If you’re looking for a story about how data drives performance, let us introduce you to Dr Wahyuni Dian Purwati, emergency physician and hospital director at Siloam Mampang in Jakarta, Indonesia. Her commitment to promoting excellence in prehospital care has led to Siloam Ambulance Call Center winning an EMS Angels Award – a first for Indonesia – and using the awards criteria to review and raise the standard of care.
Siloam Ambulance Call Center (SACC) is an emergency medical service associated with the Siloam Hospitals, a private healthcare group that includes nine WSO/Angels Award winners and four diamond hospitals. The SACC was the brain child of Julie McCaughan, a former critical care nurse from Australia who is now a senior director at Siloam Hospitals HQ. At her suggestion, an ambulance call centre was established in 2009, initially serving only one and then two and then six hospitals. The service was focused on excellence from the start, with strict training and certification requirement for doctors and nurses. Today, it is connected to 41 hospitals and boasts a dispatch time of under three minutes.
Dr Wahyuni first heard of the awards for prehospital stroke care at a 2024 emergency physicians congress in Kuala Lumpur, Malaysia, and asked Angels consultant Jidin Abdullah to help SACC join the program.
One of the main aims of the EMS Angels Awards program is to help prehospital teams identify performance gaps that can be addressed through targeted actions. This was exactly what happened when Dr Wahyuni and Jidin uploaded the SACC data in RES-Q. The analysis revealed a gap in prenotification, one of the criteria for an EMS Angels Award. In four out of the 31 cases they scrutinized, doctors had failed to prenotify hospitals of stroke patients as the protocol required. Following remedial action that involved the heads of hospital emergency departments as well as the ambulance teams on standby at their hospitals, Dr Wahyuni can confidently say that the prenotification rate is now 100 percent.
The SACC operates in Greater Jakarta, the most populous megapolitan area in Indonesia, the second-most populous urban area in the world, and the world’s tenth most congested city. A 2022 study of emergency service use in Jakarta found that a majority of patients attending the emergency departments of the five hospitals surveyed had been conveyed to hospital by car or motorcycle, but concluded that delays as a result of dense traffic was only one of the reasons why ambulance use was low. The study also found that almost 40 percent of patients were not aware ambulances were available, and large numbers lacked the ability to recognize symptoms that require emergency transportation.
Public awareness education is high on Dr Wahyuni’s list of priorities, so more people will benefit from “bringing the emergency department to the patient” and – most crucial for stroke patients – being transported to stroke-ready hospitals.
“Increase stroke awareness among the population,” is the first piece of advice Dr Wahyuni would share with EMS companies that want to emulate the SACC’s success. Teamwork and collaboration between hospitals and EMS is likewise important, as is a patient-centered approach. “We do our best not only for the award,” she says, “but because patient safety and health is number one for us.”
They’re very proud of the award, but even prouder that raising the standard of prehospital stroke care means patients receive the best possible care along the entire stroke chain of survival.
“Stroke care doesn’t start in the hospital,” Dr Wahyuni says. Winning an EMS Angels Award makes it official: “Our stroke service is now complete.”
