MAL_map



[accordion] [acc_item title=”General”] Capital – Kuala Lampur
Land Size – 328,657 sq km
Population – 26,160,256
Language(s) – Bahasa Malaysia (official), English, Chinese and other local dialects

[/acc_item] [acc_item title=”Overview”]
  • Ÿ“Emergency medicine (EM) and prehospital care in Malaysia are still in an early phase of development but have improved significantly over last 5 years since the start of an EM physician program” (Hisamuddin, 415)
  • ŸResult of increased demand from public as well as increase incidence of motor vehicle collisions
  • ŸGov’t spends over US$1.5b/year on health care resulting from injuries (Hisamuddin, 416)
  • Ÿ“As the number of emergency physicians increases, the quality of prehospital care is expected to improve” (Hisamuddin, 420)
[/acc_item] [acc_item title=”History”]
  • ŸRecent “Vision 2020” program instituted by late Prime Minister has helped improve health care, and therefore increased public demand for improved EMS system
[/acc_item] [acc_item title=”EMS System Model”]
  • ŸAmbulances are staffed by doctors, nurses or non-medical ambulance drivers
    • Most prehospital care is focused in urban centers
  • ŸPrehospital Provider Agencies
    • Government agencies – typically based in hospital facilities
      • Ministry of Health
      • Ministry of Education (university hospitals)
      • Civil Defense
        • EMS, S&R, Firefighting, Disaster Management
      • (Police and Fire uninvolved in EMS)
    • Private agencies
      • Red Crescent
      • St. John’s Ambulance
      • Some from private hospitals
  • ŸKuala Lampur
    • “Services are provided mainly by NGOs such as St. John’s Ambulance and Red Crescent personnel, who are trained by qualified emergency physicians” (Hisamuddin, 420)

[/acc_item] [acc_item title=”Lead Agency”]
  • ŸMinistry of Health
  • ŸMinistry of Education (University hospitals)
[/acc_item] [acc_item title=”Levels of Care; Education and Training”]
  • ŸGeneral “Load and Go” approach
    • “Not much patient stabilization occurs in the field and this might contribute to significant morbidity and mortality in victims” (Hisamuddin, 417)
  • ŸAmbulances
    • MOH recently replaced old light duty vans with modular vehicles
      • Light duty vans staffed by untrained personnel with minimal equipment (scoop, stretcher, c-collars & splints)
        • Patient compartment is so small it prevents any patient care from being provided
      • New modular vehicles more spacious and may have BLS or ALS equipment (including portable ventilator/ultrasound)
        • Manned by doctor or trained support staff
    • “Equipment provision … often relies on the annual budget of the ED that controls the ambulance services. This places the burden on the ED that already struggles for its own development” (Hisamuddin, 419)
    • Emergency ambulances often used also for interfacility transfers
  • ŸTraining
    • Currently, no designations/certification standards for prehospital providers
      • Doctors
      • Nurses
      • Medical Assistants from ED
    • No formal curriculum for EMTs or non-medical drivers
      • EMT not recognized by MOH
    • St. John’s Ambulance and Red Crescent recently employ “paramedics” as primary responders – BLS/BTLS
    • “Organized training programs from basic life support … to more advanced medical management have been gradually introduced to MOH and MOE hospital-based ambulance personnel” (Hisamuddin, 420)
      • “Proposal for a degree course (Bachelor of Science) in prehospital care has been forwarded to higher education centers and the MOH” (Hisamuddin, 420)
    • Mutual Aid agreements
      • Civil Defense provides resources (i.e., ambulances, manpower, equipment)
      • University Hospital provides training and CE programs
        • However, overall lack of integration between EMS, PD and FDs, which is “partly attributed to lack of interest from various agencies and administrative coordination at higher levels” (Hisamuddin, 418)
[/acc_item] [acc_item title=”Medical Direction”]
  • Ÿ“Two-way communication between the field and hospital exists; however there is no consistent system or protocols that govern utilization” (Hisamuddin, 418)
    • Advanced notice of critical patients doesn’t occur routinely
    • Providers may rely on personal cell phones
[/acc_item] [acc_item title=”Specialty Services”]
  • ŸAncillary Services – Rescue/Air Medical Support
    • “Very limited and rarely used unless in a mass casualty incident” (Hisamuddin, 418)
    • Can be provided by Royal Malaysian Police, Armed Forces, and Malaysian Helicopter Services
  • ŸInjury Prevention Programs
    • “Total number of victims that sustained severe injuries due to road traffic accidents alone is declining” (Hisamuddin, 416)
      • Possibly because of gov’t organized programs like road-related injury prevention, vehicle/road safety program implementation, improved hospital acute care
[/acc_item] [acc_item title=”Dispatch”]
  • Ÿ999 – MOH or MOE
  • Ÿ991 – Civil Defense
  • ŸNo uniform communications/dispatch/receiving system across nation
    • Agencies typically rely on own systems
    • Incoming calls come to hospital ambulance station or ED
      • Variety of personnel may take calls, some may have little training
    • No call-screening, prioritization or pre-arrival instruction
    • “Identifying patient location and gaining call-back information can be extremely difficult due to lack of street addresses and poor information from the caller” (Hisamuddin, 418)
  • ŸSchool of Medical Sciences (Universiti Sains Malaysia) – recently initiated first EMD program
    • Initial feedback has shown improved ambulance response times “and, most important, increased public awareness concerning prehospital emergency care” (Hisamuddin, 417)
      • One survey showed 45% reduction in RTs (East Coast of the Peninsula of Malaysia)
[/acc_item] [acc_item title=”Emergency Medicine”]
  • Ÿ“Relatively new specialty … but rapidly expanding … [and] increasingly recognized within the health care system” (Hisamuddin, 417)
    • “Since the development of EMS training programs, there has been an increasing interest among emergency medical providers to improve the prehospital care system” (Hisamuddin, 417)
      • Equipment upgrades
      • Increasing in manpower
      • Prehospital care training course development
      • Public education
  • ŸFollows Anglo-American model
    • 4yr Masters in EM program, offered at only one school presently
    • Only 20 EM physicians [as of 2007] in Malaysia (Hisamuddin, 417)
  • ŸCurrently EDs (“accident and emergency units”) are primarily staffed by physicians with “little to no advanced training in EM”
    • General practitioners, surgeons and orthopedists
  • ŸSpecialties w/in EM also being developed
    • Disaster Management
    • Prehospital Care
    • Critical Care
    • Observation Medicine
[/acc_item] [acc_item title=”Disaster”]
  • Ÿ“The presence of [a disaster management] EM postgraduate program has, to some extent, disseminated the interest in disaster medicine among the health care providers throughout the country” (Hisamuddin, 420)
  • ŸPast events:
    • Train derailment
    • Landslides
    • Flooding
    • Collapsed apartment building
    • 2006 Southeast Asia Tsunami
      • Hit vacation islands of Penang And Langkawi
        • 88 dead; 6 missing; 300 injured; approx. 700 houses destroyed
      • Early warning systems and Lifeguards had warned public to stay indoors “due to the choppy waters sighted earlier” (Hisamuddin, 420)
      • “Peninsular Malaysia was spared full impact of the tsunami as it is sheltered by the island of Sumatra and not directly exposed to the Indian Ocean” (Hisamuddin, 420)
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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