The GMOA’s wrath against the defibrillator in the ambulance

By Janitha Devapriya

GMOA Secretary Dr. Nalinda Herath at a press briefing on Tuesday warned the public not to use the Indian Ambulance Service because they run the risk of getting electrocuted if they board the ‘Indian Ambulance’. 

He was alluding to a front page graphic account in a leading daily on the pre-hospital care free ambulance service that commenced on 28 July and to the comments of Dr. Harsha de Silva made during a media briefing on Saturday, 30 July. He drew attention to the fact that the MOU signed by Ministry of Health and the Indian entity entrusted with the task of implementing the ambulance project in Sri Lanka is not disclosed and kept as a guarded secret.

The GMOA Secretary said that Dr. Harsha de Silva explained about the defibrillator that is part of the medical tools available in the ambulance and expressed serious concerns whether the emergency medical therapists, actually it is emergency medical technicians, deployed are properly instructed to use the defibrillator. 

A therapist, as generally understood, is a person who has received training to help treat mental or physical health problems whereas the medical technicians deployed in this project are trained to administer emergency medical care or first aid until the patient is handed over to hospital care. 

Dr. Herath displayed a defibrillator used in hospitals with two pads or ‘paddles’ as he said, to give electric shock treatment to patients with cardiac arrest. He went on to say that the decision to use shock treatment can only be made by an experienced doctor and every patient cannot be given this treatment without studying the ‘ECG waves’ displayed on the monitor. This is not even permitted to be administered by a recently-passed-out doctor unless he or she is supervised by a senior doctor.

On the other hand, he said the EMTs with a three-month training are deciding whether to use a defibrillator which does not even have a monitor to show an ECG wave. Shock treatment, he said, should only be given if ‘shockable’ waves are detected and not if ‘unshockable’ waves are displayed (his words). If the treatment is not administered properly, because it is an electric current, the patient may even die.

He went on further to say that a heart that has stopped beating cannot be revived by connecting a device like starting a stalled car with a ‘jumper’ by connecting to the battery of another car with the jumper. Dr. Herath wished to emphasise to Dr. Harsha that a defibrillator is not a thing like a ‘jumper’ and it is not a simple thing like reviving a heart that has stopped beating by giving a current from another source. He said Dr. Harsha should understand the difference. He was not challenging Dr. Harsha’s economic knowledge but said it is better for him to talk to some of his schoolmates who are doctors and also members of the EXCO of GMOA to understand the implications.

In his concluding remarks, Dr. Herath said: “People may have saved their lives by getting to hospital in a three-wheeler though it is not a good mode of transport but a vehicle with a stretcher should be ideal. However, though there is a stretcher and a defibrillator in the Indian Tata Ambulance, people should think twice before getting into these risky Indian ambulances and decide whether to die by a tree fall or electric shock from the ambulance. As persons who received free education here, we have to tell the people not to subject themselves to this danger. Do not get into the Indian vehicles and die through electrocution.”

Dr. Herath due to his virulent hate on anything Indian and his abhorrence of the present regime went on to criticise Dr. Harsha de Silva who merely explained that an automated external defibrillator is one of the medical equipment available in the ambulance and apparently forgot what Dr. Harsha tried to emphasise. Not surprising after all that he forgot his A/L results, an important milestone in any student’s life, when questioned during a political TV talk show in April. 

The defibrillator Dr. Harsha de Silva mentioned during a media presentation is a device that is capable of diagnosing treatable rhythms (detecting the ECG wave) itself and can be used by any bystander or responder (e.g. EMT) successfully with little or no training. These AED devices are available in airports, rail and bus stations, supermarkets and selected public places in many countries so that anyone coming to the assistance of a person subject to a cardiac arrest can use the device as it has easily understandable voice prompts. 

The device runs on a durable battery and there is no danger of electrocution as imagined by Dr. Herath. His ignorance of current developments in the world of patient care is surprising. Furthermore, every patient subject to trauma by road accidents, etc. carried by an ambulance need not be treated with a defibrillator as the knowledgeable doctor suggests. His attempts at scaremongering are deplorable.

In passing I must mention, if Buddhism from India is okay, if our language is a derivative of Sanskrit from India, if our music and certain drama forms are inherited from India, if we can use Tata buses and lorries, Ashok Leyland buses and vehicles, Maruti, Alto and Nano cars, if Ayurveda from India is okay, why is this hatred only for Indian-made ambulances?