HOSPITAL BASED The SWOT in ASEAN

AMBULANCE SERVICE Economical Era

ASEAN NATIONS
ECONOMIC COMMUNITY
• ASEAN has emphasised regional cooperation in the “three pillars”, which are
security, sociocultural integration, and economic integration.
• The regional grouping has made the most progress in economic integration by
creating an ASEAN Economic Community (AEC) by 2015.
• The average economic growths of ASEAN's member nations during 1989–2009
was Singapore with 6.73 percent, Malaysia with 6.15 percent, Indonesia with 5.16
percent, Thailand with 5.02 percent, and the Philippines with 3.79 percent.
• This economic growth was greater than the average Asia-Pacific Economic
Cooperation (APEC) economic growth, which was 2.83 percent.
Ambulance services in South East Asia is going
through a period of unprecedented change…..

• Rapid economic growth.

• Rapid population growth.
• Increasing affluence and demand for better,
and in some cases, private ambulance services.
• Ambulance services reform and broadening.
• The introduction of new growing challenges…
EMS IN ASEAN • The focus of emergency health care in SE Asia relies heavily on
the hospital system, with little emphasis on prehospital care other
than rapid transport.
• The quality of services available at all levels appears to be
directly related to the economic status of that country, and the
efforts of government and health authorities to identify and
support the development of prehospital services.
• Countries such as Thailand and Singapore both have established
prehospital care systems, although the Thai model appears to
have less significance in regional areas.
• Siem Reap suffers greatly from the absence of a prehospital
care system, which is perhaps due to Cambodia’s economic
standing rather than an unwillingness to develop such a model.
• Clearly, each city represents a community at differing levels of
social and economic development, yet all are influenced by
foreigners’ expectations of emergency care, which can be
provided at a cost.
 Ambulance Services in The Philippines
THE PHILIPPINES

• Provided by government, private and volunteers.

• Ambulance with paramedic – not any in most cities.
• Hospital Based :1 -2 ambulances.
• Response time ?40 mins.
• In Metro Manila
• Lifeline rescue 911 with paramedics
• Response time ? 30 mins
• Membership based

Iloilo City Emergency Modified vans serve as June 19, 2015—Philippine Charity
Responders medic 4 ambulances Sweepstakes Office giving ambulance to
ambulance (1-23-2013) various local government
 ambulance service in Metro Manila
PRIVATE LAND AND
AIR AMBULANCES

Airgurus Ltd. Co., launched in 2007, is Lifeline is the first and only dedicated "Emergency Quick Response" (EQR) service in
the Philippines.
a Philippine-based company which
provides charter services to both
private and public sectors.

Services offered range from simple

flower dropping to medical
evacuation – local, national, and even Ambulance service for dialysis Ambucore Ambulance Services, Quezon
across the globe. patients (round trip package) City
 EMS in Thailand
• Provided by either the government or private and voluntary
THAILAND organisations.

• Many resort towns

• EMS remains an area that is still under development and the
service delivery can at times be somewhat chaotic.
• Holiday destination
• However the situation continues to improve following the
• An increasingly popular implementation of Emergency Medical Systems Act 2008.
form of tourism within
Thailand is “medical This law led to the formation of The Emergency Medical
tourism”, a phrase coined Institute of Thailand (EMIT)
to reflect foreigners • The Act was implemented in order to regulate and improve the
travelling to the area for standards of EMS, particularly in voluntary organisations.
cosmetic surgery at Sirima Jaiplum, 2014 Pairoj Khruekarnchana, 2014
significantly reduced
prices compared to
similar treatments in
countries like Australia or
the USA.
Ubon Ratchathani, – Aug 7, 2013 : Air Ambulance Aviation in Thailand
Pornchai Kaotong and unidentified provides services for domestic and
nurse in an ambulance car international sectors.
 EMS in Thailand
• Hospital based

THAILAND • 2-3 ambulance staffed by drivers.

• There is no prehospital care provided in the ambulances,
only (rapid) transport.
• Ambulance mostly crewed by an attendant and a driver,
no significant clinical skill or training was required.

Chiang Mai, - December 26

An injured policeman is treated inside an 2014: Ambulance van of Pattaya Memorial Hospital
ambulance after confronting anti-coup protesters Maejo Subdistrict
Administrative Organization.

SINGAPORE
• A highly sophisticated
metropolis with a
population of some
4,608,1671,1
• economy built upon trade
and finance without the aid
of natural resources or
industry.
• regarded as one of the
cleanest and most modern
cities in the world
EMS in Singapore
• Integrated emergency response system, run by Singapore
Civil Defence Force (SCDF
• Single tier system.
• Paramedic services consist of a three person crew comprising
a driver, a medic first aider, and a paramedic.
• Able to provide BCLS and defibrillation using Automated
External Defibrillators (AEDs)
• Paramedic education and training involves a two year
commitment to diploma level with components of theoretic and
on-road phases.
SINGAPORE
AMBULANCE • Ambulance vehicles
• consist of Mercedes-Benz Sprinters of a single stretcher variety,
SERVICE •
but have the capacity to transport up to four patients
Motorcycle response units are also a feature of the SCDF
system, with police, fire and ambulance motorcycles available to
combat response in the often heavy traffic.
• Computer-aided dispatch
• In-vehicle cameras record each response to a case.
• Basic pharmacology is utilised, including adrenaline, GTN
and aspirin, however S8 drugs such as Morphine for
analgesia are not included as part of the paramedic
pharmacological regime.
• Monitor/defibrillator with inbuilt SPO2 capability
provides 3-lead ECG capabilities, however arrhythmia
management is limited to cardiac arrest defibrillation of
VF and VT.
MALAYSIA Emergency Medical Services in Malaysia

• As the economy and standard of living improved, the demand for

EMS increased.
• EMS within the country are best described as being in the
“developing” phase.
• Provided by Ministry of Health, Civil Defense, and non-
governmental organizations such as Red Crescent and St. John’s
Ambulance.
• There are no uniform medical control or treatment protocols,
communication systems, system management, training or education,
or quality assurance policies.
• Recent development and interest in Emergency Medicine training
program has gradually led to improved EMS and prehospital care.
NAR Hisamuddin - 2007
MALAYSIA Ministry of Health
Ambulance Service
• Hospital/Clinic Based
• AMOs and nurses as main
providers
• Common 999 entry point
(October 2007)
• Free
• 24 hour on demand service
Special Situations:
Partners in providing the service:
• Civil Defence Malaysia
• St John’s Ambulance
• Malaysia Red Crescent Society
• Volunteer Fire & Rescue
Services
VIETNAM Health System in Vietnam

• Combines aspects of Eastern and Western medicine.

• The government is developing a universal healthcare plan to
cover all residents with basic medical care.
• Public hospitals in Vietnam
• Generally underfunded and poorly equipped.
• Quality and availability is poor in rural areas, and in some of the most
remote parts of the country healthcare is non-existent..

• Private hospitals in Vietnam

• Excellent standard.
• Mostly located in Hanoi or Ho Chi Minh City and staffed by doctors from
USA, Korea, Japan and France, as well as Vietnamese doctors who have
trained overseas.
• Caters for the needs of expats
VIETNAM EMS in Vietnam

• EMS number is 115

• Ambulances are known for having a slow
response time.
• Paramedics do not always speak English and
equipment may be substandard.
• Some private hospitals in Vietnam’s bigger Khanh Hoa Pre-Hospital Trauma Care

cities provide a faster and more efficient

private ambulance service.
• Many use taxis to get to the nearest private
hospital for emergency medical treatment.
MYANMAR, EMS in Myanmar, Cambodia and Laos
CAMBODIA
& LAOS • Ambulance services in these countries can generally be categorized
as underdeveloped; the countries themselves could also be
categorized the same way.
• Myanmar’s recent political and economic opening has revealed an
extremely improvised and underfunded healthcare system.
• Cambodia and Laos are increasing being left behind by other SE
Asian peers.
 Siem Reap, the location of the temples
of Angkor and home to the Khmer

CAMBODIA empire up until the 15th century, attracts

almost one million visitors per year to
the 150 square kilometer site.

• The town has a population of 798,000, and is

• There is no ambulance service funded or supported
Cambodia remains an essentially
impoverished country
• education is rudimentary, and
• health care supported primarily by
foreign NGOs.
serviced by a children’s hospital (Angkor Hospital
for Children), the Royal Angkor International
Hospital, the Siem Reap Provincial Hospital and a
number of private clinics.
by the government, and the primary services for
emergency transport are those attached to
hospitals and private clinics. These are rudimentary
and offer basic transport to the hospital or clinic
represented.
 SWOT ANALYSIS OF HOSPITAL BASED
EMERGENCY AMBULANCE SERVICE IN ASEAN
OPPORTUNITIES FOR EMERGENCY AMBULANCE
SERVICES IN THE REGION
The development of ASEAN Economic Community as
global hub in medical and healthcare services is
premised on a number of developments that serve
as opportunities:
• In all of these countries tourism is a major
industry attracting millions of foreigners every
year.
• The changing demographic landscape with an
aging population accompanied by the rise of
chronic and non-communicable diseases.
• The expanding middle class and rising income.
OPPORTUNITIES Road Safety: A Development Challenge for ASEAN
FOR EMERGENCY
AMBULANCE
SERVICES IN THE
REGION Road accidents are a leading cause of death and injury worldwide.
By 2020 the World Health Organisation (WHO) projects that road
crash injuries will be the third highest threat to public health,
outranking other serious public health problems such as tuberculosis,
diarrheal diseases, HIV/AIDS, and lower respiratory infections.
In South Asia along, road traffic fatalities are expected to increase
from 135,000 in 2000 to 330,000 in 2020 (World Report on Road
Traffic Injury Prevention, WHO, 2004). That's a 144 percent
increase in deaths from road crashes.
Out of an estimated 1.18 million deaths and millions of injuries
globally each year due to road accidents, 60% occur in Asia. This
reflects not only traffic growth but also high road accident.
SINGAPORE Opportunities of Emergency
Ambulance Services in Singapore

Key Facts
 25 total hospitals
 10,756 hospital beds. • The changing demographic
landscape with an aging
 15 Public Hospitals
population accompanied by
 10 Private Hospitals the rise of chronic and non-
Health Issues communicable diseases.
“Developed Country”
ailments such as cancer,
cardiovascular diseases
and strokes; these accounts
for 60% of all deaths.
SINGAPORE Strengths and Opportunities of Emergency Ambulance Services in
Singapore

• Excellent Ambulance Services • low barriers to entry

• State of the art equipment • clear policy coherence between

• Quality and standard of medical
care
• High quality of medical
professional workforce
• Sufficient new products and
service
• Service orientation
• Government and private services.
• Available local training institutes
and universities
local and foreign health care
service providers.
• ageing population
• the rise of chronic and non-
communicable diseases
• increase in income of the middle
class in the region
• the increasing popularity of the
region as a medical hub
 THAILAND Strengths and Opportunities of Emergency Ambulance Services in
Thailand

Key Facts • private hospitals are in place

 1,200 total hospitals • heavy investment in modern equipment and facilities
 2/3rd of hospitals in
public sector.
• huge number of expatriates living in Bangkok and the
over10 million tourist arrivals
 Average of 2.1 beds per
1,000 people • investment in training and education
Health Issues • increasing demand for health and wellness tourism all over
HIV/AIDS, which in the the region
early 2000 emerged as
the country’s leading cause
of death.
 Strengths and Opportunities of Emergency Ambulance Services in
THAILAND Thailand

• leading tourist destinations in

the region
• strong local demand for
cosmetic surgical procedures
Study: Thailand’s roads 2nd
most dangerous in the • changing demographic
world (By Casey Hynes Feb features
25, 2014
A recent study b)y the University of
Michigan’s Transportation Research
• rise of chronic and non-
Institute confirmed what many already communicable diseases
know about Thailand: that being on the
road there can be a treacherous business.
Thailand ranked number two in the
university’s study of road fatalities in the
Thailand ranked number two in the university’s study of road fatalities in
world, with 44 road deaths per 100,000 the world, with 44 road deaths per 100,000 people
people. It was second only to Namibia,
which had 45 road deaths per 100,000.
Fatalities from road accidents made up
5.1 percent of Thailand’s overall deaths.

MALAYSIA
Key Facts
 358 total hospitals
 138 public hospitals
 38,394 public hospital
beds.
 2880 public health clinics.
 220 private hospitals.
 6589 private medical
clinics
Health Issues
• Non-communicable
diseases such as
cardiovascular diseases
and type 2 diabetes.
• Dengue fever
Strengths and Opportunities of Emergency
Ambulance Services in Malaysia
• cheap ambulance service cost in
the country
• highly–trained personnel, up-to-
date facilities and supporting
services
• multi-ethic population and
culture
• use of English language
• stable political environment
• locational advantage
• strong business association
• presence of quality assurance
system
• Halal hub in the region
• tax incentives
• provision of exposure tours to
agents
• high returns
• awareness on alternative
medicine
CONSTRAINTS: WEAKNESSES AND THREATS OF
THE EMERGENCY AMBULANCE SERVICES
• However, these opportunities can be hampered by a list of weaknesses and
threats to the sector.
 Weaknesses and Threats of the Emergency Ambulance Services
MALAYSIA
• Internal and external brain drain among health professionals
• TCM is unorganized and unregulated
• Quality of nurses from expanded nursing schools
• Quality of doctors from medical schools overseas
• Medical tourism may pose bio-security and nosocomial risks
• Financing schemes may favor foreigners over citizens
• No standardized governing body.
• No local training institution.
 Weaknesses and Threats of the Emergency
SINGAPORE Ambulance Services

• disparity in the quality of health professionals

and the quality of management staff
• segmentation of the health care travel
industry in the region
• limited information on price of ambulance
services
• limited access to credit for SME
• debate on economic gain vs. social service
 Weaknesses and Threats of the Emergency
THAILAND Ambulance Services

• limited number of training institutions to meet

expanding demand in Emergency Ambulance
Services
• internal brain drain of health professionals
• impact of medical tourism on provision of
ambulance services
• inadequacies in foreign languages
• regulations on treatment in foreign countries
• portability of medical insurance
• malpractice
 To recap…

SUMMARY
• Emergency ambulance service is an important component of
healthcare and medical services which contribute to regional
integration.
• The strengths and weaknesses of the sectors are influenced mainly by
internal factors as well as some external factors while opportunities
and threats are mostly coming from external factors.
• Internal factors consist of resources and other characteristics inherent
to the firms consisting of human, physical and financial resources, as
well as the availability of appropriate technology.
• External factors, on the other hand, consist of a set of features in the
environment where the sectors operate including the external market
environment, domestic market environment, presence of supporting
industries and the state of infrastructure.
 The analysis of strengths, weaknesses, opportunities and threats was
SUMMARY made for the emergency ambulance services mainly in Malaysia,
Singapore and Thailand
• The emergency ambulance services is confronted with a set of opportunities
including the huge tourism industry in the region, the changing demographic
landscape, aging population, rise of chronic and non-communicable diseases,
rising income and the growth of the middle class.
• Medical tourism is a capital intensive industry utilizing complex facilities, state of
the art equipment and employing highly skilled, sometimes foreign-trained health
professionals. This sector is dominated by few large holding companies that
control a network of hospitals based ambulance service in the region.
• In terms of supplying services, the hospital based emergency ambulance services
utilize primarily mode 2 with foreign patients seeking medical treatment in
internationally accredited hospitals in the region.
• Emergency ambulances has a number of externalities because emergency
ambulance services is not only a service to be traded regionally and globally
but a public good for domestic consumption.
• In transforming the AEC into a global services hub, the challenge for the countries
and for the region is to respond to these opportunities by enhancing the strengths
of the sectors and mitigate their weaknesses and threats.
THANK YOU