I did indeed look like I was having some problems.. duh.

Off we go...the nurse telling me it was alright, me fighting for some O2.

Then she began the advanced life support..

She gently took me by the hand.

I'm confused by your post. If it was a "meat wagon" how could it have a nurse and emergency oxygen inside? your quite lucky to have that in Thailand. I'm not sure I really agree with the level of lack of care you feel you were given here, apart maybe from them not being able to find you. If you have breathing difficulties but are upright and walking, you are considered stable. The most any responder would do is give you O2 and observe you while transporting. A nurse has much more training even than the paramedics we normally get in the west. If you "crashed" on the way, I'm sure she would have provided further care/treatment.

I will agree that at that time I was "stable".

But,

There was no O2. or any other equiptment on board other than a gurney.

She had no clue as to what to do. ( as I have found out that most RN's have no clue in a field setting, clinical yeah, fine..)

I was a first responder back in the west.

A (MOS;18D) army medic for 20 yrs. ( 16yrs actice, 4 yrs reserve )

Worked as a paramedic for a city FD for 1.5 yrs until I was hired on as a cop.

It was a joke.

I speak from experience.

In Pattaya visiting ( wife loves seafood there ) during the week of 13 Jul to the 16th. One day during this period, an older gentleman stopped his motorbike almost in front of the hotel where we were staying, climbs off and proceeds to go into a full code.

Folks on the mobile phones dial 1669.

Here comes the "Rescue" pick-up truck, sirens blaring. ( have to admit, they were pretty fast..) Driver and attendant pick the guy up from the street, into the bed of the truck, and away they go...attendant giving one man CPR..

Hats off to 'em, the attendant was working hard and making a valiant effort on this guy.

Never found out if the man survived or not, which I could almost bet he did not...

But I have given up on the thought that anyone could recieve really good ALS support here.

[Nash]

I wanted to chime in with my own personal experience with CM ambulances.

I had a minor motorbike accident last November on the road that goes between Narawat Bridge and San Khampeng at one of those dangerous intersections near the motorcycle dealerships / cafes.

To be fair, an ambulance arrived (I assumed someone else called 1669) within about 10 minutes. The accident looked much worse than it was and there was a lot of blood from a puncture wound on my foot but I was not seriously injured. I wrapped my foot up in my T-shirt and opted to walk to Dr. Wong's Clinic around the corner with the help of a friendly, English speaking Thai pedestrian who saw the whole thing and accompanied me to the hospital and later to the Police station.

It felt good to know that at least in that circumstance, if I had been more seriously injured, I would have had the option of being taken to a hospital in an ambulance. Regardless of the level of experience of the individuals inside, it is better than no care at all, which as mentioned by other posters, is exactly what you would get in other SE Asian countries.

[ScubaBuddha]

After my accident last year and the day I was released from the hospital, my right lung collapsed. Needless to say breathing became somewhat of a problem, a real problem.

Wife called the emergency number and informed them of our address.

20 minutes and still a no show.

Wife called again ( Thai speaker ) and again informed them where to go.

Another 10 minutes.

Wife at this point was frantic, I was holding myself up at the fence fighting for breath.

She calls again. Still no ambulance.

Few more minutes pass..

I see the flashing blue light on top of the "meat wagon" parking down the street.

I had to walk to the ambulance so they could find me.

Climbed in without any assistance, the nurse stood there looking at me and saying that I did indeed look like I was having some problems.. duh.

Off we go...the nurse telling me it was alright, me fighting for some O2.

Then she began the advanced life support..

She gently took me by the hand.

I'm confused by your post. If it was a "meat wagon" how could it have a nurse and emergency oxygen inside? your quite lucky to have that in Thailand. I'm not sure I really agree with the level of lack of care you feel you were given here, apart maybe from them not being able to find you. If you have breathing difficulties but are upright and walking, you are considered stable. The most any responder would do is give you O2 and observe you while transporting. A nurse has much more training even than the paramedics we normally get in the west. If you "crashed" on the way, I'm sure she would have provided further care/treatment.

I will agree that at that time I was "stable".

But,

There was no O2. or any other equiptment on board other than a gurney.

She had no clue as to what to do. ( as I have found out that most RN's have no clue in a field setting, clinical yeah, fine..)

I was a first responder back in the west.

A (MOS;18D) army medic for 20 yrs. ( 16yrs actice, 4 yrs reserve )

Worked as a paramedic for a city FD for 1.5 yrs until I was hired on as a cop.

It was a joke.

I speak from experience.

In Pattaya visiting ( wife loves seafood there ) during the week of 13 Jul to the 16th. One day during this period, an older gentleman stopped his motorbike almost in front of the hotel where we were staying, climbs off and proceeds to go into a full code.

Folks on the mobile phones dial 1669.

Here comes the "Rescue" pick-up truck, sirens blaring. ( have to admit, they were pretty fast..) Driver and attendant pick the guy up from the street, into the bed of the truck, and away they go...attendant giving one man CPR..

Hats off to 'em, the attendant was working hard and making a valiant effort on this guy.

Never found out if the man survived or not, which I could almost bet he did not...

But I have given up on the thought that anyone could recieve really good ALS support here.

Ok I did misunderstand some of the things you said. I thought you were saying there was O2 available, but you had to fight for it. You got something totally different than I have ever seen: A meat wagon with a nurse.

[ChrisNW1]

Hi there all!

We have just returned from 3 weeks in Thailand - and are in the process of planning to move there in about 5 years time (my partner is Thai) to Khon Kaen or very nearby.

As a volunteer in the UK with the Red Cross, I was interested in seeing how the Thai Red Cross operates and what their areas of service delivery are, compared to that of the UK. Vastly different organisation - but saying that, I was massively impressed with their work and will be volunteering with them when we move there to live.

Moving more onto topic however, I was intrigued by the set-up for emergency ambulance provision (as I am involved with this with the Red Cross in London, trained IHCD Amb Tech/Emergency Driver etc with 16 years experience in this area) and was intrigued that the Thai Red Cross DO NOT provide this type of service, but was directed towards the 'Rescue' service.

Does anyone here have any contact/involvement with this service in Khon Kaen? I would be interested in talking to and meeting up with people involved with this when we are back there in April next year.

Hope to hear back from someone!

Regards

Chris H

[PMNL]

I do not know the service you talked about but at Khon Kaen hospital,. they have a very strong EMS team who work to cover the whole province and being training center(Paramedic school) for Isaan region. You can contact DR.Nakorn/Dr. Somchai the surgeon who in charge at emergency department. They will be more than happy to discuss with you. I will try to get their email address and lwt you know asap.