Medical - MAJOR RANT

[The Snark]

As a retired paramedic I've noticed quite a lot of progress made in the emergency medical fields lately and I offer my hearty congratulations on the increased level of training and expertise.

HOWEVER. Front page, Thairath paper today. 2 traffic accident extrications photographed in progress. Patients already on back boards. Both had obvious head injuries. NO C COLLARS!!

<deleted> If your patient survives, how about giving a little thought to the rest of their lives paralyzed from the neck down!

Mai pen rai may do wonders for domestic tranquility but 'close enough' only counts with horseshoes, hand grenades and hydrogen bombs. Learn the proper procedures and do it right or find another profession!

[NeverSure]

I suggest the hydrogen bomb. You won't get their attention with horseshoes or hand grenades.

And no, I won't be the first to suggest that if you aren't happy with Thainess that you return to your home country. But there are a lot of risks living in a 3rd world country.

[wilcopops]

Two points come to mind here.

firstly - the extremely inconsistent standards of training THROUGHOUT the Thai healthcare industry, which reduce your chances to a lottery. Mistakes and omissions in treatment are commonplace.

secondly - thailands high road death figures - whilst many seem to put this down entirely to "bad driving" they fail to understand that effect emergency services can play a huge part in whether or not someone survives a road traffic incident.

Successive Thai governments have failed to satisfactorily address other of these aspects

Edited November 18, 2014 by wilcopops

[David48]

Mate ... fair point.

The medical system ... well, certainly the 'Emergency Services' has a lot of room for improvement.

.

[The Snark]

Two points come to mind here.

firstly - the extremely inconsistent standards of training THROUGHOUT the Thai healthcare industry, which reduce your chances to a lottery. Mistakes and omissions in treatment are commonplace.

secondly - thailands high road death figures - whilst many seem to put this down entirely to "bad driving" they fail to understand that effect emergency services can play a huge part in whether or not someone survives a road traffic incident.

Successive Thai governments have failed to satisfactorily address other of these aspects

You got that right. They tout world class hospitals (here and there) but.....

Let me take it back a few years. My first job as a raw EMT putting myself through college. (read 28 hour days, 9 1/2 days a week). Our ambulance company was also a funeral home. Our ambulances, 2 Cadillacs and a Buick were retired hearses. We had no standing orders. ALL procedures performed by doctors orders over the radio. If the radio failed, common, it was grab and run. A bleeds painted the back of the units about once a week. Our operation area included 'death highway' the Pasadena Freeway into LA. The local wrecker truck used to put the mangled heaps out front of their service station. Some in multiple pieces, some where make and model couldn't be recognized.

That is about where Thailand is at right now in many places.

Neversure: "And no, I won't be the first to suggest that if you aren't happy with Thainess that you return to your home country."

I retired, and am disabled. I came to the third world to lend my expertise to outlying areas working independently and for NGO's teaching hygiene and basic first responder to the locals until my disability floored me. <deleted>

[CharlieH]

From what I have witnessed, the people attending are nothing more than glorified removal men/taxi service to get you to the hospital. If they paint there pick-up white or buy a minibus and remove the seats,buy some flashing lights, they are good to go.

[cooked]

Have you seen them performing CPR on TV? Not the way I learnt it,and possibly completely useless. No three quarter prone positioning. No holding the hands of people that are evidently dying.

A lot of phone cameras get used though.

[wilcopops]

I have posted my concerns about all aspects of Thai healthcare many times before.

it seems to me that many "expats" and the like are beguiled by Corbusier style furniture and fishtanks into believing that the expertise they will receive is top class - in many cases this couldn't be further from the truth.

On top of the problems cir=ted above the Thai healthcare system has virtually no facility of comeback - it is nigh-on impossible to hold a practitioner responsible frothier actions and any compensation is bot a long time coming and a pittance.

Any country that thinks a pickup with lowered suspension is a suitable vehicle for an ambulance needs to review its emergency services - and fast.

[thaipod]

This is why they got the name " The body snatchers ".

[liddelljohn]

In defence of thai medical system I have to say that 3 times the Thai medics at Bumrungrad, and pattaya bangkok and memorial have actually saved my life ,,, and what made it more impressive is that o 2 occaisions the UK NHS had missed the problems completely after repeated consultations

However another private thai hospital completely destroyed my wifes youngest sisters life by giving her HIV infected blood after a miscarriage , a tribunal held by government officials found against the hospital as stated that ''safe blood was available to the hospital from local government screened blood bank only 1km away ,, but they would not by law be allowed to charge for that clean blood , so bought in tainted blood from a private source ''

unfortunately even with a damning report from government officials testimony she has not been able to get compensation even after repeatedly sueing the hospital concerned ,

health services in thailand are a lottery

[The Snark]

What I fail to understand is the locals wish to make claims likening their accomplishments to first world then, as the ambulance services, they often treat the job as if it was a joke. Haphazard, lackadaisical, and usually ready to laugh should a screw up get pointed out. Stupid stuff like front page newspaper of a person doing chest compressions at nearly a 45 degree angle from vertical and the news article is complimenting their efforts. Call me old fashioned by I've got a phobia about ramming some broken cartilage into grandma's lung.

Speaking of blood donation screw ups, one I am still dumbfounded about. I went to the Red Cross to donate blood. I told them I was A Pos and showed them the remnants of my RC card. They pointed out it was 20 years old and no good. Excuse me, but it is valid on planet earth. Why not in Chiang Mai? Do the locals change blood types now and then?

I mean, for crap sake. The last I checked medical is all about saving and preserving life. Where did the fun and games and silliness come from?

As for C collars, I've taught over 200 CPR classes. Figure 3000+ CPR cards handed out. In the basic patient management part of the course I've sacrificed dozens and dozens of apples and pencils. Shove pencil into apple, grab end of pencil and shake hard so it breaks. Then explain, apple is your head, pencil is your neck. Significant force trauma or head injury=C collar. Not rocket science. Better safe than sorry.

So I've got a few thousand layperson first responders better trained than the average Thai emergency medic? Come on Thailand! Get with the program!

I'm not saying screw ups never happen in the first world. However, emergency med is pretty standardized and rudimentary. First responder learns X, EMT1, learns X and Y, EMT 2 learns X, Y and Z. X, Y, and Z are standard the world over based on 2 SIMPLE things; keep oxygenated blood flowing to the brain and don't compound the injury.

Edited November 18, 2014 by The Snark

[krisb]

Even worse stories of patients having kidneys removed before they even got to hospital.

[mgjackson69]

From what I can see, by and large the 'rescue services' here are a bunch of kids playing. One guy puts some lights on his pickup truck, the he and a few buds go hang out at an 'oil station' until a crash happens.

Even for the ones who truly want to help people, I suspect that their level of training/knowledge is pretty low.

[benalibina]

Mate ... fair point.

The medical system ... well, certainly the 'Emergency Services' has a lot of room for improvement.

.

That might well be but thanks to those same Emergency Services i am still alive and was fortunate enough to have my children born in the same hospital as where they saved my life....after hours of reanimation. Even a tuk tuk came into play with it.

There are many things wrong in the Thai medical system, i cant close my eyes for that, but i will forever be grateful to the emergency medical team which saved my life.

Edited November 18, 2014 by benalibina

[ATF]

Have you seen them performing CPR on TV? Not the way I learnt it,and possibly completely useless. No three quarter prone positioning. No holding the hands of people that are evidently dying.

A lot of phone cameras get used though.

I hit a pick-up at 200kph on my m/c but I had a full Moto GP suit on and woke up in back of one of the Bodysnatcher's trucks. The very young guy removed my helmet. No neck brace but he did hold my hand which I will never forget. I didn't realise how simple but important that was. I didn't know how badly I was injured or what was going on.

The doctor balled him out though for removing my helmet. Fortunately I wasn't seriously injured but took me six months to recover.

[cooked]

From what I can see, by and large the 'rescue services' here are a bunch of kids playing. One guy puts some lights on his pickup truck, the he and a few buds go hang out at an 'oil station' until a crash happens.

Even for the ones who truly want to help people, I suspect that their level of training/knowledge is pretty low.

There is a crossing not far from here that I, as an ex- traffic planner, found horrific. White knuckles every time. There were always an ambulance or two lurking like vultures under the trees, there was even a lady selling chicken and drinks. Now, hey presto, traffic lights! I wonder where they are now?

[uptheos]

Even worse stories of patients having kidneys removed before they even got to hospital.

What, you mean in the back of a pick up or during a detour to someone's house?

I wonder if the guys in ER noticed?

[krisb]

Even worse stories of patients having kidneys removed before they even got to hospital.

What, you mean in the back of a pick up or during a detour to someone's house?

I wonder if the guys in ER noticed?

ER guys are in on it.

Its a medical conspiracy I tells ya!

[pieeyed]

A mate of mine back in the early 90's was driving a pick up that crashed and he was stuck behind the steering wheel. The body snatchers showed up stole his 5 baht gold chain and left.

[VillageIdiot]

Even worse stories of patients having kidneys removed before they even got to hospital.

What, you mean in the back of a pick up or during a detour to someone's house?

I wonder if the guys in ER noticed?

ER guys are in on it.

Its a medical conspiracy I tells ya!

Where do you get your information?

Could you provide a link please.

[wilcopops]

A mate of mine back in the early 90's was driving a pick up that crashed and he was stuck behind the steering wheel. The body snatchers showed up stole his 5 baht gold chain and left.

according to Possum you can doge a steering wheel in a crash!

[wilcopops]

In defence of thai medical system I have to say that 3 times the Thai medics at Bumrungrad, and pattaya bangkok and memorial have actually saved my life ,,, and what made it more impressive is that o 2 occaisions the UK NHS had missed the problems completely after repeated consultations

However another private thai hospital completely destroyed my wifes youngest sisters life by giving her HIV infected blood after a miscarriage , a tribunal held by government officials found against the hospital as stated that ''safe blood was available to the hospital from local government screened blood bank only 1km away ,, but they would not by law be allowed to charge for that clean blood , so bought in tainted blood from a private source ''

unfortunately even with a damning report from government officials testimony she has not been able to get compensation even after repeatedly sueing the hospital concerned ,

health services in thailand are a lottery

"In defence of thai medical system I have to say that 3 times the Thai medics at Bumrungrad, and pattaya bangkok and memorial have actually saved my life ,,, and what made it more impressive is that o 2 occaisions the UK NHS had missed the problems completely after repeated consultations"

what is disturbing is that people don't seem to realise how completely irrelevant this kind of comment is.

​we are talking about a healthcare service that covers 70 million people and has an unacceptably high rate of inappropriate actions.

we can't even take your comments seriously about "missing" the problem

[wooloomooloo]

This is why they got the name " The body snatchers ".

That's if they can get through the traffic in a timely manner, of course.

[smokie36]

I'm available to sort it all out for 200k Baht a month plus medical and pension benefits.

So long as I get flown to Singapore if I'm sick.

[samran]

Some people would see a consulting opportunity in this. Odds are those guys you see on the news paper have very few opportunities to be exposed to best practice or don't have complete sets of equipment due to funding.

A few free volunteer sessions, you never know what it could turn into. You could also volunteer with the charity ambulances who would probably love the assistance of someone like you.

[wilcopops]

Have you seen them performing CPR on TV? Not the way I learnt it,and possibly completely useless. No three quarter prone positioning. No holding the hands of people that are evidently dying.

A lot of phone cameras get used though.

I hit a pick-up at 200kph on my m/c but I had a full Moto GP suit on and woke up in back of one of the Bodysnatcher's trucks. The very young guy removed my helmet. No neck brace but he did hold my hand which I will never forget. I didn't realise how simple but important that was. I didn't know how badly I was injured or what was going on.

The doctor balled him out though for removing my helmet. Fortunately I wasn't seriously injured but took me six months to recover.

how were the people in the pick=up truck after you hit them,

and whats the speed limit in thailand,,?? you hit them at 200kph, great,another wana be teanager

you would of gone to jail when you came out of hospital in your own country

A false argument. The topic is the standards of emergency healthcare.

Edited November 19, 2014 by wilcopops

[The Snark]

Some people would see a consulting opportunity in this. Odds are those guys you see on the news paper have very few opportunities to be exposed to best practice or don't have complete sets of equipment due to funding.

A few free volunteer sessions, you never know what it could turn into. You could also volunteer with the charity ambulances who would probably love the assistance of someone like you.

Tried this. A few years back Chiang Mai received funds to start an EMS program. A friend and I arranged a meeting with the coordinators. I had been in on forming an EMS in Humboldt county and brought along my medical books from first responder coordination through ACLS implementation. We gave our presentation inclusive of the basics of how to integrate multiagency and multiple response services as PD, and fire departments (traffic control, manpower, heavy equipment etc).

They asked to see our books and get back to them the next day. The next day they gave us the books back, the spines broken on all of them from being photocopied, then told us they will get back in touch with us. A European trained doctor fumed, telling us they weren't going to pursue it. His comment was bitter: "It's like we bleed a different colored blood here."

They never did get back to us. 8 years on and the EMS is still pie in the sky. Random uncoordinated actions. No standardized training. No universal protocols.

We also went to several of those independent response agencies. The truck with a stretcher in it operations. They were bemused, and some even thought we were joking when we tried talking about levels of medical training, designated care facilities as so on. They are no different from tour touts, getting kick backs to deliver the patients to certain hospitals.

Edited November 19, 2014 by The Snark

[ATF]

To the OP I would say to you that the Bodysnatchers are a charitable organization which is underfunded and under-trained.

However they do provide a valuable service. Any changes would have to come from the Government or co-ordination with hospitals and insurance companies. No one is ever charged for the service they provide.

To be honest I think they do as best as possible given the resources at their disposal.

[samran]

Some people would see a consulting opportunity in this. Odds are those guys you see on the news paper have very few opportunities to be exposed to best practice or don't have complete sets of equipment due to funding.

The coordination thing is also a killer. Each organisation is a Kingdom and turf wars are tough and relentless.

A few free volunteer sessions, you never know what it could turn into. You could also volunteer with the charity ambulances who would probably love the assistance of someone like you.

Tried this. A few years back Chiang Mai received funds to start an EMS program. A friend and I arranged a meeting with the coordinators. I had been in on forming an EMS in Humboldt county and brought along my medical books from first responder coordination through ACLS implementation. We gave our presentation inclusive of the basics of how to integrate multiagency and multiple response services as PD, and fire departments (traffic control, manpower, heavy equipment etc).

They asked to see our books and get back to them the next day. The next day they gave us the books back, the spines broken on all of them from being photocopied, then told us they will get back in touch with us. A European trained doctor fumed, telling us they weren't going to pursue it. His comment was bitter: "It's like we bleed a different colored blood here."

They never did get back to us. 8 years on and the EMS is still pie in the sky. Random uncoordinated actions. No standardized training. No universal protocols.

We also went to several of those independent response agencies. The truck with a stretcher in it operations. They were bemused, and some even thought we were joking when we tried talking about levels of medical training, designated care facilities as so on. They are no different from tour touts, getting kick backs to deliver the patients to certain hospitals.

I understand. I work a bit with government here a bit and the experience ranges from totally ignoring to bemused 'interest'.

What works best and is the hardest slog of all is to basically come in and help according to the local rules until slowly slowly you build up the trust. Not for the faint of heart, you swallow your pride a lot, and to be honest, you say you are retired the you might just not want to have the hassle.

Interesting to hear your experience nonetheless.

Edited November 19, 2014 by samran

[simple1]

Some people would see a consulting opportunity in this. Odds are those guys you see on the news paper have very few opportunities to be exposed to best practice or don't have complete sets of equipment due to funding.

The coordination thing is also a killer. Each organisation is a Kingdom and turf wars are tough and relentless.

A few free volunteer sessions, you never know what it could turn into. You could also volunteer with the charity ambulances who would probably love the assistance of someone like you.

Tried this. A few years back Chiang Mai received funds to start an EMS program. A friend and I arranged a meeting with the coordinators. I had been in on forming an EMS in Humboldt county and brought along my medical books from first responder coordination through ACLS implementation. We gave our presentation inclusive of the basics of how to integrate multiagency and multiple response services as PD, and fire departments (traffic control, manpower, heavy equipment etc).

They asked to see our books and get back to them the next day. The next day they gave us the books back, the spines broken on all of them from being photocopied, then told us they will get back in touch with us. A European trained doctor fumed, telling us they weren't going to pursue it. His comment was bitter: "It's like we bleed a different colored blood here."

They never did get back to us. 8 years on and the EMS is still pie in the sky. Random uncoordinated actions. No standardized training. No universal protocols.

We also went to several of those independent response agencies. The truck with a stretcher in it operations. They were bemused, and some even thought we were joking when we tried talking about levels of medical training, designated care facilities as so on. They are no different from tour touts, getting kick backs to deliver the patients to certain hospitals.

I understand. I work a bit with government here a bit and the experience ranges from totally ignoring to bemused 'interest'.

What works best and is the hardest slog of all is to basically come in and help according to the local rules until slowly slowly you build up the trust. Not for the faint of heart, you swallow your pride a lot, and to be honest, you say you are retired the you might just not want to have the hassle.

Interesting to hear your experience nonetheless.

I recall there is a Westerner in Pattaya who goes out with emergency medical teams, understand he has built a good reputation with the Thai teams. No idea if he has influenced policy / protocol for emergency medical responders.