Speeding to save lives

An ambulance crew carry a patient downstairs. Photo: Yang Hui/GT

Behind the scenes with Shanghai's ambulance crews

In 2013, the Shanghai Medical Emergency Center, which is responsible for dispatching ambulances throughout Shanghai, sent 628,000 ambulances out on emergency calls.

Guan Min, the head of the office of the Shanghai Medical Emergency Center told the Global Times, "the number of ambulance call-outs keeps increasing by 10 percent every year."

Summer is the busiest period of the year for the city's 120 ambulance emergency line and this is when high temperatures seem to trigger extra cases of sunstroke, heart attacks and strokes. The ambulance dispatch center is located on the ninth floor of the Shanghai Medical Emergency Center and the Global Times followed two ambulance crews for a day and a night, tracking their moves and seeing how they handled this demanding life saving work. In Shanghai, there are 119 ambulances bases, and 34 of these are in inner Shanghai.

The alarm sounds at the Baoding ambulance base in Hongkou district and within a minute ambulance crew Zhang Jin, the driver, Zhou Jun, the paramedic and Cao Xin, the doctor, are on the way to the Shanghai Pu'an Nursing Home.

Man collapsed

An elderly man has collapsed and his children have called an ambulance to take him to the hospital. It takes about three minutes for the ambulance to reach the place and the crew quickly walk to where the man is lying down. Doctor Cao Xin examines the man, checking his respiration and pulse and the others then place him on a stretcher and take him to the ambulance. The man's daughter joins her father in the ambulance.

In the ambulance on the way to the Shanghai Yangpu district's Shidong Hospital where the family want their father taken, Cao gives the man oxygen and attaches an ECG monitor. It takes 20 minutes to reach the hospital and the man is moved to a bed in the hospital emergency room where Cao briefs the hospital doctor on the man's condition.

Outside the driver Zhang is presenting the bill for 86 yuan ($13.82) to the daughter and collecting her payment - the bill includes 30 yuan for medical services, 30 yuan for transport, plus extras for kilometers traveled over 3 kilometers, and charges for the ECG monitor and oxygen. This mission is accomplished.

The ordinary white and blue ambulances seen around the city are converted seven-seat Istana vans. Usually a crew of three share the shift - doctor, paramedic and driver. The paramedic rides in the front with the driver while the doctor travels in the compartment alongside the medical equipment and drugs.

In every ambulance the driver has a unique GPS unit which displays the patient's address, telephone number, symptoms and the location, speed and timeline.

Zhang said when the crew log on, the GPS unit displays a "waiting" logo. The second the crew get a dispatch order, the logo changes to "on the way" then "attending," "traveling to hospital," "transferring to hospital" and finally "waiting" again.

Wu Qinqin is the chief operator of the 120 emergency line and told the Global Times that as the center receives a call, the phone number and location automatically appear on screen. The operator then takes the name, exact address, symptoms and intended hospital and an ambulance is sent to attend.

Heart attacks

Back in the ambulance Cao said taking the elderly man to hospital was an easy case. Sometimes patients suffer cardiac arrests in situations like that. If this happens the paramedic joins the doctor to help treat the patient. If there is no time to stop, the doctor has to try to save the patient on his own. "One 69-year-old man suffered a serious heart attack in the ambulance recently but we saved him with the defibrillator."

Cao graduated from the Medical School of Nantong University in 2010 and joined the Shanghai medical emergency center as an ambulance doctor, a job that in four years has seen him meet a huge variety of patients and situations.

For him an ambulance doctor must have a good attitude to the work. Unlike the doctors who work in hospitals and wear neat white coats over suits and ties, ambulance doctors wear a short uniform and have to help carry the patients on stretchers.

"After five years of concentrated study at medical school and graduating as a doctor I still have to do the physical work of carrying patients. It's easy to see how some graduates feel unappreciated."

Wu Lei is a senior official with the Medical Emergency Center's east branch, where the Baoding base is sited and said some of the work ambulance doctors had to do was carried out by orderlies in hospital. He said ambulance staff were prone to suffer from hearing problems caused by working with sirens blaring constantly, digestion illnesses because of their irregular meal times and back problems because of the heavy lifting involved.

Most of the time it is not the patients who call ambulances but family members, bystanders or police. This can cause problems if the patient doesn't want to go in an ambulance.

"Before I was assigned to Baoding base, I worked at a base in Huangpu district where many expats live. One night an expat got drunk and passed out on the floor. The police called us to take him to hospital and we put him in, unconscious, in the ambulance. But he woke up on the way to hospital and attacked me, punching me and knocking my glasses off," Cao said. With no one else in the back of the ambulance and no security cameras to record the event Cao could not press assault charges.

Can be fined

On the other hand if ambulance crew members make a mistake in their duties and patients complain, they can be fined hundreds of yuan. Doctors like Cao earn just 5,000 yuan a month. "I love the job but what I earn does not match what I have to do," Cao said.

In this crew driver Zhang earns 3,500 yuan a month and paramedic Zhou earns less than 3,000 yuan a month.

Zhang has driven this ambulance for more than two years - when he began with this vehicle it had 27,000 kilometers registered but now the clock reads 70,000 kilometers. "I have driven this for longer and more often than I have driven my own car." He began working in the ambulance service as a paramedic before becoming a driver.

Before 27-year-old Zhou became a paramedic in 2010, he was working as a luggage inquiry agent for China Eastern Airlines and was earning about twice as much as he does now. "When I was a kid, I wanted to be a doctor, but I didn't do well at school. Becoming a paramedic partly fulfills my dreams. That's the only reason I do this," Zhou said.

But idealism doesn't pay bills and ambulance doctors, paramedics and drivers are leaving the service for better conditions elsewhere, official Wu said.

"In the past 10 years, we have not been able to hire any medical school graduates from Shanghai. We have had to go to other provinces to look for new staff. First we went recruiting to Zhejiang and Jiangsu provinces, then Jiangxi Province. Now we even go to Heilongjiang Province in the northeast and Hainan in the southeast," Wu said.

Young ambulance doctors are also frustrated by the limits of the career path. China has yet to regulate pre-hospital emergency care so there are no obvious gradations for staff at present.