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Emergency Medical Services –

the service and components within

Malaysia perspective

MECC ORGANIZATION STRUCTURE

MECC SERVICE OBJECTIVE

MECC PERAK STATISTIC

LECTURE 0UTLINES

CHALLENGES AND SUMMARY5

Understand the

various components

of EMS

Understand the

function of

MECC

Introduce the role of PED

LECTURE OBJECTIVES

WE TEACH PUBLIC DURING EMERGENCY….

DO THESE…

• 994 – Fire and Rescue Department

• 991 – Civil Defence Department

• 995 – gas-related emergencies.

• 112 – if use cell phone

WHEN TRYING TO GET HELPTHEY FACE THIS…..

WHO DO I CALL

FIRST?

EMERGENCY NUMBERS

COORDINATED PRE HOSPITAL EMERGENCY

RESPONSE – MECC

• Developed as part of MERS 999 system

• October 2007 (Perak officially started Jan 2015)

• Regionalization of Pre Hospital Emergency Response

• State-based centers in Malaysia – hospital based

• Emergency Physician as Medical Director

• Communications hub for multi-agency ambulance

network

• Medical Direction help for interagency network

MECC

ONE STOP CENTER

FOR ALL

MEDICAL

EMERGENCIES

MECC: ORGANIZATIONAL STRUCTURE

MEDICAL

STANDBY

HEAD OF EMERGENCY AND

TRAUMA DEPARTMENT

STATE

DIRECTOR

HOSPITAL

DIRECTOR

CLINICAL

EMERGENCY CARE

AREA

PRE-HOSPITAL

CARE

DISASTER

MANAGEMEN

T

AMBULAN

CE

SERVICE

MECC

MECCSERVICE OBJECTIVES

• Answer all calls requesting for emergency

ambulance service

• Public

• Health facilities

• Dispatch appropriate response team in

accordance to triage category and protocol

• Responder service level – BLS, ALS

• Mode of response – ambulance, motorcycle,

bicycle, doctor’s care

MECCSERVICE OBJECTIVES

• Information monitoring hub for all major emergency

incidents

• Coordination and communication centre for all

ambulance movement

• 999 ambulance, interfacility and retrieval

• Monitor various phases of response

• Interagency activation and coordination

• Maintain communication with responding team

• Receives reports from teams at regular interval

• Facilitate Medical Direction

EMERGENCY CALL MANAGEMENT STRUCTURE

TM 999

Call Centre

Caller

Medical

Call Centre

21

MECC

PreHospital Care

District Hosp

(One Line)

AmbulanceNGOs Ambulance

Incident Site

10s

10s

10s Call Mx

1Min Call Mx

Health Clinics

Ambulance

EMERGENC

Y CALL

TAKER

AND

OPERATOR

S

EMERGENC

Y

DISPATCHER

S

930 931974

927 933

822

909938 957

902 913

975

874854

957

907

993

850

999

921 932965

906

1014

652 649

700666 658 658

711679

719

647

593

771

0

200

400

600

800

1000

1200

JUMLAH RESPON KECEMASAN AMBULAN HRPB 2016

PAGI PETANG MALAM

0

500

1000

1500

2000

2500

3000

JUMLAH RESPON KECEMASAN AMBULAN HRPB

2015- 2016

2015 2016

13671278

13581432 1393 1439

13251438

13721470 1523 1531

2111 2057

2334

2110 2161 2181

23602293

21752251

2172

24392439 2419

26192494

2579

2316

26062533

25982510

2403

27502815

2640

3057

2732

2959

2596

2833 28812735

30452924

3085

JAN FEB MAC APRIL MEI JUN JUL OGOS SEP OKT NOV DIS

2014 2015 2016 2017

TOTAL 999 CALL IN MECC PERAK 2014-2017

131

106 110121

100

160 163

123117

188 187

89

122

95

120125

116124

96

116 119 118123

110102 105

114106

101

65

80

111104

96105

118

0

20

40

60

80

100

120

140

160

180

200

JUMLAH KES RUJUKAN INTERFASILITI

AMBULAN HRPB TAHUN 2015-2017

2015 2016 เชงิเสน้ (2015)

7975

81

7168

46

5861

7470

58

75

10

2529 30

27

15 16

44

2320

40 38

15

5 4 5 6 4 6 6 7 6 7 5

JUMLAH KES RUJUKAN INTERFASILITI

AMBULAN HRPB TAHUN 2017

PAGI PETANG MALAM

0

50

100

150

200

250

300

JAN FEB MAC APRIL MEI JUN JUL OGOS SEP OKT NOV DIS

NUMBER OF DIRECT CALL TO HOSPITAL IN PERAK

2014 2015 2016

20…

20…

0

200

400

600

800

1000

1200

JAN FEB MAC APRIL MEI JUN JUL OGOS SEP OKT NOV DIS

319 321361

450 437

352300

350314

370 362413

713 700736 723 744

710

856786

716778

708

795780

834

929885

916

776

951 9481009

949

863

10581012 995

11371076

1128

947989

1088 1071

11601104

1185

2014 2015 2016 2017

AMBULANCE RESPONS FOR DISTRICT HOSPITAL IN PERAK

2014 - 2016

19.5

20

20.5

21

21.5

22

22.5

23

23.5

JAN FEB MAC APRIL MEI JUN JUL OGOS SEP OKT NOV DIS

PHC AMBULANCE RESPONSE TIME

2015 - 2016

2015

2016

MECC

ORGANIZATION,

STRUCTURE, PROCESS

AND TECHNOLOGY

MECC: STRUCTURE LAY-OUT

ORGANIZATIONAL STRUCTURE IN MECC

Emergency

physician in-

charge

MECC Supervisor

on-site PPP U32

Emergency Call

Takers

(PPP, JT)

Emergency

Dispatchers

MECC Supervisor

PPP U36

MECC Care Taker

PPP U41/42/44

STAFF QUALIFICATION

MECCTELECOMMUNICATIONS STRUCTURE

• System network infrastructure

• Data server

• Interagency network

• Communications structure

• Telephone – independent from hospital

• Cellular and fixed

• Radio devices – primary and secondary

• Data transfer capability

• Voice communication capture capability

MECCTOOLS TO FACILITATE SERVICE

• Computer Aided Dispatch

• Emergency Call Management Protocols

• Standard Time - synchronisation

• Response Monitoring Display

• Individual Response Monitoring Sheet

• Resource Monitoring Display

• Individual Resource Assignment Sheet

• Map of area

• Street map of locations

• Street map of location and facilities

Call Card View

Area MappingDespatch Resources

View

COMPUTER AIDED DISPATCH

STANDARD - WORKSTATION

COMPUTER AIDED DISPATCH (CAD)

EMERGENCY CALL MANAGEMENT PROTOCOLS

INDIVIDUAL RESPONSE DISPLAY

Suggestion of nearest

ambulance to respond

RESPONSE MONITORING DISPLAY

CALL

RECORD

NUMBER

INCIDENT

LOCATION

TRIAGE

CODE

RESPONSE

STATUS

RECORDED

TIME

FLEET MANAGEMENT

AREA MAPPING

GEOGRAPHICAL INFORMATION SYSTEM

MECCPROTOCOLS OF SERVICE

• Daily Functions And Preparations Of Dispatchers

• Emergency Call Management Protocol

• Primary Response Activation Protocol

• Interagency Activation Protocol

• Multiple Casualty Response Activation Protocol

• Emergency Response Monitoring Protocol

• Secondary Response Activation Protocol

• Medical Direction Facilitation Protocol

MECC

INFORMATION TO FACILITATE COMMUNICATION

• Knowledge and understanding of Ambulance Response

Protocols for each provider

• Primary Response Protocol

• Medical Direction Request Protocol

• Secondary Response Request Protocol

• Discharge against Medical Advice Protocol

• Knowledge and understanding the scope of service for

responders

• Level of service response – BLS, ALS, Intermediate

• Equipment and medication (if any) carried by responder

THE CHALLENGES

• ‘I DON’T WANNA CALL 999 BECAUSE IT WILL DELAY MY

TIME TO BRING MY SON TO HOSPITAL’- FATHER OF

ASPIRATED CHILD WITH CARDIORESPIRATORY ARREST

• ‘I ADVISED THE MOTHER TO BRING HER BABY BY HER

OWN BECAUSE IT WILL BE DELAYED IF WAITING FOR AN

AMBULANCE’-MO FROM KK , 6 MONTH OLD BABY WITH

MULTIPLE APNEIC EPISODE.

• BYSTANDER WITNESS ARREST CALL 999 BUT REFUSED

TO DO CHEST COMPRESSION ONLY CPR.

• MISUSE MECC

SUMMARY

• Regionalization of Pre Hospital Emergency Response

• State-based centers in Malaysia – hospital based

• Emergency Physician as Medical Director

• Communications hub for multi-agency ambulance network

• Medical Direction help for interagency network

• Structure, process and technology to save lives

• Need to increase awareness to Health provider and civillian on

999 and MECC.

CRITERIA FOR PT TRANSFER

• Inpatient foreigner case who requests to be hospitalized in

their country of origin. Cases which have been discharged are

not to be transferred via ambulance. Patients / relatives will

have to arrange their own transport.

• The in-charge doctor of the respective discipline / department

has agreed to proceed with the transfer request.

• All unstable cases are kept in the current hospital and to be

stabilized before transfer.

• Transfer can only be made upon approval by the receiving

hospital.

ARRANGEMENT FOR PATIENT TRANSFER

• The arrangement shall be made at least 24 hours earlier.

• Adequate info and explanation shall be made to patient &

family members of the potential risks.

• Call centre must be informed of the details of transfer

• Referring institutions shall send all documents via email/fax

to the receiving institution. Receiving states/province health

office shall be informed via phone once agreement on

patient transfer is achieved.

• Receiving district health office shall facilitate and coordinate

the patient trasnfer process with relevent agencies at the

border check point. The agencies include;

• Malaysia-Thailand Border Coordination Office)

• Immigration

• Custom

• DOT (dept of transport)

• AKSEM (Malaysian Border security Agency)

• Police

• Civil defence

TRANSFER PROCESS

• Once transfer request has been approved by receiving institution, all necessary

documents and equipment shall be prepared. The referring institution shall reconfirm

the estimated time of departure, estimated time of arrival at the transfer zone. Any

delay or incidents that occurs during transportation of patient shall be updated to

the receiving side.

• The transfer of patient between ambulances shall take place in the free zone

between immigration checkpoints of Malaysia and Thailand. The designated transfer

area shall be agreed by both bordering state and province. In any event of rain during

transfer process, alternative area (e.g. covered parking bay) shall be identified.

• Pre-transfer notification to other relevant agencies a few hours prior to transfer is to

ensure a coordinated response between agencies and the transfer zone is evacuated

at least 10 meter radius from public passage.

TRANSFER PROCESS

• In the event of infectious disease case transfer, the areas that need to be

evacuated for the transfer process between ambulances is at least 15

meter radius. The area will only be reopened to the public after

disinfection process has been carried out at the transfer area. This

notification will also ensure the use of the Green Lane at the Immigration

and Custom check point and to ensure smooth process of immigration

procedure for the patient and accompanying relative(s).

• During passing over of the case, all documents shall be signed by the

representatives of both referring and receiving teams (Annex 7 and Annex

8). All documents shall be completed in two copies and each referring and

receiving team shall keep a copy for the reference. Any updates / progress

of the patient during the journey shall also be passed over to the receiving

team.

ISSUES

• All notifiable disease cases either discharged against medical advice or

transferred must be informed to the foreign District Health Office.

• In case of death during transfer process, the present transporting

ambulance shall bring patient to nearest health clinic / hospital in the

present state/province for death declaration and documentation.

Death certificate and Burial Permit Certificate shall be produced by

the state/province that death occurred. Foreign Institution Call Centre

should be informed on the event of death. Cross border dead body

transportation should be dealt together according to both countries’

laws.

ISSUES

• Transfer of detainee case shall be dealt with according to

the rules and regulations in the present country.

• In the case of an accident involving the ambulance, the

nearest local emergency medical service of the present

transporting ambulance shall respond.

• In the case of patient being unable to pay their hospital bills,

the embassy of their country of origin shall be referred to.

THANK YOU