KHON KAEN, 5 August 2008 (IRIN) - Given the number of bad traffic accidents, the lack of a formal emergency medical response system in most of Thailand meant the injured were at the mercy of passersby who threw them roughly into cars, often causing additional injury, or stole their possessions and left them for dead.

However, in the northeast Khon Kaen Province, Witaya Chadbunchachai, director of the Trauma and Critical Care Centre at Khon Kaen Hospital, stands before a large map and points to the 150 miniature ambulances, each representing an emergency medical response unit, possibly the most extensive and well-trained system of pre-hospital medical response in Thailand, if not the region.

"We now have 43 medical stations, each with one or more ambulances staffed by emergency medical technicians and pre-hospital emergency response nurses," Witaya told IRIN. They provide critical care for those with medical emergencies and trauma - the most common in Thailand, as in neighbouring countries, being horrific traffic injuries, usually involving motorbikes.

"An additional 99 sub-district stations are staffed by First Responders, many of whom use vans and pick-ups rather than ambulances," he said. They are trained in advanced first aid, including providing cardio-pulmonary resuscitation. In all, the response teams make some 30,000 emergency transports per year and average 14 minutes to the scene of an accident and 20 minutes to the hospital, according to data, covering the 10,886 sqkm province.

Helmet campaign

In 1989, Khon Kaen Hospital began a programme, supported by the World Health Organization (WHO) and later by the Japan International Cooperation Agency (JICA), to improve trauma skills as well as keep data and surveillance on the injuries, their patterns, the times and places they occurred and transport times.

A key finding, according to hospital officials, was that while most patients were medical emergencies not traumatic injuries – some 80 percent of the trauma injuries were from motorcycle accidents and 90 percent of in-hospital mortalities were from such injuries.

This led Khon Kaen hospital in 1992 to begin conducting helmet safety awareness campaigns and eventually to take the lead in advocating for the adoption in 1996 of national legislation requiring all motorcycle riders to wear helmets. According to hospital statistics, the legislation led to a significant decrease in motorcycle injuries,

However, according to hospital statistics, many riders - particularly the young and those drinking - did not wear their helmets at night, thus the rate of serious injuries and deaths increased. To address the issue, in 2008 the World Bank is supporting a "helmet for youth" safety and awareness programme with the hospital.

Data collection

In 2003, the trauma centre was designated a WHO Collaborating Centre for Injury Prevention and Safety Promotion. While the project includes training in pre-hospital care, it also focuses on injury surveillance, epidemiology and statistical collection. "A big issue for WHO," said Witaya, "is to establish a database on these issues, as most of the countries in the region don't have a statistical data collection system or adequate information to show how big a problem trauma actually is."

"Basically we are now considered a model for both in-hospital and pre-hospital trauma care for the country and the region," said Witaya. In the past eight years, with the support of the government, JICA and WHO, some 8,000 emergency medical specialists have been trained and are at work in Khon Kaen Province and throughout Thailand.

"We have also hosted, with the support of the government, WHO and JICA, numerous medical delegations from 11 neighbouring countries to visit our Trauma and Critical Care Centre and study our emergency response system," Witaya said.

In addition, the hospital runs a One Stop Crisis Centre (OSCC). "Through the [OSCC] we are the first hospital in the region to provide assistance to children and women who have been abused, either through sexual abuse or domestic violence … 10 years ago there was no such service," Janyaporn Ratanakosol, its head, told IRIN.

OSCC includes psychologists, counsellors, medical support, shelter if needed, even legal representation, and has outreach and awareness programmes to district hospitals and communities throughout the province. It receives more than 300 cases per year, 2,407 since it began operations.

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