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Shi Guanglei (right) has seen many colleagues quit. Photo: Alice Yan

Ambulance crew shortage costing lives, Shanghai experience shows

Shanghai is indicative of national crisis, with too few doctors willing to staff emergency vehicles

Yong Xinwei believes her father might still be alive today had an ambulance arrived much sooner after he collapsed at home early this year.

Her family called the medical-emergency service immediately in January when the 89-year-old lost consciousness, showing only the whites of his eyes, but the ambulance only arrived 90 minutes later.

"We called the emergency hotline three times, pleading with them to send the vehicle as quickly as possible. But we were told there was no ambulance available," said the woman, who lives in Shanghai's Putuo district. "The municipal emergency centre finally dispatched an ambulance from Zhabei district to pick up my father."

The elderly man passed away the next day. He had suffered a cardiac arrest several weeks earlier and had only recently been discharged from hospital.

Yong's experience is common in China's largest city, where residents face long waits after calling the medical-emergency hotline. This is due mainly to a shortage of ambulance doctors.

Unlike Hong Kong, where trained paramedics provide frontline emergency medical services, mainland cities require most ambulances to carry licensed doctors. In a few ambulances, mostly for transferring patients between hospitals, nurses look after patients.

In Shanghai, there were only 475 ambulance doctors, a shortfall of more than 40 per cent, said Wang Juan, the director of the municipal medical emergency centre's human resources department.

The city of 24 million residents owns more than 600 ambulances, which far exceeds the national standard of one ambulance per 50,000 residents.

"But we have a severe lack of ambulance doctors," Wang said.

"Over the past few years, we've tried very hard to recruit more doctors or to keep the ones we have from leaving, but with not much success."

Few medical graduates were keen to work in ambulances, Wang said.

"The pay is poor, considering their qualifications," she said.

"They work more than 10 hours a day and about 20 per cent of their income comes from working overtime. Most of their working hours are spent doing hard physical labour - carrying patients - and they seldom receive the same recognition from society as hospital doctors."

She said when ambulance doctors got older and no longer had the strength to carry patients, they found few career opportunities if they resigned, with hospitals seeing their experience as too narrow.

In 2012, a doctor training programme was launched in Shanghai to improve ambulance doctors' chances of being hired at hospitals, Wang said.

"As a result, more ambulance doctors have quit the centre than have joined us over the past two years," she said.

Shi Guanglei has been an ambulance doctor for just a year, yet can claim to be one of the city's most experienced following the exodus of many of his colleagues.

With a disposable income of just over 4,000 yuan (HK$5,025) per month and no permanent residency granted, the Anhui native said he found it hard to settle down in Shanghai.

"Although I love my job, which gives me sense of achievement by helping save people's lives, I won't stick with it for too long because I don't often practice medicine," he said. "I'm more like a labourer carrying patients. My medical education is being wasted."

Jia Dacheng, a leading expert in pre-hospital emergency medical care based in Beijing, said the shortage of ambulance doctors was common in mainland cities. For instance, in Beijing, 86 medical graduates were recruited as ambulance doctors between 2004 and 2006, of which only four remained at their posts, he said.

Last year, Shanghai's health authority ordered a local technical school to launch a course in emergency medical care, and its first batch of 68 graduates are expected to work as ambulance doctors in 2016.

Until then, the city's rapidly ageing population would make the shortage of ambulance doctors more acute, Wang said.

Shanghai has 14.4 million permanent residents, of whom 27 per cent were aged 60 or above at the end of last year, according to statistics from the municipal Civil Affairs Bureau.

"It means high demand and a heavy workload for our ambulance doctors," Wang said.

This article appeared in the South China Morning Post print edition as: Ambulance shortage risks lives
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