17 November 2009 Fairview Hotel, Nairobi, Kenya

1. Emergency Medical System Development PilotStakeholders Conference 17 November 2009 Fairview Hotel, Nairobi, Kenya

2. Today's agenda Topic Objective Welcome & Introductions Opening and Keynote Address Academic role Africa Collaborative for EMS EMS Development Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps

3. Welcome Asante Sana Many Thanks Merci Beaucoup

4. Setting the foundation for action Why are we here? We Share the Same Dream... Why are you here? ...You Have the Same Passion... Healthcare - The Most Basic Commitment of a Society to its Fellow Citizens Why now? ...A Window of Opportunity Emergency Healthcare- The Most Vulnerable Stage The journey Life-Long for many, a 3 year labor of love for the UCLA Team

5. Introductions - Building bonds to overcome challenges Please share your Name Organization Role

6. Vision for today There are risks and costs to a program of action. But they are far less than the long range risks and costs of comfortable inaction John F. Kennedy Let us reflect throughout today on how to create a foundation for practical and united action

7. Today's agenda This section WIP Topic Objective Welcome & Introductions Opening and Keynote Address Academic role Africa Collaborative for EMS EMS Development Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps

8. A new model of health care needs to be developed Silo approach to health care has failed us Care coordination is needed at every level and every transition point Pre-Hospital (Emergency Care) Hospital Rehab Chronic & Long-Term Care Current system prevents comprehensive care coordination: This is a global problem What are alternate approaches?

9. Sustainable change requires systems thinking and the collaboration of three groups Working together in a balanced and collaborative manner is key

10. Emergency medicine is a consistent challenge globally Emergency Medical System- A Global Problem The Continuous Improvement Challenge in Developed Nations A “Silent Killer” in Developing Nations Sub Saharan Africa, South America, MENA, U.S. (Underserved)

11. Role of academia is valuable as a facilitator and developer of insights Relative Independence U.S. Universities: University of California, Stanford University, (Duke, UNC, etc) Local Universities: TBD Multi-Level, Multi-Profession Systems Thinking School of Medicine School of Management School of Nursing School of Education

12. Review of pilots Africa Pilots Nigeria, South Africa, Kenya, Why Kenya? East Africa- Kenya, Tanzania, Nairobi Pilot(s): Phase I- Initial 2 sites, Consult & Consensus- FAST (NO WRONG DOOR)

13. Today's agenda Topic Objective Welcome & Introductions Opening and Keynote Address Academic role Africa Collaborative for EMS EMS Development Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps

14. THE GROWING NEED FOR EMSINTERNATIONALLY

15. Emergency Medical Services (EMS) Systems development

16. Emergency Medical Services (EMS) Systems

17. Ems system components and attributes

18. Ems system components and attributes

19. Regional Description Models

20. Prehospital System ModelsThe five model types for EMS system

21. Hospital models

22. Basic framework

23. Phase approach for Ems program cycle

24. Phase I Analysis

25. Phase II Planning

26. Phase III Implementation

27. phase iv evaluation

28. Developing a Successful Program

29. Today's agenda Topic Objective Welcome & Introductions Opening and Keynote Address Academic role Africa Collaborative for EMS EMS Development Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps

30. International EM – A Case Study India – GVK Emergency Management and Research Institute (EMRI) Collaboration with Stanford University, USA. Dr. S Mahadevan, Stanford Emergency Medicine Developed a successful Emergency Medical Services System in several states in India Overview of this system

31. GVK EMRI Started in August 2005 Not-for-profit professional organization operating in the PPP mode Private entrepreneur funded initial startup costs Government provided 108 emergency service and legislation Only professional emergency service provider in India today Handles medical, police and fire emergencies through the "1-0-8 Emergency service”

32. Quick Facts Over 1900 Ambulances and 15 Prime Responder Vehicles across 9 states Ambulance reaching in 14 minutes in urban areas and 22 minutes in rural areas 100% Virtual handholding by Paramedic and Physician in critical cases Medical Emergencies (Vehicular Trauma 18%, Maternal Complications 22%, Suicidal attempts 6%, Cardiac 4%, etc) 46,000 + Lives saved 12,000+ Associates – Ambulance (90%), ERC (5%), Support (5%) Source: http://www.pressreleasepoint.com/node/165826/pdf

33. EMRI EMS Project Emergency Medical Technician (EMT) Training program Extensive education initially provided by Stanford, trained Indian instructors who now train future EMTs. Universal toll-free number Call Center that dispatches ambulance Provided jobs for community

34. EMRI EMS Project Improves healthcare Created public demand When private funding reduced, public implemented policy for EMS Now funded by Indian Government and private sources Expanded to several other Districts

35. Key Points for an EMS System Learning from India’s EMRI EMS project, sustainability is the TOP priority in design Infrastructure Emergency Number Call Center Employees (Nurses, EMT, Doctors) Hospital Emergency Departments

36. Key Points for an EMS System Education Community Emergency education EMT, ER Nurse, Emergency Doctor Cooperation/Dedication from Stakeholders

37. Public Health In response to resolution WHA60.22 on emergency-care systems, adopted by the World Health Assembly, May 2007, WHO/Europe actively contributes in the following aspects: Devising standardized tools and techniques for assessing need for pre-hospital and facility-based capacity in trauma and emergency care Reviewing legislation Determining standards of essential trauma and emergency care Providing guidance for the creation mass-casualty management systems Encouraging research

38. International EM – Emerging Areas Will Kenya have the first Comprehensive Emergency System in Sub-Saharan Africa? A chance to be a leader amongst Sub-Saharan African nations?

39. Thank You Acknowledgements (to name a few) UCLA EMPH, Fred Hagigi DrPH, MBA, MPH Charles Otieno, M.D., MPH, Jonathan Crisp, M.D. Shubha Kumar, DrPH, Julie Elginer, DrPH MBA Nanette Ramzan, Edith Omwami PhD S. Mahadevan, M.D. Jerome Hoffman M.D., Scott Votey M.D., Seve Rottman M.D., Marshall Morgan M.D. UCLA Emergency Medicine residency Luis R. Goldfrank, M.D.

40. Today's agenda This section WIP Topic Objective Welcome & Introductions Opening and Keynote Address Academic role - Africa Collaborative for EMS EMS Development: Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Set the foundation for today's conference Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps and preparation for Thursday

41. Today's agenda This section WIP Topic Objective Welcome & Introductions Opening and Keynote Address Academic role - Africa Collaborative for EMS EMS Development: Nairobi Pilot Project Required Elements of an EMS System The Call to Action Identification of Next Steps Set the foundation for today's conference Review of: Emergency Medical System a Priority of the Ministry of Medical Systems Reforms Agenda Review the role of universities and researchers in facilitating this process Set the foundation for the pilot project Review lessons learned from India’s EMRI Program Stakeholders group discussion to align on practical action Outline immediate next steps and preparation for Thursday