∗9999: Bringing International Protocols to Vietnamese Ambulance Response

As Vietnam’s medical landscape continues to evolve, Ho Chi Minh City’s first 911-styled emergency service (EMR ∗9999) may be the first step towards adopting international emergency standards that could eventually see advanced paramedical and ambulance services extending nationwide. Funded by private investment, EMR ∗9999 not only features a fleet of hi-tech ambulances with built-in life-preserving technologies, but it also introduces the globally-recognized ProQA response system—a computerized set of protocols that guides emergency call-takers as well as real-time ambulance dispatch.

Professional emergency medical dispatcher (EMD) Marvin Mesina has been based in Saigon for the past nine months to oversee the implementation of the ProQA system and train the team who answer emergency calls. To learn more about the challenges of instituting such a vital healthcare service in the Vietnam context, we speak with Marvin about his experiences in developing this program.

What qualifies you to be an EMD trainer, and how did you come to work in Vietnam?

I started in 2007 in Montreal at Urgences-santé, one of the largest ambulance providers in Quebec—it’s the only one in Montreal. They take a minimum of 900-1000 calls in 24 hours. I was lucky, I worked there for eight years and didn’t have any horror stories—I never had anybody trying to kill themselves on the line or anything like that, although my colleagues did. For us, someone who’s having a cardiac arrest on the phone is a daily routine, so that’s not something extraordinary. I’ve had a childbirth case, so that was one of the highlights. But at some point I stopped taking calls, because I was the team leader, supporting the team.

While I was in Montreal, a businessman in the Philippines acquired the ProQA system, and I started getting in touch with them saying, “I’ve been doing this for eight years, maybe I could give you a hand in the project.” The Philippines is my country, I was happy and excited to see that this was happening there. At that time, 911 would get you the Pizza Hut hotline!

While I was there, an executive from Family Medical Practice in Vietnam came over to get some ideas, and he asked me what my position was. I told him I was taking care of training, so he offered me the chance to come here for a month to train the EMDs in Vietnam, and then after that he offered me a job. I love it here, you can’t complain when it’s sunny all the time.

What is the experience of taking emergency calls like?

I think most EMDs will tell you that whenever they hear the phone ring, there’s always a certain level of anxiety, because you never know what you’re going to get. Someone could have been shot, or it could be someone having a heart attack. So there’s always that level of excitement. One thing you learn in training is that when you lose that excitement, it’s time for you to quit. You might sound like a robot when you’re following the protocol scripts, but you still need a certain level of compassion. Empathy is a big thing when you’re trying to comfort someone saying “listen, I’m here to help you”—they can feel it in your voice. If you don’t sound sincere, they’ll know it.

Actually, an EMD dispatcher has a stress level above a paramedic or a firefighter, because an EMD gets yelled at on the phone for something minor, but a paramedic can calm people down when they get there, because the patient sees someone is there to help. With us, they don’t see us, they just hear someone asking them protocol questions on the phone, which is annoying. The ProQA system that we use is really the most efficient way to get the right emergency assistance to them as fast as possible, but they don’t know that.

What did you think of the setup here compared with what’s available overseas?

It’s better than I expected. I didn’t know at first that it was going to be privately-owned by a clinic. In the Philippines we were managing networks of ambulances, all owned by different companies, so we had a nationwide coverage area. We’re not there yet here. The service is growing, and after we expand our ambulance fleet and our coverage area this month, the visibility will go up. The number of calls is starting to increase, especially in the weekends, but it will take time for people to understand that we’re not just for subscribers or to bring business to the clinic. We accept calls from anyone within the area we cover and take them to whatever medical facility will give them the best treatment, not only Family Medical Practice.

What’s the difference between the calls you’d get overseas and the calls you get here?

Besides problems like psychiatric issues and suicides, it’s exactly the same thing. Some people might even call you for a fever or a minor headache.

You said that everything is the same except for psychiatric calls?

Because here, psychiatric problems are taboo, right? When I first asked the EMDs what they knew about that, most of them didn’t even know that it exists in Vietnam because it’s a taboo. When you have those family values, people hide psychiatric problems from society. I think it’s an Asian mentality that even when someone in your family has a psychiatric illness or is an alcoholic or drug user, you don’t talk about it, and even if they’re sick, you just hush-hush, because you don’t want to be judged by the community.

What has been the greatest challenge in implementing ProQA here?

Traditionally, Vietnamese people haven’t been relying on the national ambulance system, I think it’s because the emergency hotline has to take the time to verify if an emergency case is genuine, and also the ambulances they have here aren’t fully equipped. There’s no immediate care, guidance or medical instructions over the phone—it’s only about calling and waiting for the ambulance to arrive, which heavily impacts the mortality rate.

That’s the thing we need to educate the locals here on—that there’s now an emergency response service in the city that will provide immediate assistance even before the ambulance arrives. I think they should stop taking motorbikes or taxis to hospital, because a lot of people die on the way before they get medical care. We can now save a lot of those lives by giving basic medical advice over the phone that can stabilize the patient while they wait for an ambulance.

By contrast, most expats here know that we have to ask a series of questions about the emergency that they’ll have to answer before we can respond with the most appropriate solution, depending on the severity of the case.

Another problem is that we don’t have paramedics as a job in Vietnam. I guess when we have those, then things will start to change. Because paramedics are not recognized in this country, the emergency doctors have to play the role and run around fetching patients outside, which is inefficient. Instead, they should be at the medical centers attending to patients at the facility.

Will you stay here a long time?

I want to see where EMR ∗9999 goes, I’m curious. My original plan was to stay for six months to see how it improves and evolves. It’s been nine months now, I’ll stick around for a while. It is a promising project; it might sound clichéd, but it is to help people. It’s a business, but it’s a business to help others. I am that kind of person who has a certain compassion—I do feel I should be helping people!

Marvin Mesina - ∗9999 Emergency Call Center Manager, Family Medical Practice Ho Chi Minh City