• 1990 Suwa Seriya Foundation Chairman Dumindra Ratnayaka on the ‘Adopt an Ambulance’ initiative

 Just call 1990 – that is the number etched as a lifesaver for Sri Lankans anywhere in the country. The Suwa Seriya ambulance service has been lauded for being the most efficient Government service in the business of saving human lives. It was established by the 1990 Suwaseriya Foundation Act, No. 18 of 2018. However, the requirement for the upkeep of the service is Rs. 3.9 billion annually, which, unfortunately, with the crises in the country, is seeing a shortfall of Rs. 1.5 billion. The efficiency of the ambulance service which is one of the best tech enabled State run enterprises is clear in its numbers. A call centre that has just 30 personnel in its administrative team deals with 5,300 calls per day, manages the fleet of 297 ambulances, handles 1,050 cases daily, has a 98.9% answer rate on the first ring, and runs 25,000 kilometres every day. Efficiency is absolute with an average response time of 11.5 minutes per case by a team of 745 pilots and 744 emergency medical technicians (EMTs), all highly trained to handle diverse emergencies. 

However, given that the team and fleet requires continuous development, upgrades, and improvements to administer a service that is deemed world class, the shortfall in funds means a compromise in the service quality. Upgrades, training, and the maintenance of equipment may be conceded or stalled, operating the service only for a limited period or only in case of dire emergencies may also be options, all of which will however place many lives in danger. Given the dire straits being faced, the 1990 Suwa Seriya Foundation embarked on an “Adopt an Ambulance” campaign, requesting corporates and individuals to adopt an ambulance to meet the shortfall in funding. Foundation Chairman Dumindra Ratnayaka was on Kaleidoscope this week, explaining the rationale behind the campaign, its success, and the realities of operating an Islandwide ambulance service. 

Following are excerpts of the interview:

What is special about 1990 Suwa Seriya?

 The 1990 service is all about saving lives – that’s our motto. To save lives and to be efficient at it, we work very hard. The fact that some of our unique selling points now are world class, emphasises our need to continually improve. Our response time of 11.5 minutes anywhere across Sri Lanka, for instance, is world class. The fact that 98.9% of our calls are answered on the first ring or we call back if a call gets dropped is also world class. Every case we get is handled. The technology we use is some of the best in the world, which is why our quality can be seen as being among the best emergency healthcare services.

How would ‘Adopt an Ambulance’ benefit the operations of 1990?

 The Act requires the Government to fund us and thus far, we have not had any issues because the Government recognises the vital aspect of our services. Unfortunately, last year’s (2022) challenges were unprecedented and inflation caused our costs to increase. The Treasury is able to give us only Rs. 2.5 billion of our requirement and we are Rs. 1.5 billion short. Rather than compromising on our service, we decided to ask for public help. We need Rs. 5 million per ambulance to ensure the maintenance of the vehicle and the equipment, training and skills development, licensing, and the operational costs. The response has been unbelievable. 

In less than two months, corporates came forward with Rs. 600 million – while we still have a shortfall, this truly shows the generosity of the people. It also shows that the corporate sector believes in us because we have credibility as the most efficient Government service. We have continuously obtained unqualified audit reports from the Auditor General and have always been transparent. This is why we have gained that confidence.

Could you expand on the facilities within the ambulance and the competencies of the personnel working the system?

 The 1990 service is a pre-hospital care ambulance service providing preliminary care to patients from wherever they are until they get to a hospital. We have dealt with road accidents, heart attacks, strokes, bomb attacks, and myriad other situations. We provide the care required to stabilise the patient while being transported to the hospital. The pilot drives the ambulance, but is trained to assist the EMTs, who are also known as paramedics. EMTs undergo intense three months of theory and practical training in addition to continuous on the job training. The equipment in the ambulance supports a patient’s life. We are definitely more than an ambulance and a stretcher, with highly-trained personnel and equipment, including oxygen, saline, and emergency care medicines that can make assessments and monitor patients. The 1990 service meets global standards in pre-hospital care.

What are the tech enabling factors in the 1990 service?

 The whole operation is an end-to-end process managed with technology being the backbone. This starts from the ambulances which are global positioning system enabled and connects with our emergency management system (EMS). The system is equipped to know when an ambulance leaves the base, reaches the patient, gets to the hospital, the time taken to hand over the patient, the idle time, and moving time. All these have key performance indicators (KPIs) and if any KPI is violated, an exception is created and managed. The EMS dispatches the ambulance based on which one would reach the patient faster and not necessarily the one closest to the patient. It actually managed two factors: faster reach to the patient and minimum amount of running so that fuel is not wasted. 

Ambulances are distributed among 297 locations Islandwide with the staff reporting to the base that they are assigned to. They check in and check-out via an application (app) connected to our human resource system, allowing for the calculation of the staff presence and overtime. This use of tech also means that we require less staff. The total field staff of 1,500 and the 300-strong ambulance fleet is managed by just 30 people, which means that we have cost efficiencies in salaries and resources, and less wastage.

There is also medicine management tracked by the system – usage and never allowing medicines to expire. Medicine is moved from one ambulance to another to reduce wastage. Fuel efficiency is also managed. When fuel is pumped, the mileage and litres are entered into the system. Any exceptions are flagged and attended to.

What have been the challenges you have experienced since the launch?

 Sri Lankans weren’t used to having an emergency ambulance system. We had to educate the people that help was just a call away. We also had to deal with negative publicity due to various political and like-minded declarations. But, the fact that we were providing a valuable service to the people of Sri Lanka negated that negativity. Covid-19 was probably our biggest challenge due to the workload. We were getting about 20,000 calls a day and the number of cases increased exponentially. We collaborated with the Sri Lanka Medical Association and Mobitel, which helped us triage patients prior to going to the hospital. 

We still took 20,000 calls. There was definitely no ‘work from home’ for us. Everyone came to the office. The Easter Sunday bombings also showed us that we were able to handle extraordinary situations. After Covid, one of our biggest challenges was staff leaving us to go abroad because, with this training, the world is their oyster. With inflation hitting the roof, the biggest difficulty was in salaries as we have to remain within Government salary scales.

What is next for 1990?

 While we remain with our primary task of attending to emergencies and saving lives, our next step is on what we can do better. We have two projects in the pipeline. One is the development of a wearable bracelet primarily for senior citizens and motorcyclists so that if they have a fall or an accident, an alarm is triggered in our call centre for immediate attention. Data from five minutes prior to the incident is transmitted for a quick assessment, which can save valuable minutes to save a patient’s life and help us save lives better. The second is what we call a “Connect Ambulance”. Together with Microsoft Wavenet and Dialog or Mobitel, we intend to transmit visuals from the location to the doctor on call at the call centre. This will be video and voice so it will assist the doctor to make a better assessment. Augmented reality will be installed in the system for information to pass through more efficiently. Both projects are in the testing stage. 

We are trying to reduce the response time to 10 minutes because every second counts in an emergency, especially in the case of a heart of a stroke patient. Our initial assessments conclude that we need 115 ambulances to be 10 minutes away from any habitable location in the country. We are also in the process of increasing our fleet – the Government has given us 25 ambulances and the Asian Development Band will be gifting us 45 ambulances.

 (The writer is the host, director, and co-producer of the weekly digital programme ‘Kaleidoscope with Savithri Rodrigo’ which can be viewed on YouTube, Facebook, Instagram, and LinkedIn. She has over three decades of experience in print, electronic, and social media.)