EMS Around the World: China Prioritizes Better EMS

The government of China is considering new measures aimed at tightening control over the quality of EMS provided in the country and creating conditions for expanding its range, according to recent statements made by senior officials of the Ministry of Health and some local analysts. 

Despite a significant increase in investment by the government in the national EMS sector in recent years, the quality of services provided in China remains generally low, even compared with other emerging nations. This has traditionally sparked criticism from the public, but in recent months the number of such complaints has significantly increased. 

In China the EMS industry is part of the national healthcare system. A couple of years ago the government officially announced that the development of its domestic healthcare industry, including its EMS sector, will become one of its priorities for the near future. For this purpose the volume of state funding for the industry was increased to 6.5% of China’s national gross domestic product. This is a record commitment in the modern history of China. 

Still, the increase in state support has not yet resulted in a radical change in the Chinese EMS industry, which remains complex. 

Acute Shortages

According to experts at the Chinese University of Hong Kong—a leading institution of research and higher education located in Shatin, Hong Kong—the biggest problems of Chinese EMS are an acute shortage of ambulances in the country and existing services that can’t meet the needs of the country’s nearly 1.4 billion people. 

Those problems remain pressing despite an order last year from the Ministry of Health that specified every city should have at least one ambulance for every 50,000 people. The majority of Chinese cities and provinces do not meet these requirements. 

The situation is slightly better in large industrial cities of the country, such as Beijing and Shanghai, where official responses can be supplemented by unofficial services for those who can pay. However, in rural, remote areas of the country, the levels of accessible EMS are close to catastrophic. In rural areas and smaller cities, prehospital emergency services—accessed in China through the emergency number 1-2-0—may not be available at all. 

One reason behind this is economic stratification—a traditional problem in China. Historically the rates of economic development in the country’s northwestern regions were significantly lower than those in the eastern provinces, where such major cities as Shanghai are located. That was mainly due to their lack of access to the sea and traditional focus on agriculture. 

However, the situation has changed in recent years, as development of the northwestern provinces, including its poorest areas, has been declared a priority for the Chinese government. According to state plans, this will entail improving the quality of healthcare services, including EMS. 

Currently the Chinese EMS system is divided into three parts: prehospital emergency services, emergency departments, and intensive care units. Prehospital emergency services include ambulance services and prehospital care funded primarily by provincial and city bureaus of public health. 

According to experts at the Chinese University of Hong Kong, most metropolitan cities in China have two types of ambulances: One is a general ambulance, and the other carries additional equipment for monitoring patients and extra medications to help the critically sick. 

The cost of emergency treatment is usually covered by patients themselves, although roughly 25% of the urban population has medical insurance. 

Personnel Upgrades 

In the meantime, the Chinese government is aware of existing problems and considering ways to solve them. Part of this involves paying more attention to the training of healthcare personnel, including those in the EMS sector. 

China does not have a recognized paramedic profession. Instead, physicians, nurses, and drivers work in emergency service centers that provide both transport and inpatient care. Specialized training is not required, and the majority of doctors there do not have it. Chinese prehospital and emergency systems often have shortages in these physician positions, which may be caused by differences in wages, training, and recognition for their work compared to other doctors. 

Still, with plans for training at some of China’s leading hospitals and healthcare institutions with the participation of foreign experts, there is optimism the situation will change. In addition, local governments will pay particular attention to further development of the emergency centers and special services, including air transport and care. 

At present, the number of such centers in the country is close to 200—low for a country of such size. 

Greater use of air transport in EMS is also among the Chinese government’s priorities. According to recent data from the World Health Organization, the annual number of road traffic deaths in the country is estimated at more than 250,000. It is hoped that air evacuations from both clogged Chinese city streets and remote rural areas could speed medical care and save lives.

Illegal Ambulances 

With China’s traditional shortage of state-operated ambulances, a need has been filled by private services, the majority of which operate without any permits or licensing. The number of companies providing such unlicensed services in China has increased significantly in recent years and continues to grow. Often the personnel on such ambulances have few if any qualifications. 

According to a 2016 article, “These rogue operators suborn emergency hotline workers with kickbacks, advertise their services prominently, and readily use hospital facilities. While an ambulance service is at least rendered, the fly-by-night nature of the operation and the lack of medical expertise of the ambulance staff have become a serious cause for concern.”¹ 

According to statements from Ministry of Health spokesperson Chen Zhu, there is a need to significantly tighten state control over such unregistered ambulances. New legislation expected to be introduced could restrict or prohibit their activities.   

Reference

1. Fang F. Enter the strange world of rogue Chinese ambulance services. Epoch Times, 2016 May 11; www.theepochtimes.com/enter-the-strange-world-of-rogue-chinese-ambulance-services_2055683.html. 

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.