Songkhla Provincial

Administrative Organization

Effective Integrated Pre-hospital Emergency Care System

Abstract

The unpleasant world championship, According to the World Atlas website, about the country with the highest road deaths in the world in 2017, has moved up to the top of the world. It was found that the death rate was 36.2 cases per 100,000 populations. While government policies have been set up to prevent road accidents, including accident relief measures. The emphasis is on the preparation of the emergency medical service system so that people can access the emergency medical system thoroughly, equally and with standard quality. Therefore, they have set up a notification and dispatch center in every province, using the number 1669 as the emergency notification and emergency number to assist emergency patients in a timely manner. Ther centers will be set up with the hospital in each province. Provincial Administrative Organization has created an innovative approach to integrating the new dimension of work in order to help people with illnesses and emergency situations thoroughly and effectively. It was set up as a public service by the local government based on authority and mission that was effectively transferred. This serves the needs of people in all areas, enhances people's quality of life and reduces the rate of loss of life and disability of people in the area. We hope that this innovation will be useful for the development of emergency medical systems for local governments in all areas. More importantly, we would like to thank all the working groups and networking parties involved in driving this innovation.

Content

Page

1. Introduction 1

2. Name of Innovation, Objectives and Goals 4

3. Background and Problems in Area 4

4. Innovation Initiative 8

5. The use of human resources, personnel, materials, equipment, budgets or 9 other resources in the implementation of the work.

6. Innovation Process 17.

7.Impact of Innovation 20

8. Innovation Assessment 25

9. Sustainability and Innovation Transferability 26

10. Lessons and Capacities for Promoting Sustainable Development 27

Executive Summary

Innovation: Effective Integrated Pre-hospital Emergency Care System

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1. Introduction Songkhla is a province in the lower Southern part of Thailand and the fourth largest city in the country with a population of 1,415,835 which is the second largest population in the Southern part. Its population density is 190.19 persons per square kilometer; the area is the third largest in the Southern part and the 27th of the country. Geographically, from the

Northern part of the province to the South lies an elongated peninsula called “Sathing Phra

Peninsula” and the Southern part area is rectangular and connected to the elongated peninsula by

Tinsulanonda Bridge. Most of the area in the North is low land while the East is a plain near the sea; the South and the West are mountainous with high lands that are important water sources.

Administratively, has three types of administration as follows.

1) Central administration consisting of 221 central government offices and 4 independent public agencies;

2) Provincial administration with two administrative levels: provincial level consisting of

34 offices, and district level consisting of 16 districts, 127 sub-districts, and 1,023 villages; and

3) Local administration comprises 141 organizations consisting one provincial organization, 92 or sub-district organizations, and 48 municipalities (2 Nakhon or city municipalities, 11 or town municipalities, and 35 Tambon or sub-district municipalities).

The population of Songkhla Province comprises these main races: Chinese, Malay, and

Thai. Thus, there are diverse cultures and languages. Songkhla is also an important port and a resort town of Thailand where there are natural attractions and fertile natural resources on land and underwater. District is a center for trade, transportation, and is a junction city of the

Southern part of the country with rapid economic growth. With its rapid economic expansion, - 2 -

Songkhla Province is prosperous with good quality of life, convenient and comfortable living. However, the rapid economic growth also results in many problems. Physical problems include traffic congestion, crowded city areas, and insufficient housing for city people. There are also environmental problems, social problems, crimes, economic problems, and increasing road accidents. Moreover, there are health problems such as stroke and heart disease that seem to be increasingly more severe and resulting in paralysis, disabilities, and sudden deaths.

Fortunately, in Thailand there are approximately 20 emergency numbers: 191 for all emergencies and dangerous incidents and 1197 for traffic problems, responsible for by local police, 1669 for emergencies and accidents, responsible for by provincial hospitals in all 77 provinces where services include medical advice and ambulances for different levels of emergency and severity.

The emergency medical services in Thailand originated from services provided by non- profit organizations with financial support mainly from donations while government organizations including the Ministry of Public Health, Metropolis, Police Department (presently, the ) initiated the pre-hospital care services but they had different limitations. Not until 2000 that the Ministry of Public Health established the Office of

Emergency Medical Service (Rescue Narenthorn Center) under its administration, and emergency medical services became one of the four main policies of the Ministry. Then rescue units were launched at hospitals in seven provinces as pilot projects before they were expanded across the country with the “Rescue Narenthorn Center” of Rajavithi Hospital in Bangkok as a model. The number 1669 was designated as the hotline for emergencies to coordinate, communicate, control and dispatch services. In the beginning, financial support was provided by the National Health

Security Office and the services were not yet completely and clearly systematic.

Nevertheless, presently, the emergency medical services system is controlled by the Emergency Medical Act, B.E. 2551 (A.D. 2008) and the National Health Security Office is responsible for management and coordination of all parties of government and private sectors involved. Local administration organizations are promoted to play a role in management to have - 3 - cooperation in the practice of emergency medicine with the purpose of providing emergency medical services to emergency patients and protecting their rights of access to emergency medical systems with the same rights, equal and quality standards. Emergency patients also receive timely and efficient medical assistance and treatment. Therefore, management to have a system of efficient emergency medical services is an essential mission of the local administration organizations.

The local administration organization is the main organization in charge of public services, policy, regulations and guidelines that can affect the outcomes of public services in the local area. The local organization is also responsible for determining what types of public services to provide, how and for whom. However, even though the local administration organization is directly responsible for management of the town, its role nowadays has changed from being a provider to a supporter by encouraging different sectors to participate and play a role in developing the town more than they used to do in the past. This new approach of public administration attaches importance to people participation because they are citizens and partners of the town. Considering the dimension of town management policy, it can be seen that participation can play a role in all steps of the policy process from policy forming to implementation.

Figure 1: Map of Songkhla Province - 4 -

2. Innovation, Objectives and Goals

2.1 Innovation: Effective Integrated Pre-hospital Emergency Care System

2.2 Objectives: To provide emergency patients in Songkhla Province with access to efficient, equal, and timely emergency medical services 24 hours a day; to reduce loss of life as a result of delayed on-the-scene medical services; and to reduce the death rate en route to hospital.

2.3 Goals: All emergency patients can have access to emergency medical services equally with more efficient and timely medical assistance; reduction in deaths and disabilities; upgrading people’s quality of life in terms of access to public services; and increase of confidence among local people and tourists.

3. Background and problems

Thailand is ranked the second country with the most road traffic deaths (The World Atlas website, 2016). This is a great loss of human resources and economy to the country. It can be said that Thailand has 25 road traffic deaths daily or one death every hour and is estimated at 2.8 percent of the gross national product (GNP). The government realizes the importance of the annual loss of more than 200,000 million baht and 11,000 lives, and a large number of disabilities caused by road accidents. These losses are important as factors leading to poverty as one-third of the deaths are those of breadwinners and most of them are from middle-income or low-income families. Thus, the action plan, Decade of Action for Road Safety 2011-2020 has been implemented aiming to reduce the rate of road traffic deaths to below 10 persons per 100,000 population in 2020. In order for all parties involved to have a clear direction for addressing and successfully reducing road accidents, the government has provided 8 major guidelines for road safety concerning the following: wearing helmets, reducing risk factors of drink-driving, reducing risk factors on road infrastructure, controlling speeding, upgrading vehicle safety standards, improving competences of vehicle and road users, developing emergency medical services, treatment and rehabilitation systems, and improving the road safety management systems. - 5 -

The government policy, according to the Global Plan for the Decade of Action for Road Safety 2011-2020 (the five pillars), particularly Pillar 5: Post-crash response, has formed guidelines for emergency medical services system development, and timely and thorough coverage of services of treatment and rehabilitation of road accident victims. Two core indicators are assigned for the entire country: 1) hotline emergency numbers, and 2) Rescue centers, and the optional indicator is training on emergency medical services for emergency medical personnel. Thailand uses the emergency number 1669 for all Emergency Medical

Dispatch Centers in the entire 77 provinces. The centers provide medical advice and ambulances for all levels of emergency and severity, and the nearest hospital with highest potential immediately provides timely medical treatment. Most emergency teams are provided by local administrative organizations, other organizations under the Ministry of Public Health such as government hospitals, and private hospitals and foundation hospitals, etc. Songkhla Province has mobilized policy according to the master plan and provincial agendas to reduce the death rate and emergencies resulting from road traffic accidents.

The province has continuously conducted the activities since 2000 under the One Rescue Unit, One Tambon/Sub-district Project. However, presently there is no law on the operation of this project, and legal problems, thus, remain important obstacles. Consequently, at the beginning, some local administrative organizations did not want to join in the operations. Nevertheless, with the clear intention of mobilizing the emergency medical services system, Songkhla Provincial Administrative Organization has developed the system continuously until the present time. Later, a bill was passed and the Emergency Medical Act, B.E. 2551 (A.D. 2008), Section 33, Clause 2, states that local administrative organizations are responsible for operating and managing local emergency medical systems. There is also a bill on Determination Plans and

Process of Decentralization to Local Administrative Organizations Act, B.E. 2542 (A.D. 1999) which stipulates the roles and duties of local administrative organizations in emergency medicine for people to have access to emergency medical services equally with standard quality, and efficient and timely medical assistance and treatment. Therefore, management of the emergency - 6 - medical services system is a significant mission of local administrative organizations to save people’s lives.

Songkhla Provincial Organization in conjunction with the National Institute for Emergency Medicine has raised awareness and built an ideology among administrators and related parties in the development of Songkhla Provincial Emergency Medical Services System by holding the Second Annual National Emergency Medicine Conference for Local Administrative Organizations in 2015 with the theme “Thai Local Synergy for Sustainable

Emergency Medical Reformation” for participants to apply the knowledge gained from the conference to develop emergency medicine in each local area and to have preparedness for the emergency medical system to enter the ASEAN Economic Community (AEC). There were 1,800 participants including observers from ASEAN member countries.

The conference resulted in cooperation from all parties concerned to consult about the problems of road traffic accidents and other emergencies faced by people in Songkhla Province. Such cases are sufferings and misfortunes causing a large amount of damage that can be prevented and reduced. Songkhla Provincial Administrative Organization organized a meeting in conjunction with Songkhla Provincial Public Health Office, Songkhla Provincial Police, Songkhla Provincial Traffic Center, private hospitals, rescue foundations, Road Accident Victims Protection Co., Ltd., Songkhla Branch, and emergency medical party networks and partners to discuss road traffic accidents and emergencies faced by people in Songkhla Province.

The outcomes of the meeting are concluded as follows.

1. Road traffic accidents: They are resulted from unsuccessful enforcement of traffic law in Songkhla Province due to limited budgets, limited number of officers resulting in frequency of having to work 24 hours a day with responsibilities in traffic management and road safety, limited use of information technology while economic grows rapidly resulting in changes in traffic and use of road surfaces on both sides of the streets. The rapidly increasing number of vehicles makes it more difficult for motorists to drive safely. Cooperation from all parties concerned is needed for organizing activities to provide knowledge and understanding, and to campaign for creating safety culture, awareness in safety and traffic safety society in educational - 7 - institutions at all levels as well as in the community. In addition to road safety for all, the purpose is also for all parties involved to seriously and continuously cooperate and support in terms of budgets.

2. Emergency illnesses and health conditions: These are heavy burdens for emergency medical services as the number of emergency cases doubles each year. As a result, emergency rooms and the hospitals cannot adequately respond to the needs for treatment. There are also lacks of budgets and medical personnel. Furthermore, people lack knowledge and understanding of emergency medical system, emergency illnesses, first aid skills and basic life support (bls). Additionally, the emergency medical dispatch centers are not completely accessible for all people; they lack efficiency, international standards, and follow-up and evaluation systems.

Referral of emergency patients between hospitals and patient’s rights protection and rights for medical treatment are still problematic for low-income people.

3. Songkhla Provincial Public Health Office is in charge of academic support for EMS Ambulance Registration and Certification Office, and reimbursement for emergency medical units. The problems faced include insufficient manpower resulting in having to hire part-time staff whose career path is uncertain; and working space is limited and inconvenient.

4. Hat Yai Hospital Emergency Medical Dispatch Center, Songkhla Province, has no person directly in charge of because it is not a main duty of the hospital’s accident and emergency section. Other problems include no career advancement path for the staff; limited working space and salary differences between staff working for the center and those working in the hospital’s accident and emergency room.

5. Local administrative organizations’ problems include the following. The emergency medical services system is new for the organizations, especially during transition of persons responsible for the job who lack knowledge and expertise concerning emergency medical services; inconveniences in providing medical advice; worries about emergency medical policy when the person in-charge is replaced; limited budgets, especially for Tambon/sub-district organizations resulting in obstacles to procurement of emergency ambulances and standard - 8 - medical supplies and equipment such as AEDs (automated external defibrillators), confined space rescue equipment, etc. which are all required for rescue services.

6. Problems in human resources for emergency medical services are that there are limited staff number and most of them are volunteers, and thus, there are often different volunteers with different competence in providing services. There are limited training courses for potential development to increase the number of emergency responders, and there are limited training courses for upgrading the practical emergency medical units in Songkhla Province due to high expenditures in organizing training courses. As a result, there are not enough emergency medical units to cover all areas, and efficiency of existing units can further be improved.

7. Problems in working individually and not integrated as a team—problems arising when working in a team include no clear policy or guidelines for teamwork or working together, no concrete and clear coordinating center to manage the emergency medical services system, lack of integration in human, financial, and equipment resources, lack of problem analysis among administrators of different organizations and party networks. These are required for all involved to know the problems and the direction for reformation of Songkhla Provincial emergency medical services system to proceed in the same direction and according to each organization’s responsibilities emphasizing the people-centered approach.

4. Innovation initiative

A prototype of management of emergency medical dispatch center: Songkhla Provincial Emergency Medical Dispatch Center integrates staff of local police and local administrative organizations to build an integrated model to concretely save lives of emergency patients at one stop.

Songkhla Province is a socio-economically important sea port where population and communities keep expanding all the time. Looking after people in all aspects, therefore, requires cooperation from all parties concerned. This initiative is derived from cooperation from many parties to work together in a new form to pilot development of the emergency medical services system of Songkhla Provincial Administrative Organization under the hotline number 1669, the - 9 - one-stop medical service number (One Number, One Service) consisting of Songkhla Provincial

Emergency Medical Dispatch Center No. 1669, Songkhla Provincial Police hotline No. 191, (calls to these two numbers are free of charge), and the CCTV Control Center. The initiative integrates these three organizations at one place, Sri Kiatphat Building of Songkhla Provinicial Administrative Organization to solve problems for emergency sufferers and victims. It is a new initiative derived from work analysis that found an integration of individual work as a team in emergency situations is better than working individually. The initiative integrates and create mechanisms of working in a coordination manner to reduce steps in the work process, to pool resources for use together, and to support each other towards the same goal of solving problems in providing medical services at one-stop. The initiative can provide and deliver medical services to emergency victims from the beginning or on the scene to reduce the death rate and disabilities as well as to respond to the needs of people at the utmost.

5. Use of administrative resources in personnel, materials, equipment, budget, and others

5.1 Use of administrative resources in personnel: Integration of the three centers under the name Songkhla Provincial Administrative Organization Integrated Emergency Medical Coordination and Dispatch Center using the hotline number 1669, the One Number One Stop Service. The initiative is a concrete integration of human resources with an interdisciplinary team working in shifts to provide services 24 hours a day. It is a center where pre-hospital treatment begins from giving medical advice to transferring emergency victims to hospital. The interdisciplinary team consists of the following.

5.1.1 Medical personnel under Songkhla Provincial Public Health Office comprising emergency physicians from , Hat Yai Central Hospital, and those under Ministry of Education, Office of Higher Education which is (Prince of Songkla University Hospital), a physician from this hospital is the Medical Director of the center, who controls and supervises the operations and management of the integrated emergency medical dispatch center. Other personnel are from Hat Yai Hospital, Songkhla - 10 -

Hospital, and all 16 district hospitals. Personnel under the hospital under the Ministry of Defense, private hospitals and Prince of Songkla University Hospital are advanced emergency care units admitting emergency victims transferred from pre-hospital sites.

5.1.2 Personnel under Songkhla Provincial Administrative Organization comprising professional nurses who work as emergency medical dispatcher (EMD), emergency medical dispatch supervisor, and emergency medical coordinator, emergency medical call takers who take calls directly from people, through and from other emergency centers to communicate and coordinate for medical assistance, and primary care advice for emergency victims and community emergency reporters, direct and control the operations, record emergency calls and direct, coordinate cooperation from organizations involved in emergency medical services and coordinate transportation of victims to the hospital. For personnel of the CCTV control center, they monitor, prevent and suppress violence, analyze road accidents on the CCTV systems of Songkhla Provincial Administrative Organization, prevent repeated road accidents, facilitate transportation of victims to hospital, and facilitate data copying from CCTV for use as evidence.

5.1.3 Personnel under Songkhla Provincial Police Division and Songkhla Provincial Traffic Center consist of police officers who take calls and notify police officers in the area to control the emergency for security of life and property, prevent repeated cases, facilitate emergency units in entering the scene, increase the speed of entering the scene and transport emergency victims to the hospital by controlling the traffic light and coordinating with officers controlling the CCTV systems.

5.1.4 Personnel of Provincial Police Region 9 work on mobile CCTV units to monitor, prevent and suppress violence and crimes in economic areas. The mobile CCTV systems on the van records images through a 4G system and transmit them to Songkhla Provincial Administrative Organization Emergency Medical Dispatch Center.

5.1.5 Personnel of local administrative organizations, recue foundations and associations act as emergency medical units and emergency medical personnel who take calls and transfer data to emergency medical dispatch centers and coordinate with Songkhla Provincial - 11 -

Administrative Organization Integrated Emergency Medical Center to provide and deliver primary care as well as transporting emergency victims to the nearest hospital.

5.2 Use of administrative resources: materials and equipment

5.2.1 Use of resources in the emergency medical services system of Songkhla Provincial Administrative Organization

1) Songkhla Provincial Administrative Organization Integrated Emergency

Medical Dispatch Center - Radio over IP RoIP Gateway and telephone 1 set - Desktop radio and power supply 5 units - Handy talkies 5 units Random number phone (1669)50 linesComputers 12 sets

2) Equipment supporting the Emergency Medical Unit Computers 130 sets

- Mobile phones 120 units - Ambulances with medical equipment 128 units - Ambulances with advanced medical equipment 1 unit - Automated External Defibrillators (AED) 80 sets

5.3 Use of administrative resources: Budgets and other resources—It is a responsibility of all the organizations that are integrated to use the resources according to the MOU that emphasizes decentralization of management and work in a networking manner. Guidelines have been jointly formed for the work to be carried out in line with missions of each organization with shared information. Local people’s potential is developed for them to be community emergency responders. Ambulances and medical supplies for emergencies are made available to all areas resulting in synergy for strong and sustainable operations. The emergency management is jointly performed by the following organizations.

1) Songkhla Provincial Administrative Organization is responsible for operation and management of the Songkhla Provincial Administrative Organization Integrated Emergency Medical Coordination and Dispatch Center and for support in the following.

- Procurement of equipment including ambulances, mobile CCTV systems vans, confined space rescue equipment, fire engines, etc. - 12 -

- Development and support of information technology systems

- Organizing monthly meeting of emergency medical party networks

- Summary and report on performance of all emergency operations

- Implementation and upgrading of public services systems

- Annual Mass Casualty Incident Drill with 74 party network organizations

The numbers of personnel at Songkhla Provincial Administrative Organization Integrated Emergency Medical Coordination and Dispatch Center 29 persons

Figure 2 Locations of ambulance stations throughout Songkhla Province

- 13 -

Figure 3 A map of the center of the emergency parking area

Development of party networks potential through continuous training and publicizing through different media to keep people informed of emergency medical services:

- First aid and emergency medical responder (EMR) training

- Emergency medical technician (EMT) and advanced emergency service training

- Aquatic rescue training

- Use of Type 2 Frequency synthesizer training

- Operation information system training

- Assistance for aggressive psychiatric patients training

- Emergency medical party networks meetings (at least twice a month)

- Teams of supervisory visits

- Public information system (PIS) training - 14 -

- Emergency medicine leaflets to provide knowledge for the public

- Knowledge Management (KM) manual for emergency medical technician-basic (EMT-B) and aquatic rescue training

There are 151 emergency medical units and 231 emergency vehicles in Songkhla Province classified as follows. - 21 Advanced life support units (ALS) with 56 ambulances

- 13 Basic life support units with 44 ambulances - 117 First response unit (FR) with 131 ambulances

The number of personnel in the emergency medical system: there are 2,420 staff members consisting of the following: - 43 physicians - 638 nurses - 3 emergency medical paramedics - 52 advanced emergency medical technicians (advanced EMT) - 109 emergency medical technicians (EMT) - 1,559 emergency medical responders (EMR) - 16 others

Graph 1

Emergency Medical Personnel Registered In Emergency

Medical Systems Songkhla Provinc

2500

2400

2300 2200 2100

2000 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD

Graph 2 - 15 -

Report Number of Emergency Medical Unit and Emergency

ambulance Emergency Medicine System Songkhla Province

250

200

150

100

50

0 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD Emergency Medical Unit Emergency ambulance

2) Municipalities, Tambon/Sub-district administrative organizations, foundations, and associations in Songkhla Province are responsible for the following.

- Control and supervise emergency vehicle drivers and manage standard shift schedule and planning to have drivers on duty 24 hours a day.

- Manage emergency medical units to deliver assistance to victims in local and nearby areas

- Determine budgets for expenditures on staff payment, fuel and maintenance of ambulances, patrol vehicles, fire engines, water trucks, and confined space rescue equipment

- Summary and report on work performance of the local and nearby areas

- Accept complaints on problems and coordinate with the center to solve the problems

3) Songkhla Provincial Administrative Organization Integrated Emergency Medical Coordination and Dispatch Center is responsible for call taking and emergency medical dispatch; coordinating emergency medical units, transporting emergency victims to hospitals, and it is a training place for different organizations. - 16 -

4) 21 government and private hospitals in Songkhla Province admit patients from all levels of emergency medical units.

5) Songkhla Provincial Public Health Office provides academic support for emergency medical units and acts as certification and registration office for emergency medical units.

6) Regional Health Service Support 12, Songkhla Province is responsible for providing personnel for setting specifications of ambulances and medical supplies, annual ambulance and medical equipment inspection.

7) Thai Auto Fleet, Co., Ltd. collaborates in holding activities, providing and coordinating in looking after materials and equipment continuously.

8) Road Accident Victims Protection, Co., Ltd. provides information on road accident victims protection, supports materials and equipment in assisting the public

9) Office of Disaster Prevention and Mitigation cooperates in providing speakers and academic support.

10) National Institute of Emergency Medicine (Public Organization) provides academic support, budgets, and personnel for work estimation at all levels.

11) Songklanagarind Hospital, Songkhla Hospital, Hat Yai Hospital,

Songkhla Provincial Public Health Office, Songkhla Naval Base Hospital and Public Health College in are party networks and training units.

12) Sapsomboon Kansuesan Shop, helps repair all the communication radio systems

13) The civil societies which are all 9 foundations and associations jointly operate and play important roles in mass casualty incidents. - 17 -

14) Independent public agency, the Office of National Broadcasting and

Telecommunications commission provides academic support and supervises the radio communication systems.

15) Provincial Police Region 9 takes calls, coordinates the traffic systems, provides assistance to people facing troubles and requesting help.

6. Innovation Process

Since 2000, Songkhla Provincial Administrative Organization has been working to solve the problem of loss of life of people from accidents and emergency illness under One Tambon One Rescue Program. Emergency ambulances with medical supplies are supported by local administrative organizations that are ready to participate in emergency medical operations. In 2008, the National Emergency Medicine Institute issued the Emergency Medical Act, BE 2532 (2008), Section 33, Paragraph 2, to the local administrative organization for its operation and administration to manage local emergency medical systems. As a result, local administrative organizations in the province are more alert to participate in emergency medical operations.

In 2015, Songkhla Provincial Administrative Organization in collaboration with the National Institute of Emergency Medicine organized the 2nd national emergency medical conferences of local administrative organizations under the name "Thai local power towards

Sustainable Emergency Medical Reform." It energizes and creates a shared ideology through the exchange of learning in emergency medical systems in order to develop in each area. It also provides an emergency medical system ready to enter the ASEAN community. It is the beginning of all sectors to recognize the problems and the drive for reforming the emergency medical system in Songkhla province in the same direction, depending on the mission of each authority. It focuses on the people at the center, which has established emergency notification and emergency medical coordination center of the Songkhla Provincial Administrative Organization.The purpose of the establishment is to prepare personnel, equipment and facilities for emergency medical operations. - 18 -

In 2016, the Songkhla Provincial Administrative Organization has promulgated the provisionson on Emergency Medical Services, Songkhla Provincial Administrative Organization, which is a local law used to express a clear intention to drive an emergency medical system in Songkhla. The executive has joined the National Emergency Medical Director. As a result, the drive for emergency medicine in Songkhla is clearer and more concrete.

Later on, Songkhla Provincial Administrative Organization launched the management model, which is an integrated model of emergency life saving in a single step. They have built a new collaborative working model by establishing an integrated notification and dispatch center with hotline number 1669 (One Number One Stop Service). It consists Songkhla Province Receiving and Reporting Center 1669 CCTV Control Center, Songkhla Provincial Administrative Organization Emergency Response Center, and 191 Songkhla Provincial Police. They have integrated these three centers in the same building at Sri Kiat Patana Building of Songkhla Provincial Administrative Organization. They aim to provide emergency relief to people in Songkhla province 24 hours a day, free of charge. In the first stage, the CCTV system was installed at the risk of Songkhla province, 337 points, and the CCTV system was set up at the Songkhla Provincial Administrative Organization. This makes it easy to keep the lives and property of the people in Songkhla. They also set up a police alert center 191 in the same place.

Songkhla Provincial Administrative Organization has operated and managed emergency medicine before the hospital. They have set up a joint working area with municipalities, sub- district administration organizations, the Ministry of Public Health and the Foundation, Songkhla Provincial Public Health Office, Hat Yai Hospital, Songkhla Hospital, Community Hospital in Songkhla, the hospilats under the Ministry of Defense, private hospitals, and Prince of Songkla University.

In addition, what the Songkhla Provincial Administrative Organization puts the most importance to care about people in Songkhla is the unforeseen emergency illness. So, they set up a notification and dispatch center 1669 at the Songkhla Provincial Administrative Organization to facilitate the integration of the three centers. Consequently, it was found that both emergency and safety issues in people's lives and property are more effective. It also integrates the national - 19 -

police headquarters and aorganizations to set up such a center. This will benefit the people and

tourists in Songkhla. It also ensures that when an emergency occurs, the emergency cases

can be safely assisted. This will lead to better quality of life for people in Songkhla.

Input Processing Output

1. Emergency accident 1. Coordinate, integrate and 1. All victims are properly manage human resources, Emergency illness, crime, unrest and promptly assisted by the materials and supplies in the area including the flood participation process. 2. Set up a 24-hour service system. Hurricane and mudslides 2. Reduce death, disability, 3. Driven by a shared management 2. Policy of Management system: suffering from the difficulty Strategic Action Plan, Budget in treatment including - Development of human Development Plan and economic loss. resources. Operational Plan. - Create network partners' 3. Rapid and comprehensive 3. Number of government participation. help system. 7. Impact of Innovation organizations, associations, - Bring information technology to 4. Develop service system. foundations, private and civil the emergency. society associated And prepare for the incident. - Provide public communication And help the victims 4. Information in Emergency to the public. accurately, quickly and Medical Systems In life security - network conferencing Sharing safely according to academic systems and property. And staff and Brainstorming principles. involved - Supervision, follow-up and

visits to operating oraganizations. 5. Raise the level of public 5. Number of supplies including

- The morale of the operation. services more efficiently. ambulance, CCTV camera, car, - Shair resources are most CCTV, vehicle, fire truck, water 6. There are places where beneficial. truck, stapler, AED machine WAR ROOM can be set up

4. Reducing operational steps 6. Emergency Operations and operating immediately.

5. Making MOU Organization at each level / area.

6. Creating a common ideology in the province. - 20 -

7.Impact of Innovation

7.1 Performance in 2017

Task Performance Notes

Emergency - Emergency Operations 32,829 times medical system - start time in 2 minutes 30,784 times

- Respones time in 10 minutes 28,127 times

- Loss of life while delivering 0 is no loss of life.

- 6 training courses for 1,140 people

- Supply of 80 AEDs

- Provide 1 high-level emergency ambulance

- Emergency ambulance support provided by the network to local operations covering all 129 districts.

- 6 sessions of emergency medical network

- Appointment of emergency medical committee under

Emergency Medical Services Act 2016

CCTV center - View 121 video clips from CCTV cameras.

- Utilize CCTV images to route emergency delivery and traffic management to emergency medical systems.

- Flood monitoring 23 times

Notification Center - Get traffic notification and solve traffic problems 121 191 times - CCTV incident tracking 119 times

- Suspicious Vehicle Surveillance Using CCTV 859 times

- 21 -

Task Performance Notes

Automobile Supported 14 vehicles in the area car for inspection and Inspection save peace of Tambon Nam Kham, Tambon Nam Noi, Tambol Klong Lha, Tambon Rawa, Tambon Wang Yai, Tambon Ban Mai, Tambon Bo-Dang, Tambon Wat Chan, Rattaphum Police station, Ranod Police station, Ko-Hong Police station and Cha-na Police station which have total perfomances 646 times

Mobile CCTV Supported mobile CCTV for Hatyai Police Station, which has operated 289 times.

Fire Truck / Water Khao Roop Chang Municipality 518 times

Truck Natawee Nok Municipality 58 times

Tung Kha Min SAO 52 times

Kra Dng Nga SAO 29 times

Songkhla PAO 163 times

Training Plan Practical training for victims included 71 organizations and 336 participants. It also coordinates disaster and

emergency situations.

- 22 -

Graph 3

Emergency response channel from 2010 to 2017 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 numbertime of 2,000 - 2010 2011 2012 2013 2014 2015 2016 2017 AD AD AD AD AD AD AD AD Receive emergency from 1669 2,920 3,752 3,695 4,937 5,752 7,388 9,662 12,601 Receive emergency from other 93 46 14 57 411 185 13 1 number Receive emergency from 191 34 9 8 5 4 7 1 6 Receive emergency from the 15,170 13,511 10,756 11,752 11,640 13,992 15,258 12,175 network Receive emergency from other 53 39 54 37 27 13 4 19 channel

Graph 4

Type of emergency

16,000 14,000 12,000 10,000

8,000 6,000

4,000 number of of time number 2,000

- 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD Traffic accident 6,206 5,356 6,050 6,386 7,407 8,006 6,856 Other accident 2,239 1,740 1,991 2,114 2,481 2,877 2,619

Emergency 7,757 6,519 7,639 8,230 10,343 13,790 13,858 Childbirth 995 819 986 963 1,138 1,267 1,340

Psychiatry 39 31 30 41 53 73 72 Other 121 62 92 100 163 11 57 - 23 -

Graph 5 Duration of resuscitation from 2010 to 2017

25,000 2

20,000 15,000

10,000

5,000 number of timeofnumber

- 2010 2011 2012 2013 2014 2015 2016 2017 AD AD AD AD AD AD AD AD in 2 min 17,671 16,810 14,105 16,383 17,311 21,022 18,480 23,799 in 3 - 5 min 492 445 344 334 422 476 509 848 more than 5 min 108 102 78 71 101 87 110 155

Graph 6

Graph of response time from 2010 to 2017

10 minutes

22,014 19,589 17,391 15,674 16,225 15,015 15,019

12,821

number of time

more than 10 minutes 3,256 2,788 1,996 1,683 1,706 1,069 1,609 1,688 2010 AD 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD in 10 min 15,015 15,674 12,821 15,019 16,225 19,589 17,391 22,014 more than 10 min 3,256 1,683 1,706 1,069 1,609 1,996 1,688 2,788

- 24 -

Graph 7

The results of the operation from 2010 to 2017

24,745 24,439 21,343

17,607 17,569 16,784 16,464

14,131 number of timeofnumber

2043311465673- 1011062632024581 15811374176835 1430427776832 13464974803- 3037637228 2329317234 1411929376176- 2010 AD 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD Treatment - Delivery 17,607 16,784 14,131 16,464 17,569 21,343 24,745 24,439 no accident 67 101 83 77 74 72 72 141 cancle 331 263 158 83 46 63 31 61 No treatment- Don't go to - 24 41 30 - 30 29 29 hospital

Treatment - Don't go to hospital 204 106 76 76 80 37 23 76 Treatment-Die-Don't delivered 3 1 5 2 3 2 4 19

Dies while delivering 14 20 11 14 13 8 3 - Dies before the rescures arrived 65 58 37 42 49 30 31 37

Graph 8

Status350 of casualties in emergency from 2010 to 2017

300

250

200 Dies at the ER

150

100 number of people of number Dies before the rescures 50 Diet while delivering 0 2010 AD 2011 AD 2012 AD 2013 AD 2014 AD 2015 AD 2016 AD 2017 AD Dies at the ER 141 179 128 158 217 251 248 333 Dies while delivering 14 20 11 14 13 8 3 0 Dies before the rescures 65 58 37 42 49 30 31 37 arrived - 25 -

Graph 9

8. Innovation Assesment

8.1 A monthly performance report is required. All operating units report their monthly performance on the 5th of the following month.

8.2 Make a summary of the monthly performance classified by how to notify, level of operation, number of causes, number of patients, referral and access time, etc.

8.3 Prepare a summary of the performance report of the information processing unit to evaluate the operational value.

8.4 Make Annual Assessment by National Institute of Emergency Medicine. The standard for emergency notification and emergency medical services is as follows:

1) Death among deliveries is expected to decrease from 100% by 2016. - 26 -

2) Critical emergency patients who received emergency treatment within 8 minutes,

77.33% (1st place in the country)

3) Emergency patients who reported by emergency number 1669 increased from

55.46% to 72.95%.

8.5 Evaluate service satisfaction from people in the area: The level of satisfaction for emergency medical services was 92.40%.

Graph 10 A chart showing the satisfaction of the emergency medical system

Overview of all elements 92.40

1669 Hotline Service 84.80

Service of rescuers 95.00

Ambulance Equipment, Tools and Facilities 97.20

78.00 80.00 82.00 84.00 86.00 88.00 90.00 92.00 94.00 96.00 98.00 100.00

9. Sustainability and Innovation Transferability

9.1 This is done through the expertise of the practitioner. The Alert and Emergency Center can be a mentor for the practice of the curriculum as a lecturer in the education and answer the questions of the study.

9.2 This is the source of experience that Boromarajonani College of Nursing has sent students to receive training in specialized nursing program in nursing. - 27 -

This is also the source of EMC rescue survivor, Emergency Medical Response (EMR) and

Emergency Medical Technician (EMT).

9.3. This Integrates and creates concrete participation in the public, private and civil society sectors. At least 156 organizations can establish strong networks and manage organizations in public service. The public can access standard services throroughly and equally, including emergency medical emergencies, utilizing CCTV cameras, fixing traffic issues, fire service, and getting help requests. Shared resource operations reduce workflow, save time, budget and personnel in operation. This includes strategic plans, operational plans, budgetary provisions, knowledge management, and related laws that support ongoing and sustainable operations which are consistent with the mission of each authority.

10. Lessons and Capacities for Promoting Sustainable Development

The use of information and technology in the workplace makes the operation more effective in terms of emergency response and treatment preparation. The development of community empowerment in self-care and self-reliance was conducted by training people in the area as emergency responders. This can increase the speed of access to the incident, including context-specific training and problem-solving in the area. In addition, it can increase the staff's performance and elevate the unit to the standard prescribed by the emergency medical institute. Determining the location of emergency ambulance parking in the center of the service area can speed up access and delivery. Furthermore, emergency ambulance, materials and supplies supports are available to cover all areas, so that victims are promptly and equally assisted. Continuously networking and organizing the EMS Songkhla stage, honoring the good people has created a strong bond and commitment. All of these contribute to the achievement of both quantitative and qualitative goals.