Nigeria’s emergency medical services still underdeveloped — Olaniyan

In this interview with SADE OGUNTOLA, Mr. Abiola Olaniyan, an emergency care specialist and the CEO of ResusPro Nigeria, a training centre for resuscitation and emergency care education, discusses the status of Nigeria’s emergency medical services and what Nigerians should know about emergency care after an accident or medical crisis. Excerpts:

RESUSPRO Nigeria is a premier medical training institute dedicated to advancing resuscitation and emergency care education across the country. What is resuscitation and emergency care all about?

Resuscitation is the process of reviving someone from a life-threatening state such as cardiac arrest, respiratory failure, choking or shock. In simple terms, it is the immediate effort to restore breathing, circulation, and consciousness when these vital functions have stopped or are failing. Emergency care, on the other hand, encompasses the broader set of actions and interventions provided to individuals experiencing medical crises, whether it is trauma from a road traffic accident, a heart attack, a stroke, poisoning, or severe bleeding, to preserve life or prevent further deterioration.

Resuscitation and emergency care are about time and precision. When someone collapses from a heart attack, every passing minute without CPR and defibrillation reduces their chance of survival by about 10 per cent. Similarly, in trauma cases, rapid control of bleeding and stabilization before hospital transfer can mean the difference between life and death.

At ResusPro Nigeria, our mission is to ensure that healthcare professionals, corporate organizations, and ordinary citizens are equipped with the skills, confidence, and knowledge to act decisively in those critical moments. Our vision is to improve the art and science of lifesaving in Nigeria.

What is the current state of Emergency Medical Services (EMS) in Nigeria, and how does it impact patient outcomes?

The truth is that Nigeria’s EMS is still underdeveloped. In many countries, EMS refers to a well-coordinated system where a person in distress dials a single emergency number (e.g., 999), trained paramedics arrive within minutes in a well-equipped ambulance, provide lifesaving interventions on the spot, and transport the patient safely to a hospital with a receiving team already prepared. Unfortunately, this seamless chain is largely absent in Nigeria.

While some progress has been made – for example, Lagos and Osun states have introduced some structured ambulance services – the reality across most states is fragmented and inconsistent. Ambulances are often unavailable, poorly equipped, or lack trained paramedics. In some cases, ambulances serve only as transport means without even basic resuscitation equipment (and the worst-case scenario is where they are used to transport corpses). The result is poor survival rates, particularly in cases of heart attack, trauma, and obstetric emergencies.

This gap significantly impacts patient outcomes. Many deaths that occur on our roads, in workplaces, and even in homes could be prevented with a functioning EMS. At ResusPro Nigeria, we believe that while the government works on building national EMS frameworks, training individuals and organizations to respond effectively can bridge a huge part of the gap. A well-trained first responder can stabilize a patient before transfer, significantly improving survival chances.

Many hospitals claim they have accident and emergency units or departments. What is missing in their effectiveness in meeting the needs of Nigerians with critical or emergency conditions?

Accident and Emergency (A&E) departments exist in most tertiary and secondary hospitals in Nigeria. However, the effectiveness of these units is limited by several factors. First, staff training is often inadequate. While doctors and nurses are highly committed, many have not had structured exposure to advanced trauma life support, cardiac life support, or triage systems. This sometimes leads to delays or errors in critical decision-making.

Second, equipment unavailability and shortages are common. Many emergency units lack defibrillators, ventilators, and point-of-care diagnostics, making it difficult to provide evidence-based care. Third, the high patient load, combined with limited manpower, leads to overcrowding and long waiting times, which negatively affect outcomes, as most of the conditions are time sensitive.

What is missing is not the presence of physical structures labelled as “Emergency Units”, but the integration of training, equipment, and protocols that make such units effective. At ResusPro Nigeria, we support hospitals by training staff in international best practices and helping them establish protocols for triage, resuscitation, and coordinated response. An emergency unit is only as effective as the preparedness and efficiency of its team.

How do you perceive the response of Nigerians in emergency situations? People, rather than helping, are seen taking video recordings of the situations, say road accidents or casualties.

It is worrying that in many emergencies, such as road accidents or sudden collapses, bystanders are often seen recording videos instead of rendering help. This unfortunate trend reflects three issues: lack of knowledge, lack of confidence and the “pride of providing an eyewitness account”. Many Nigerians simply do not know what to do in such situations, while others are afraid of doing the wrong thing or being held liable.

What most people don’t realise is that the first five minutes after an accident or medical crisis are often the most critical. For example, if someone collapses due to cardiac arrest, starting CPR immediately can double or even triple their chances of survival. Yet, instead of acting, many bystanders become spectators.

At ResusPro Nigeria, we are taking steps to change this culture. One of our upcoming initiatives is the “SAVE NOT STREAM” campaign, which seeks to educate Nigerians on the importance of stepping in to help during emergencies rather than taking pictures or videos. Through this campaign, we aim to shift mindsets and emphasise that real heroism is measured not by how many views a video or picture gets, but by how many lives are saved.

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 Are there laws regarding responses to medical emergency situations in Nigeria? If yes, to what extent are these laws being implemented?

Yes, Nigeria has frameworks such as the National Health Act (2014), which guarantees access to emergency medical treatment regardless of ability to pay at the point of service. There is the emerging concept of the Good Samaritan Law, which protects people who step in to help during emergencies. Also, under the Compulsory Treatment and Care for Victims of Gunshot Act 2017, Nigerian hospitals are legally mandated to provide immediate and adequate treatment to gunshot victims, even without a police report or a monetary deposit, and must then report the incident to the police within two hours of starting treatment.

The problem is not the absence of laws but poor awareness and weak enforcement. Many citizens are unaware that they cannot be denied emergency care in public hospitals. Similarly, bystanders are unsure if helping at an accident scene might expose them to legal consequences.

What we need is stronger advocacy, public education, and practical enforcement. Part of our mission is not just skills training but also sensitization; helping people understand their rights and responsibilities in emergency situations.

What can be done to ensure every Nigerian is knowledgeable about critical lifesaving interventions like CPR and basic life support skills?

We need a multi-level approach. First, CPR and first aid should be included in the national school curriculum, starting from the secondary level. Countries like Japan and Norway have made this part of their educational system, and the result is a generation of citizens who know how to respond in emergencies.

Second, CPR training should be mandatory for certain groups, viz., drivers, teachers, security personnel, Corps members and corporate organizations. The Federal Road Safety Corps, Nigerian Police Force, National Youth Service Corps, National Orientation Agency and professional associations can partner with training providers to roll this out. Third, there should be regular nationwide awareness campaigns using media, social platforms, and community outreach. At ResusPro Nigeria, we have already begun this journey, and we envision a Nigeria where CPR knowledge is as common as road safety rules.

What are common errors that people commit when helping people in medical emergencies that Nigerians should note?

Several errors are common and often dangerous. For instance, moving accident victims roughly, leading to spinal injuries or worsening of already existing injuries. Others include pouring palm oil on victims of poisoning or burns, transporting critically injured patients in unsuitable vehicles without stabilization and delaying urgent hospital transfer due to waiting for relatives’ consent.

These errors come from myths, lack of training, and desperation. At ResusPro Nigeria, we emphasize evidence-based interventions that prioritize safety. For example, controlling bleeding with direct pressure, ensuring open airways, and rapid transport to a hospital are much more effective than unverified traditional practices.

What are the major challenges facing emergency care in Nigeria, and how can they be addressed?

The challenges are systemic: there is a lack of EMS infrastructure, so there is no unified emergency number and limited ambulances. There is a shortage of paramedics and emergency care nurses and doctors. Many emergency units lack basic resuscitation tools. Citizens often don’t know how to respond in emergencies. And another challenge is crowd behaviour during emergencies. Gathering too close can limit oxygen and block responders; clearing space is essential for effective care.

Addressing these requires multi-stakeholder collaboration. Government must provide infrastructure and policy frameworks. The private sector and NGOs should support training and equipment. Citizens must be educated.

How does Nigeria’s Emergency Medical Services (EMS) system compare to others in Sub-Saharan Africa?

Nigeria lags South Africa, where EMS is structured and paramedic training is advanced. Countries like Ghana and Kenya are also making strides in developing pre-hospital care systems. However, Nigeria, with its population and resources, has the potential to lead the region.

By adopting structured EMS training, standardizing ambulance services, and leveraging technology, Nigeria can catch up quickly. Institutions like ResusPro Nigeria are critical in preparing the workforce for such a transformation.

What is the availability and quality of critical care facilities in Nigeria?

Critical care facilities in Nigeria are largely concentrated in teaching hospitals and federal medical centres, mainly in urban areas. This leaves rural communities grossly underserved. Even within the cities, many facilities are overstretched due to high patient demand. Intensive care units (ICUs) often have limited bed spaces and lack essential monitoring and ventilatory equipment.

The uneven distribution of resources means that a critically ill patient in a rural area may not have access to lifesaving interventions in time. In many cases, patients travel long distances to tertiary hospitals, losing precious hours.

For Nigeria to improve outcomes in critical care, we must expand access beyond major cities, equip more hospitals with functional ICUs, and ensure that staff are trained in critical care management.

Are there sufficient trained healthcare professionals to provide critical care services?

At present, Nigeria does not have enough trained healthcare professionals to meet the critical care needs of its large population. There is a shortage of intensivists, emergency care nurses, anaesthetists, and trained paramedics. This situation is further worsened by the brain drain, as many skilled professionals migrate to countries with better working conditions.

The shortage has a direct impact on patient outcomes. Even when equipment is available, a lack of trained personnel means it is underutilized or not used optimally. The solution lies in expanding local training opportunities and creating incentives to retain skilled professionals. One of our goals at ResusPro Nigeria is to empower Nigerian healthcare workers with internationally recognized certifications and training so they can provide high-quality care and improve patient survival.

What is the state of equipment and technology in Nigerian hospitals, particularly in critical care units?

The state of equipment in Nigerian hospitals remains a major challenge. Many hospitals lack essential tools such as defibrillators, ventilators, medical oxygen, suction machines, and modern patient monitoring systems. In some cases, equipment is available but poorly maintained, rendering it non-functional.

Technology adoption in emergency care is also slow. Electronic health records, simulation labs, and telemedicine, which are standard in many countries, are still limited in Nigeria. This not only affects patient care but also impacts training and research.

For Nigeria to improve, there must be deliberate investment in both quality equipment procurement and maintenance. Partnerships with private organizations and training institutions can help bridge this gap.

How appropriate are the many ambulances we have in our government hospital to respond to medical emergency situations?

Unfortunately, many ambulances are only patient transport vehicles. A true emergency ambulance should function as a mobile intensive care unit, with oxygen supply, defibrillators, stretchers, and trained paramedics. Until this becomes standard, survival rates during transfer will remain low.

What policies or initiatives can be implemented to improve emergency medical services and critical care?

Key initiatives should include establishing a national emergency number and response system, equipping and standardizing ambulances nationwide and expanding paramedic and critical care training programmes. In addition, retraining and ensuring continuous updates should be maintained; CPR and first aid training for schools, drivers, and workplaces should be made mandatory; and there should be public-private partnerships for funding equipment and training to improve emergency medical services and critical care. ResusPro Nigeria is committed to supporting these initiatives by providing internationally benchmarked training and raising awareness across the nation.