News of an ambulance in Suzhou, East China's Jiangsu Province refusing to carry a newborn sparked wide concern and criticism of China's emergency pediatric services, but what lies behind the quandary is in fact a shortage of baby ambulances and trained doctors.
The ambulance would not take a 31-day-old girl who was choking on milk powder and a second ambulance would not take the baby unless she was held by her father, and would only transport them to a hospital and not provide any on-the-spot treatment, reported the Yangtze Evening Post.
The People's Daily reported July 27 that the ambulance staff were "in a pickle," as the hospital's specialized newborn ambulance was dealing with another patient and the ordinary ambulance lacks first-aid facilities designed for newborns.
Many provinces including Northwest China's Shaanxi and Northeast China's Jilin have seen reports of young children being turned down by ambulances.
The emergency treatment of newborn patients calls for specialized doctors and ambulances, but the country faces a shortage of pediatricians, reported the People's Daily, calling the government to push for the recruitment of more pediatricians.
Shortage of specialized transport
Newborn emergency ambulances, or baby ambulances, have incubators, monitors, respirators and medical kits that are all designed for treating babies.
Of the 109 hospitals that have Neonatal Intensive Care Units in the Chinese mainland, only 50 of them have baby ambulances, according to an investigation conducted by a foundation sponsored by the now defunct Ministry of Health between June and December 2009.
Some cities have no baby ambulances, including some of China's more-developed regions.
China didn't have any specialized baby ambulances until the late 1980s, reported thepaper.cn.
A baby ambulance costs between 1 million yuan ($161,100) and 1.5 million yuan, three times the price of an ordinary ambulance, and the cost of maintaining them is high.
"We [medical institutions] are already in a tight financial situation, who will pay for a white elephant?" said Deng Liqiang, director of the legal department of the Chinese Medical Doctors Association (CMDA). "Although we believe it is valuable every time it is used, it is only a drain on funds at other times."
An emergency center in Kunshan, Jiangsu Province, purchased a newborn ambulance in the last half of 2014 for 700,000 yuan and has reportedly only used it twice since then.
The deaths of newborns account for half of all baby deaths in China, and in Beijing, the percentage reaches as high as 70 percent, according to a thesis written by Zhang Lijin, a doctor from the Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University.
Lack of pediatricians
In Beijing, the Capital Institute of Pediatrics and the Beijing Children's Hospital affiliated to Capital Medical University treat 80 percent of the city's hospitalized children, reported thepaper.cn.
"Every physician needs to see 33 patients a day, twice the average workload in the industry," said a doctor from the institute. "Children need to wait for a long time and only get a short consultation in a poor medical environment."
China has 160 million children, but less than 100,000 pediatricians, meaning an average of 0.26 doctors for every thousand children. The number in the US is 1.46 pediatricians per thousand, said Chen Bowen, director of child health and development at the Capital Institute of Pediatrics.
Pediatrics is not a popular choice for medical graduates as it requires more patience than other specializations, and pediatricians have a huge workload and often face disputes in their work as parents will argue with or even attack doctors who they think are not taking good care of their children, said an unnamed pediatrician in Nanjing, capital of Jiangsu.
Ordinary ambulances for babies?
It is difficult to get a baby ambulance to come out for an emergency as they are mainly used for transport between hospitals, which is time-consuming and means they are not free to be used for emergencies, said Yang Qiying, director of emergency center in Suzhou.
"After an emergency call, emergency command centers contact neighborhood emergency branches to send an ordinary ambulance within two minutes, equipped with a doctor, a nurse, a driver and a stretcher bearer," noted Yang.
"However, there are usually no pediatricians or specialized pediatric facilities in those branches," said an unnamed staff member from an emergency center in Nanjing.
Liao Hongjun, director of the emergency department in Nanjing Children's Hospital said that the major tasks during newborn emergency transportation are to recover cardio-pulmonary function and to ensure the child's fast and safe delivery to hospital, which is possible with ordinary trained staff and non-specialized facilities.
In fact, most newborn patients develop life-threatening conditions while already in hospital, Zhou Xiaoguang, director of newborn emergency center in Nanjing Children's Hospital, told the People's Daily. "What's more, ordinary ambulances can deal with preliminary treatment," said Zhou.
But there are legal risks associated with using normal ambulances to transport newborns.
"Once an accident occurs, you can't say the ambulance staff have no responsibility, and even if parents and patients agree with doctors that the doctor should be exempt from liability, this agreement is invalid legally," said Deng, the CMDA director.
Ambulances will continue to not take babies as long as doctors lack legal protection, said a pediatrician who requested anonymity in Guangzhou, Guangdong Province.
"Pediatricians know very clearly what newborns may suffer if treatment is delayed, and even if the babies stay alive, they may have to struggle with the after-effects for the rest of their lives," added Zhang.
The shortage of child emergency resources also reflects the unbalanced distribution of the country's already insufficient pediatric resources, which calls for deep medical reform, said the People's Daily.
