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, Thailand 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. Songkhla 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 ************************** 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, Songkhla Province 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 Tambon or sub-district organizations, and 48 municipalities (2 Nakhon or city municipalities, 11 Mueang 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. Hat Yai 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, Bangkok Metropolis, Police Department (presently, the Royal Thai Police) 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