Chirakit Hengrasmee, M.D., is an emergency room physician at Vajira Hospital in Bangkok, Thailand. Government, private or volunteer entities operate the emergency medical services in his country. That means that generally, a hospital nurse, or in extreme cases, an emergency department doctor, rides on ambulance calls. At the moment, there is no paramedic service in Thailand.
Hengrasmee hopes to change that.
Working with his hospital and local government organizations, Hengrasmee received a scholarship to come to the United States, learn about its EMS systems and develop a plan to build one of his country’s first paramedic programs. For the past two years, he has studied the EMS program at the UMKC School of Medicine. He recently earned his national paramedic certification through the school’s program.
“The United States has the most developed EMS system in the world,” Hengrasmee said. “I was assigned to come here to learn the system and build my own paramedic program to deal with mass casualties and disasters.”
Hengrasmee explained that emergency service training in Thailand is conducted at university hospitals and medical schools. In Bangkok, a burgeoning metropolis of more than 14 million people, the emergency department at Hengrasmee’s hospital began its first class of paramedic training this past August, while he was in the United States. The plan, he said, is to recruit primarily high school students and current emergency medical technicians and build a four-year, Bachelor of Science degree program for paramedics. His role, when he returns to Bangkok, will be to develop and enhance the curriculum for the final three years of the training.
Hengrasmee said UMKC’s was one of four programs that responded to his nearly 20 e-mails seeking to join an EMS training program in the United States. He chose Kansas City, because of the city’s size and the fact he had common connections with a couple of people at the School of Medicine. He also had a good grasp of American medicine before he came to the United States.
The medical system in his country actually closely follows American guidelines and clinical practices, he said.
“When I was a medical student, we studied in English and even used the same text books as in the United States,” Hengrasmee said. “All the guidelines, the treatments, they are standard, but there are some topical diseases that you never see in the states.”
Hengrasmee supervises emergency medicine residents in Bangkok, with an added focus on EMS operation and research. He did the same at UMKC, teaching pre-hospital skills, while working with emergency medicine physicians Charles Inboriboom, M.D., and Emily Hillman, M.D., on improving the transition of patient care from the paramedic to physicians.
Hengrasmee said that going through the paramedic program at UMKC, where he trained alongside area fire department paramedics, will provide an added benefit to future trainees when he returns to Thailand.
“Before I came here, I essentially had zero knowledge about the paramedic program,” he said. “I used to work only in the emergency department and would rarely ride along in the ambulance. Being a part of the paramedic class, I got the opportunity to study from the beginning how to be a paramedic, and got the experience in the field working with fire departments from Grandview and Harrisonville. The most important part is that I’ve learned from the UMKC program how to teach someone with zero knowledge in the medical field how to become a paramedic.”
His goal now, he said, is not only to teach young students to become paramedics, but also to serve as a role model for future paramedics by sharing his field experience in providing pre-hospital medical services.
“I’m not doing this for myself,” Hengrasmee said. “I’m here to enhance the EMS system in Bangkok and Thailand. The most important thing is to create an effective paramedic program in Thailand.”
Paul Ganss, M.S., NRP, NCEE, CHSE, a nationally certified paramedic, is the education program director for the School of Medicine’s Emergency Medical Services program. He said the field experience Hengrasmee received during his training would prove particularly valuable as he begins training his own paramedics in Thailand.
When the United States started developing its emergency medical service in the 1960s, the first instructors in paramedic training were physicians and nurses, Ganss said. Today, paramedics serve as the primary training instructors.
“For (Hengrasmee) to do something like this is really a big deal because he’s going back (to Thailand) and he’s going to be educating paramedics with an understanding of what a paramedic is and what a paramedic’s job is,” Ganss said. “He is now actually one of his country’s first paramedics.”
Hengrasmee said the goal is to train enough paramedics to have them in all of the government hospitals, and then begin placing them in private hospitals and rural areas of the country. He realizes it’s a lofty goal, but estimates that as many as 10,000 paramedics are needed to cover all of the pre-hospital care needs throughout Thailand.
“I’ve got just 29,” he said of the paramedic class currently training at his hospital back home in Bangkok.
“In the next five to 10 years, we want to transition from nurses to paramedics riding in the ambulance on pre-hospital calls,” Hengrasmee said. “It is going to take time, but you’ll see. Maybe in the next 10 years.”
