Nigeria is the largest black nation in the world, with a current population estimated to be over 200 million. Located in western Africa and bordered by Cameroon, Chad, Benin, and Niger, Nigeria occupies a land mass of approximately 924,000 km2 (357,000 mi2), about twice the size of California. About 1.5% of its territory is covered by water. Nigeria is Africa’s largest economy and also the largest producer of oil and gas on the continent.
Nigeria gained independence from Great Britain in 1960. Since then the country has evolved from a three-region system to a federal republic with 36 states and a federal capital territory, Abuja. Lagos and Kano are the most populous states, with combined population accounting for almost 20% of the population of the entire country.
Lagos is the commercial capital of Nigeria, home to the head offices of all the country’s commercial banks and most of its oil and gas companies. The population of the state is estimated to exceed 20 million, making it larger than more than 30 African countries. The high GDP of Lagos, however, does not translate into basic infrastructure provided by the state government. Also, the state’s rising population has not been met with equivalent development. This situation has led to recurring accidents across the state.
Of all the states in Nigeria, Lagos is the only one with an organized state-run emergency medical service and a working public safety answering point/emergency communication center. All other states, including the federal capital area, have neither state-coordinated ambulance services nor a PSAP.
EMS in Lagos
There are about 20 ambulance points (stations) for the Lagos State Ambulance Services (LASAMBUS), one in each of the 20 local government areas in the state. Built in shady locations along major roads or intersections, each station is designed to house a single ambulance equipped with a radio phone and deployable to scenes by the LASAMBUS dispatch coordinator, who sits in the state’s PSAP. Most of the LASAMBUS fleet are Type II vehicles.
At maximum efficiency—that is, each station having an ambulance as designed—about a million Lagosians will depend on each ambulance for emergency transportation. This number is grossly inadequate to meet the population’s needs, and it is even more disturbing to note that at any point in time, fewer than 10 ambulances are generally at full working capacity. Whenever one breaks down, there’s usually no organized effort to immediately get it fixed. Many times that is the end of that ambulance, which may remain grounded forever.
When calls come in to the PSAP within the state emergency command center, the dispatcher transmits the information to the required emergency response agency—generally one or a combination of fire, ambulance, and police. Each of these agencies is represented within the command center. The agency representative sends a radio message to the nearest field responder(s) to the scene. Backups and additional resources are mobilized based on proximity. For lack of tracking devices on each responding vehicle, the closest vehicle or team to the scene responds to the call. Fleet-monitoring devices are among the tools needed by the state to enhance response efficiency.
There are multiple agencies in Lagos state that have similar names and functions. These are the Lagos State Emergency Management Agency (LASEMA); LASEMA Response Unit (LRU); LASAMBUS; and Lagos Emergency Medical Services (LASEMS).
LASEMA is the state’s emergency management agency. This is the body charged by law to coordinate all responses to emergencies within the state. LRU, on the other hand, provides personnel and response assets as response capacity. LASAMBUS fields the ambulances that provide prehospital care, while LASEMS provides emergency care within the hospital.
There are ambulances branded LRU and others branded LASAMBUS. Dispatching ambulances to scenes with overlapping responsibilities like this may result in gaps in effectively managing an incident. If these agencies could be consolidated to one or two, their efficiency would improve and duplication of assignments could be better avoided.
There is an incorrect use of the term paramedic within Nigeria, and the ignorance is based on the national EMS gap. Most people think anyone attached to an ambulance is a paramedic, so whether or not you’re a paramedic by training, Nigerians don’t see you as less qualified as long as you wear the uniform and work on the ambulance.
Nearly all the staff attached to the LRU ambulances are paramedics by training, but those attached to LASAMBUS are often nurses converted into ambulance staff. These nurses are not always subjected to organized trainings like Basic Life Support and Advanced Cardiac Life Support to enhance their skills. This means at accident scenes with both LRU and LASAMBUS ambulances, responders’ competencies may vary, and that’s a potential cause of conflict.
For many years road traffic accidents have been a leading cause of preventable death in Nigeria. The WHO records that 90% of deaths from road traffic accidents occur in sub-Saharan Africa.
As the most populated country on the continent, it is safe to assume Nigeria ranks high globally in fatalities from traffic accidents. Apart from unimaginably bad roads, driver recklessness and lack of a system to ensure vehicle roadworthiness keep the numbers high.
When accidents occur, especially outside Lagos, there is no emergency number to call. Victims are either left to the mercies of other road users or take care of themselves. If they are lucky enough to have officers of the Federal Road Safety Corps make it to the scene, their lack of first aid kits and training may leave victims helpless still. These FRSC officials often end up taking patients to the nearest hospital in their patrol truck.
Upon getting to the hospital, which is often understaffed and unequipped, arriving accident victims are often not attended to with any sense of urgency. That they are carried without immobilizing injured body parts may leave them with permanent disability.
Future of EMS in Nigeria
There are essential steps required, mainly by the various levels of government, to fix Nigeria's EMS gaps. First would be to fix the country’s roads and make them safe for travel and accessible to emergency medical transport.
In addition, efforts will be required to add PSAPs, build infrastructure like helipads, establish state EMS systems, and recruit people with required qualifications for the job. This will improve response to medical emergencies across the nation.
Abiodun Awoyemi is managing director of TNN Emergency Management Services Ltd. in Lagos, Nigeria.