Nigerian Ambulance Services: For the dead or the living?

Who do you call when you have a medical emergency in Nigeria? Do you have a state or national emergency number that is readily available and accessible immediately? When you witness a road traffic accident, or someone faints on the street, would you know a number that you could call? If a pregnant woman required an emergency delivery, or your child has an asthma attack or an epileptic seizure, would you wait for an ambulance service to show up? And if you happen to witness someone elderly having a myocardial infarction (or heart attack), would you be able to get them to the closest, functioning, emergency room in less than 30 minutes? In an ideal world, if the ambulance service does arrive on time, would you trust them to be well equipped with appropriate equipment to resuscitate, triage or manage your emergency?

Unfortunately, Lagos State is the only one of the 36 states which has a relatively organized, state-run emergency medical service, as well as a functioning public emergency communication center. Despite being a planned model city, almost all emergency services in the Federal Capital Territory, Abuja are owned and run by private enterprises. Abuja ranks 5th with recorded cases of fatal Road Traffic Accidents (RTAs) after Ogun, Kaduna, Kano and Lagos state. The Lagos State Emergency Medical Services (LASEM) and Lagos State Ambulance Service (LASAMBUS) were established in 2001 to address the increasing incidences of medical emergencies in this densely populated area. There are 20 ambulance stations in the state; one in each local government area. This is clearly disproportionately inadequate to cater to approximately 17.5 million people. At maximum efficiency, each station is assigned one ambulance.

A performance evaluation of the Lagos State Ambulance Service (LASAMBUS) in 2019 concluded that response rates to RTAs between December 2019 and May 2018 were significantly lower when compared to global standards. Unfortunately, LASAMBUS responded to only 37.1% of calls related to RTA during that time frame. The evaluators had to sift through many illegible forms to make several conclusions. The most jarring of these was that the most common outcomes for RTA calls to LASAMBUS were ‘Crash Already Addressed’ and ‘Did Not Respond’. Some of the reasons cited for ‘Crash Already Addressed’ were ‘Unknown’ (81.9%), ‘Responded to by Police’ (3.1%), ‘Self-Evacuated’ (2.7%) and ‘Attended to by LASEMA or LRU’ (Lagos State Emergency Management Agency or LASEMA Response Unit). Other reasons for not responding included ‘no fuel’, ‘no ambulance available’ and ‘found RTA victim already died’.

The causes of delays which led to the aforementioned outcomes echo the very familiar rumblings of Lagosians, i.e. uncertainty of who to call on the part of the callers; poor access (bad roads), proximity, traffic congestion, and faulty ambulances were reported by LASAMBUS staff.

It is no wonder that the mortality rate from RTAs in Nigeria is significantly high. Every year, there are approximately 20.6 deaths per 100,000 people in Nigeria due to RTAs; this is in comparison to 10.8 deaths per 100,000 people in the UK, and 2.9 deaths per 100,000 people in the US. Sadly, most people in the country only rely on ambulance services to transport corpses to morgues; or during epidemics, to transport patients to isolation or care centres.

The wide gap in pre-hospital emergency resources in the country is being filled by privately owned ambulance services, such as Critical Rescue International in Ikeja, 0700 Ambulance Services in Lekki, Ambulance Nigeria in Victoria Island and Braingrace Medical Services in Surulere, etc.

The Nigerian Communications Commission recently announced that they would be undertaking the task of facilitating the development of Emergency Communications Centres in all 36 states. The plan is to ensure that all telecom operators are mandated to route emergency calls through the dedicated three-digit toll free number, 112, from each state to the emergency centre within that state. The state operators, will then process the distress call and contact the relevant Emergency Response Agency (e.g. Fire Service, Police, FRSC, Ambulance, etc.) whose primary duty is to handle the case.

Till then, please save the numbers of reliable ambulance services on your phone, and get your neighbours and friends to do the same. Otherwise, please ensure to have another means of transporting yourself to the nearest, functioning hospital.

(If you live in Lagos, please call the toll free emergency hotline at 112 for all police vehicles, ambulances, fire trucks, etc services. Or LASAMBUS/LASEMS at 08022887777,08022883678,08022887788, 01–7413744,01–7930490,01–7639939)

Dr. Helen Zidon is the Deputy Head of Medical Information at Aspen Pharma Group, where she oversees the medical information functions of Aspen territories globally for multiple widely used pharmaceutical products. She is a public speaker and advocate for Global and Public Health, accessible and streamlined medical care, and the incorporation of Medical Technology in medical academia and medical practice.