Beyond the Ambulance: Rethinking Coordination in Healthcare

How the Amissah case exposes cracks in our system , and why every clinical role matters in the race to save a life

I am just thinking out loud. Though Amissah's case can be linked to poor coordination of the various healthcare institutions, there might actually be more. What role did the ambulance and the health personnel in it play? Does their work involve just transporting patients from one point to another? I beg to differ.

This ties to a bigger problem that exists in status quo. In the healthcare space, the goal is to ensure that at every point, the patient receives the best possible care. This can only be achieved if healthcare workers work in a collaborative and coordinated fashion to maximize this outcome. Doctors have diagnostic power, but they will most likely be guessing. That is where medical laboratory scientists and technicians come in. Laboratory tests are run based on the recommendations of medical doctors to narrow down the diagnosis. The same applies to medical imaging departments. An X-ray can help differentiate between pneumonia and pneumothorax. It does not end there. After a successful diagnosis, backed by all clinical findings, the next step is treatment. This could involve the use of drugs, where the pharmacist’s expertise comes in. The drugs, after being dispensed, are going to be administered by the nurse, as seen in most cases in our setting. Nurses also continuously monitor the patient’s temperature, blood pressure, and other vital signs to ensure the patient is doing well on the ward. In a case where there is a need for a dietitian or physiotherapist consult, only a specific set of professionals can offer this. The whole point is that everyone has a role to play in the management of the patient. This also means that when a member of the clinical team fails to deliver, the patient suffers.

It is interesting to see that some health associations allow egos and personal ambitions to cloud their judgement in the clinical space. The question should rather be: how can the systems be made better, or what can one profession do to maximize the clinical outcome for the patient? My point is simple: coordinated efforts, where everyone effectively performs their duties in a well-structured system with optimized conditions for the realization of clinical outcomes in patients, is what is needed. With that being said, the role of the ambulatory service has to be clear so we know where they come in for the patient. A scenario that I believe would best explain this is a 4 × 400 meters race. Each participant on the team runs 400 meters and passes the baton to the next. The team is likely to fail if one participant underperforms. Translating this to healthcare: healthcare is a relay, not entirely a marathon. This was clear in my last article, where if at any point one particular health institution is incapacitated, they pass the baton (in this case, the patient). The stop points are the health institutions. Who then really does the running? That is where the ambulances come in. But aside from moving patients, either from one institution to another or from an incident site to the necessary health institution, they offer life-saving interventions. Cardiopulmonary resuscitation, bleeding control (as indicated in Amissah’s case), basic airway management, and stabilization of the patient are within their jurisdiction. Upon arrival, they inform the team of the interventions offered so the team can take off from there. This reduces the risk of adverse clinical outcomes, increases the prognosis for the patient, and reduces the workload on the clinical team to whom the patient will be handed over. The patient benefits.

The status quo is uncoordinated action between ambulance services and healthcare professionals, even if both are acting at their fullest capacity and not being negligent in their roles. This can also narrow down to unavailability of equipment: some ambulances do not have first aid boxes in 2026. In the emergency department, medical practitioners are always improvising in poorly equipped situations. Health professionals are understaffed and severely overwhelmed in their clinical practice. Amissah's case exposes the cracks in our healthcare system, but we can change that before another 'Amissah' happens!

See you next Monday.

Written by Damankah Ferdinand.

Edited by Joseph Broni.