"EMS in the Himalayas"

The Health Help Center (HHC) in Bhutan is the centralized dispatch and EMS center for the entire country.

It is fascinating to see this being built from scratch. It is only a few years old, and the new EMTs only a few months out of training. There are numerous challenges to building an entirely new EMS system in a Himalayan country, not least of which is training an entire cadre of new healthcare providers of a type never before seen in this country. There is some skepticism here about the ability of non-physicians to be able to provide adequate field care -- reminds me of the United States in the 1970s, in the era of "Emergency!" and the first paramedics -- and I am proud to be able to share what great care non-physician paramedics can and do provide in the States.

On the other hand, there are unexpected benefits to building a system from scratch. I had wondered if there would be difficulty in citizens in an extremely rural country being able to access 112 calling (the version of 911 here). It would be a classic administrative mistake to spend millions of dollars establishing a communications center that nobody could reach due to insufficient access to phones. In fact, not only does everyone have a mobile phone (including in the rural areas), but the coverage is fantastic. We have not yet found an area, including wilderness areas, that we did not have full coverage... and this is in a country that, by law, protects over 60% of its forests as protected/wilderness areas, and has the highest fraction of protected land areas, as well as the highest proportion of forest cover, of any Asian nation. Kelly has a hypothesis that I think is correct: the national telecommunications infrastructure was established so recently that little effort was put into establishing landlines, and as a consequence, mobile telecommunications (towers) are extremely robust. This means that personal landlines may be minimal in rural areas, but mobile phones are ubiquitous, and have even better coverage than areas in the States with similar terrain. This also is helped by fewer telecommunication companies, meaning more consolidated networks. The beneficial consequences for Search & Rescue, rescue operations, and EMS are obvious -- and in ways like this, ironically, a robust EMS/rescue system may be easier to establish than in a country with a longer history of development. Other interesting technological advances include complete GPS control of each ambulance throughout the country via Google Earth (they are green when moving and red when stationary), and the use of the HHC as a "health advice" line. Telecommunicators can even send prescriptions via SMS to callers, and there is a full-time physician assigned to the HHC for on-line medical consultations from citizens who call in with medical questions.

It is extremely exciting to be a part of this project, and my hat is off to the Bhutan Foundation, the Bhutanese Government, the Ministry of Health, and the American HVO emergency physicians working here for recognizing that EMS and EM must grow together, with parallel progress, for either to fully succeed.