May 9: How a football tragedy shaped Ghana’s medical emergency services

The deadliest disaster in Africa’s sporting history happened because Ghana was simply not prepared to prevent it.

On May 9, 2001 – during a match at the Accra Sports Stadium between Hearts of Oak and Asante Kotoko, Ghana’s biggest football clubs – a commotion caused by controversy led to mass casualties.

Following a refereeing decision that caused scores of fans to flare-up, the police stationed at the stadium fired tear gas into the crowd to control the crisis.

Feeling suffocated, fans in the stands sought salvation. But with most exits locked – and with the few opened being claustrophobically narrow – a stampede started.

By the time the distress had died down, it had claimed 126 lives and left over 200 people injured.

Former Ghana president John A. Kufuor, who had to deal with the disaster just 122 days into his first term as president, was left devasted.

“I had to rush to the hospitals [where the victims had been taken],” Kufuor tells The Fourth Estate.

“There, I saw stacks of dead bodies. I’d never seen anything like it. It traumatized me.”

In truth, it ought not to have happened that way.

But, although 126 people perished from the pandemonium, it roused a reaction that has prevented such a tragedy from happening again; a reaction that has subsequently saved thousands of lives.

That heartbreaking bloodshed, ironically, helped lay the foundations of Ghana’s emergency medical services (EMS) system.

“It was a tragedy that surprised the entire nation,” Kufuor says.

“But we tried to make the best out of a very sad situation.”

Aftermath

In the wake of the disaster, the government established a commission of inquiry chaired by legal luminary Sam Okudzeto.

Other members of the commission were Professor George K. Ofosu Amaah, former director of the Special Branch, Professor Agyeman Badu Akosa, president of the Ghana Medical Association, Professor Akua Kuenyehia, dean of the University of Ghana’s faculty of law, and Ken Bediako, a veteran sports journalist.

One of the flagship findings of the commission proved pivotal.

“It was realised that most of the victims could have been saved if they had prompt first aid from ambulances,” Ken Bediako, who jokes about being the only ‘non-professor’ on the commission, tells The Fourth Estate. “This was the keen observation of Prof. Akosa, the pathologist on the commission.”

This finding gave birth to the Ghana National Ambulance Service (NAS) in 2004 – three years later.

Today, the NAS is considered a leader in emergency medical services in West Africa, and this is due to the diligence of pioneers like Professor Ahmed Nuhu Zakaria.

Prof. Zakaria, who joined the service in 2005 and is now the Chief Executive Officer, has helped transform the NAS into a vital cog in Ghana’s healthcare delivery system. An accomplished academic and authority in intensive care medicine, Prof. Zakaria leads a legion of professionals defined and driven by a passion for saving lives.

Before the NAS was formed, the ambulance culture in Ghana was barely developed, recounts Dr. Foster Ansong-Bridjan, Prof. Zakaria’s right-hand-man and the organization’s outgoing director of operations.

“Before NAS, ambulances were facility-based,” he tells The Fourth Estate.

“A few hospitals had their own ambulances. And it was mostly for referrals to transport patients from one hospital to the other or within the same hospital.

“There was nothing called pre-hospital care – that is, care given to patients on-site, outside health facilities. If somebody was sick at home, there was no way to get the person to the hospital through an ambulance. If there was a road traffic crash, there was no way of sending people to the hospital via ambulances.”

Beginnings

Dr. Ansong-Bridjan was one of the founding fathers of the NAS, and still works here 21 years on.

An endearing NAS encyclopedia, he warmly receives The Fourth Estate into his office at the NAS headquarters located in the heart of Accra, just opposite the Accra-Tema station.

It is a timely interview, as today is his last-but-one day in office before retirement.

He is unassuming and soft-spoken. “I’m always grateful for opportunities like this to tell our story,” he says, smiling.

Before starting with the NAS, Dr. Ansong-Bridjan worked for the Ghana National Fire Service (GNFS) for 11 years. He was part of some officers at GNFS who were seconded to the NAS to start the organization along with a few civilians. They were trained for three months at the fire academy.

The NAS started with the establishment of seven pilot ambulance stations, featuring seven ambulances and 64 personnel.

After a year of operations, a committee was put together to assess the impact of the NAS. The committee lauded its work and recommended the need for expansion.

And so from seven pilot stations, they increased to 19, then to 24, as they continued to spread across the various regions.

By 2012, there were 132 stations, and by 2020, the number of stations had more than doubled, with the service now boasting of a presence in all 276 constituencies in Ghana.

“As we speak now, there are 297 ambulance stations,” Dr. Ansong-Bridjan says, proudly. “We now have 326 ambulances in our fleet across all these stations and over 3,400 personnel.”

But he admits these numbers are inadequate.

“Per World Health Organisation’s (WHO) protocols, every 50,000 people ought to have one ambulance. We need about 650 to be able to meet the target. We are not yet there at all, but we’ve started from somewhere.”

The Ambulance System

The NAS deals mainly with the emergency ambulances – vans that transport victims from sites to the hospitals, offering pre-hospital care.

The service specialises in road traffic crashes, maternal and child cases (pregnancy/childbirth complications), medical cases from homes and inter-hospital transfers.

Each ambulance, which costs between $100,000 and $180,000, is equipped with an automated external defibrillator, a patient monitor and a portable ventilator. It also features three personnel – a driver, an emergency medical technician and an advanced emergency medical technologist.

“It’s like a hospital on wheels,” Dr. Ansong-Bridjan says.

Emergency medical technicians are usually Senior High School graduates trained for a year and can perform tasks such as resuscitation and oxygen administration, while the advanced emergency medical technologists are degree holders trained for two years and can perform tasks such as advanced airway management, setting IV lines and intubation.

All drivers are also emergency medical technicians.

In rare cases, there is a paramedic on board – except currently, there are only five such paramedics within the entire NAS.

“They are trained outside and it’s really expensive to do that,” Dr. Ansong-Bridjan explains. “Currently, we have two more in training. We’ll get there.”

‘Timely care saves lives’

The NAS – which operates with the motto “Timely care saves lives” – has a standard procedure of intervening when an accident occurs.

“Someone places a call to us via the toll-free number 112,” Dr. Ansong-Bridjan says. “Every region has a dispatch center where the call is fielded. They find out where the accident is, and send an ambulance from the nearest station. When the situation is critical, like mass casualties, they will call for more ambulances from the various stations in the area.”

But, as he admits, this protocol is not always pristine.

“In some cases, people don’t wait for ambulances to come,” he continues.

“They just pick victims into cars and send them to hospitals. Handling of patients is the reason why most of them die after road traffic crashes. They tend to be handled anyhow, which is bad because in trauma cases, the spine is always suspected to be compromised.

“Due to the fact that witnesses and passers-by don’t have the training, they manhandle the patients and throw them into vehicles. That kind of handling alone can cause more harm to the patients. By the time they get to the hospitals, it is either they are already dead or their injuries have been aggravated. We need to do a lot of education for people to know how to handle patients.”

Dr. Ansong-Bridjan, who did his doctoral degree in crisis, emergency and disaster management, believes every Ghanaian should have basic emergency response skills – what he calls checking the ABC (Airway, Breathing and Circulation/pulse).

“Everyone is supposed to know how to do resuscitation,” he cautions. “When you dial 112, you will be asked a lot of questions: Is the airway compromised? You should know how to check for the airway. Is the patient breathing? You should know how to check for breathing. Is there a pulse? If there is no pulse, that’s when you have to do the CPR (cardiopulmonary resuscitation).”

“On May 9 for instance, some of the victims just fainted, and because there were no people equipped to do resuscitation and other things, they just died,” Dr Ansong-Bridjan adds. “I even heard that some people had to be revived at the mortuary.”

Challenges

It’s been 21 years of learning and growing for the NAS, and the journey has not been without challenges.

The service has struggled with prompt response time, due to long distances between sites and stations, as well as congestion on roads.

“Our roads are narrow; we lack a lot of dual-carriage roads. Even if people move to the side and open up for our ambulances, there still isn’t space,” Dr. Ansong-Bridjan laments. “Some are deliberate – they don’t open up because they suspect the ambulance is empty. But they forget that when the ambulance is going to the patient, it is actually empty.”

He also decries the challenge of prank calls – mischievous people abusing the 112 line.

“There was a time we did an analysis and there were over 20,000 prank calls to the NAS within a year,” Dr. Ansong-Bridjan reveals. “Sometimes, important cases are missed because the lines are engaged by prank calls.”

Never Again

It has been almost a quarter of a century since the May 9 disaster, and the ensuing years have become associated with the theme Never Again, amid emotional yearly memorials.

Thanks to the NAS, an offspring of the tragedy, it is unlikely something like that will ever occur again, as it has now become compulsory for ambulances to be stationed at stadiums during football matches and other mass gatherings.

In fact, there is now a permanent NAS station at the Accra Sports Stadium, the venue of the tragedy, with equipment and personnel on red-alert for any unfortunate event.

The NAS, for the last two decades, has contributed to saving many lives in Ghana.

It is sad, however, that people had to die for it to come to life.