Joy Kirimi, AAR Healthcare head of emergency rescue services and training at AAR Healthcare /HANDOUT
Kenya and specifically Nairobi has experienced a number of
tragedies, from fires to collapsed buildings. What are some of the most common injuries and medical emergencies? How significant is the golden hour during
emergencies?
This writer spoke to Joy Kirimi, head of emergency
rescue services and training at AAR Healthcare and this is what she had to say.
Q. Recent
years have seen Kenyans affected by building collapses, floods, fires, road
crashes and other disasters. From a rescue and emergency healthcare
perspective, what are the most common injuries and medical emergencies you
encounter during such incidents?
Kirimi: From a rescue and emergency healthcare perspective, the
injuries we see depend on the nature of the incident, but there are common
patterns. In road crashes and building collapses, we commonly encounter
fractures, head injuries, spinal injuries, chest and abdominal trauma, crush
injuries, severe bleeding and shock. In fires, we see burns, smoke inhalation,
airway compromise and carbon monoxide-related complications. During floods, the
emergencies range from drowning and near-drowning, hypothermia, injuries from
debris, infections, dehydration and worsening of pre-existing conditions such
as asthma, diabetes, hypertension and pregnancy-related complications.
What is
important to understand is that disasters do not only create new injuries; they
also interrupt access to routine healthcare. A patient who needs dialysis,
oxygen, insulin, emergency surgery or maternity care may become critically ill
because roads are cut off, facilities are overwhelmed, or communication systems
fail.
Q: How
significant is the “golden hour” in determining whether a patient survives or
recovers well after a serious injury? What are some of the consequences when
emergency care is delayed?
Kirimi: The golden hour remains very significant, especially in
trauma. It refers to the critical early period after a serious injury when
timely assessment, bleeding control, airway management, oxygen support,
immobilization and rapid transfer to the right facility can determine survival
and long-term recovery.
It should not
be understood as a strict 60-minute rule, but rather as a principle of urgency.
The earlier the patient receives the right care, the better the chance of
preventing deterioration. When emergency care is delayed, a patient may lose
too much blood, go into shock, suffer brain injury from lack of oxygen, develop
complications from spinal injuries, or arrive at hospital too late for
effective intervention. Delays can also mean longer hospital stays, disability,
higher treatment costs and, unfortunately, preventable deaths.
Q: Based on
your experience and available data, what are the biggest gaps in Kenya’s
emergency response system that affect patient outcomes during disasters?
Kirimi: Kenya has made progress, but there are still major gaps that
affect patient outcomes. One of the biggest gaps is coordination. During
disasters, many responders may arrive, but if there is no clear command
structure, communication channel and patient referral pathway, response becomes
fragmented.
The second gap
is access to well-equipped and well-distributed ambulances. In many areas,
ambulances are either too few, poorly equipped, or not staffed with trained
emergency personnel. The third gap is public awareness. Many people do not know
what to do in the first few minutes of an emergency, and those first minutes
matter.
We also have
gaps in data. A strong emergency response system must be data-driven. We need
to know where emergencies happen most, what types of patients are affected,
response times, survival outcomes and facility capacity. Without data, planning
becomes reactive rather than preventive.
Q: Do you
have any statistics or trends on the types of emergencies AAR Rescue responds
to most frequently, and have you observed any changes in the volume or nature
of these incidents over recent years?
Kirimi: At AAR Rescue, our emergency responses generally fall into
several broad categories: road traffic incidents, acute medical emergencies,
inter-facility transfers, school and corporate emergencies, home-based
emergencies and event-related medical support.
We have
observed that demand for organized emergency response is growing. More
institutions, schools, corporates and households are recognizing that an
ambulance is not just transport; it is a mobile clinical unit. We are also
seeing more demand for standby medical cover during events, school activities
and corporate functions.
In terms of
trends, road traffic incidents remain a major concern nationally. We are also
seeing climate-related disruptions, especially during heavy rains and floods,
affecting access, response times and patient movement. Medical emergencies such
as cardiac events, respiratory distress, strokes, diabetic emergencies and
obstetric emergencies continue to require rapid, skilled pre-hospital
intervention.
Q:
Climate-related disasters such as floods are becoming more frequent. How are
these events affecting emergency healthcare response and the demand for rescue
services?
Kirimi: Floods and climate-related disasters affect emergency
healthcare in several ways. First, they increase the number of people who need
urgent help, including those with injuries, drowning-related emergencies,
infections and exposure-related illnesses. Second, they make access difficult.
Roads may be flooded, bridges may be damaged, homes may be unreachable and
ambulances may take longer to reach patients.
Third, floods
disrupt health facilities and referral systems. A facility may be operational,
but the road to that facility may be impassable. Patients with chronic
illnesses, pregnant mothers, newborns, elderly persons and people living with
disabilities become especially vulnerable.
For rescue
services, this means we must plan beyond the normal ambulance response. We need
early warning systems, mapping of high-risk areas, coordination with counties
and disaster agencies, appropriate vehicles and equipment, and trained teams
who can work safely in difficult environments.
Q: What role
does pre-hospital care play in saving lives, and what difference does a trained
rescue team make before a patient reaches hospital?
Kirimi: Pre-hospital care is the bridge between the scene of an
emergency and definitive care at hospital. It is not simply about picking a
patient and rushing them to hospital. It is about stabilizing the patient,
identifying life-threatening problems early, initiating treatment, preventing
further harm and ensuring the patient goes to the right facility.
A trained
rescue team can open and maintain an airway, provide oxygen, control bleeding,
immobilize fractures and spinal injuries, manage shock, monitor vital signs,
perform CPR, support childbirth emergencies, communicate with receiving
hospitals and make critical decisions during transport.
The difference
is significant. Good pre-hospital care can turn a chaotic emergency into a
structured clinical response. It gives the patient a better chance of arriving
alive, stable and ready for definitive treatment.
Q: In many
emergencies, members of the public are often first on the scene. What are the
most important things individuals and communities should know or do while
waiting for professional help to arrive?
The public
plays a very important role because they are often the first people at the
scene. The first thing is safety: do not become another casualty. Before
helping, check for danger such as fire, traffic, unstable buildings,
electricity, flooding or violence.
Secondly, call
for help early and give clear information: the exact location, what happened,
number of casualties, visible injuries and any hazards at the scene. Third,
avoid moving injured patients unnecessarily, especially after road crashes,
falls or building collapses, unless there is immediate danger.
Communities
should also learn basic first aid: how to control bleeding, place an
unconscious breathing person in the recovery position, perform CPR, assist a
choking person and support someone having a seizure. Simple actions done
correctly in the first few minutes can save lives.
Kirimi: How
prepared are Kenyan households and communities for emergencies, and what
practical steps would you recommend families take to improve their readiness?
Many households
are not as prepared as they should be. Most families think about emergencies
only after they happen. Preparedness does not have to be complicated or
expensive, but it must be deliberate.
Every household
should have emergency contacts clearly saved and shared with family members.
Children and domestic workers should know who to call in an emergency. Families
should have a basic first aid kit, know the nearest health facility, understand
any medical conditions within the household and have a plan for elderly
persons, young children, pregnant mothers or persons with disabilities.
For
communities, I recommend first aid training, fire safety drills, clear estate
or apartment emergency procedures, mapping of vulnerable residents and having a
relationship with a professional emergency response provider. Preparedness must
move from being an individual concern to a community culture.
Q: From a
healthcare perspective, what lessons have recent disasters in Kenya highlighted
about the need for stronger coordination between rescue teams, hospitals,
counties and other emergency responders?
Recent
disasters have shown that emergency response cannot work in silos. Rescue
teams, hospitals, counties, police, fire services, community leaders and
national disaster agencies must work as one system.
One key lesson
is the need for a clear incident command structure. During a disaster, someone
must coordinate the scene, triage patients, allocate ambulances, communicate
with hospitals and manage referrals. Another lesson is the importance of
hospital preparedness. Ambulances can rescue and transport patients, but if
hospitals are not ready to receive multiple casualties, the system becomes
overwhelmed.
We also need
shared communication platforms, joint drills, agreed referral pathways and
real-time information on hospital capacity. The patient should not suffer
because responders are working from different systems that do not speak to each
other.
Kirimi:
Looking ahead, what investments or policy measures would have the greatest
impact in strengthening Kenya’s disaster preparedness and emergency medical
response systems?
The greatest
impact would come from investing in emergency care as an essential part of the
health system, not as an afterthought. We need stronger implementation of
emergency medical care policy, sustainable financing for ambulance and rescue
services, and national standards for ambulance equipment, staffing, training
and response times.
We also need
investment in trained emergency personnel — EMTs, paramedics, emergency nurses,
emergency physicians, dispatchers and first responders. Dispatch systems must
be strengthened because good emergency response begins with the call.
Technology can also help through GPS-enabled dispatch, data dashboards,
hospital capacity tracking and emergency hotlines that are reliable and well
known to the public.
At community
level, we need first aid and disaster preparedness training in schools,
workplaces, estates and public spaces. At county and national level, we need
regular multi-agency drills, stronger disaster financing, better urban planning
and enforcement of safety regulations.
Ultimately,
disaster preparedness is not only about responding when tragedy strikes. It is
about building systems that reduce risk, respond quickly, save lives and help
communities recover with dignity.