The St John Ambulance Service in Port Moresby: a ten-year review, 1984-1993

The National Capital District (NCD) is unique within Papua New Guinea in having a professional ambulance service which provides emergency care during transfer to hospital. This service has been run by St John Ambulance, who have maintained records of their work during their first ten years of operation. To review the operation of the service and to consider its potential for other parts of Papua New Guinea these records were transferred to a database and analyzed. The results of this analysis, together with relevant background, are presented and some of the issues which emerge are discussed. There have been heavy demands on the ambulance service to provide a taxi service for transferring patients between health facilities. Cancelled calls have also been a heavy drain on the service. Pregnancy-related requests for transport, including home deliveries, constitute the major group of emergency calls. Requests for transfer of patients with an acute medical or surgical condition requiring skilled attention provide an important part of the nonobstetrical work of the service, though this group makes up only 10% of the total number of requests. Trauma contributed 26% of the nonobstetrical emergency work of the service. The rate of requests for the population of the NCD has decreased and it is suggested that this is due to greater access to private vehicles rather than a decrease in demand for emergency transport. It is apparent that a skilled ambulance service cannot be provided cheaply, although for 1993 at 15 kina per request, or 30 kina if only the emergency requests are considered, the service is clearly efficient. Providing a similar service to other parts of Papua New Guinea with lower population densities and less sealed road would be very much more expensive. It is unlikely that the health services could approximate a similar degree of cost-efficiency to that of St John.