On Assignment
Transformation of Care
Relying on instincts forged in the Emergency Room, Dr Ng Yih Yng is helping to drive transformation in how the Home Team delivers care to the public and our officers.

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A focus on saving lives – Dr Ng Yih Yng is committed to driving transformation in the Home Team. PHOTOS: Peggy Tan, Desmond Ang, SCDF

Something has gone horribly wrong at home, and a loved one has been struck down. In desperation, you reach for your phone to call 995. 

A Singapore Civil Defence Force (SCDF) Ops Centre Specialist answers. In a calm, measured voice, she takes down the details of your medical emergency and despatches the nearest available ambulance to your location.

The Ops Centre Specialist tracks the progress of the ambulance, taking note of the traffic along its route. Meanwhile, she stays on the line with you to offer assurance and, where possible, walks you through any triage you can readily perform. 

In a matter of minutes, the SCDF Paramedics arrive at your door, ready to help. 

This is a situation that happens every hour in Singapore. At the SCDF’s state-of-the-art Operations Centre, trained Specialists field between 800 to 1,000 calls a day, on a range of medical, rescue and fire incidents. It’s a daunting volume of calls to handle, but due to a series of innovations that the SCDF has rolled out since 2013, serious medical emergencies now receive attention faster, with more lives saved. 

Helping to lead this transformation of care was Dr Ng Yih Yng, during his tenure as the Chief Medical Officer (CMO) of the SCDF. “It’s about making sure that those in need get the appropriate care in the shortest possible time, and by the right providers,” he explained.

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The SCDF Operations Centre is a 24/7 hive of activity. This year, under an agreement with SingHealth, 13 nurses have been seconded here to further enhance the SCDF’s response to medical emergencies. PHOTO: Desmond Ang

Armour MO
When Dr Ng first joined the Singapore Armed Forces (SAF) to do his National Service, he had little inkling that Medicine would be his career. This was in 1993, when there were few Government scholarships for Medicine. “But then the SAF announced that it would offer study awards,” he recalled, “so I decided to apply.”  

News about his application came unexpectedly. “We were digging shellscrapes for a defence exercise, and hadn’t slept in 20 hours,” he said. “Then an officer came and started calling out names, including mine, and said, ‘Go up the tonner!’ It was only later that we learnt we’d been selected for disruption for medical school.” 

After studying Medicine at the National University of Singapore, Dr Ng graduated in 1999 and returned to the SAF. As the unit MO at the School of Armour, he attended to the soldiers under his care, went on numerous field exercises and earned his jump wings by completing the Basic Airborne Course. After one year, Dr Ng was asked to choose a medical specialisation. “And that was when I decided on Emergency Medicine,” he said. 

A Foundation in Emergency Medicine 
At that time, Emergency Medicine was still a fairly new field in Singapore, with a community of about 30 practitioners. But Dr Ng knew it was the right choice for him, and the training he received was to serve him well throughout his career. 

“Emergency Medicine is very broad; we’re trained to deal with all kinds of bodily trauma; basically anything that comes into an Emergency Room,” he explained. “It’s our job to treat the most serious cases, stabilise patients and then pass them over to whichever specialist can best care for them. So even though we’re not specialists ourselves, we must know something about every domain.” 

Following a series of clinical and staff appointments, in 2003, Dr Ng was tasked to lead the SAF medical team for the United Nations Missions of Support in East Timor. “We ran medical posts near the border of East Timor, with doctors, nurses and peacekeepers,” he recalled. “It was quite isolated, with only chartered flights.”

Dr Ng served in East Timor from April to July. Returning home, he found everything had changed. “This was when SARS [Severe Acute Respiratory Syndrome] hit Singapore, and it was like a different world,” he said. “People were wearing N95 masks, we had huge tents outside our hospitals, and there were constant fever screenings.” 

Dr Ng was appointed the Head of the SAF’s Preventive Medicine Branch, which managed policies related to public health. Besides dealing with matters to do with occupational health and food poisoning, his portfolio now included SARS and avian flu. Given these new public health challenges, Dr Ng worked to build up the SAF’s biodefence capabilities over the next four years. 

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On duty in distant lands: Dr Ng has served with SAF contingents in East Timor (2003) and Afghanistan (2010). PHOTOS: Dr Ng Yih Yng

A New Vision for 995 
In 2009, as Head of General Staff, Dr Ng led a revamp of the SAF’s 30-plus medical centres, benchmarking them to the facilities, equipment and resources found at hospitals. He brought this experience in transformational care with him when he was seconded to the SCDF in May 2012. His task? To manage the SCDF’s Emergency Medical Services (EMS) and the training of Ops Centre Specialists and Paramedics.

Dr Ng made it his priority to understand the challenges faced by the EMS team. “As Emergency Medicine specialists, we’re taught to go back to the data, see what it tells us and break a problem into smaller components,” he said. “so that’s what we did, by speaking to our officers and listening to hundreds of 995 calls.” 

One particular challenge was the low bystander Cardiopulmonary Resuscitation (CPR) rate, despite years of public education programmes in applying CPR and using an Automated External Defibrillator. “We found that even though some of the 995 callers were trained in CPR, they weren’t doing it,” said Dr Ng. “So we asked ourselves, ‘How can we change this?’”

Dr Ng proposed a new model for managing 995 calls, one in which Ops Centre Specialists would reassure and coach callers into doing CPR. “We improved our training and redesigned our protocols and scripts,” he said. “Also, if a caller seemed to be in distress, our Specialist would be on the line with him the whole time, until our Paramedics arrived.”

To see this new model through, Dr Ng visited the SCDF Operations Centre every week to speak to the team and get feedback. And the improvements came quickly – the bystander CPR rate doubled from 22 percent in 2011 to 54 percent in 2015. 

A Systems Approach to Driving Innovation
Having addressed this first challenge, Dr Ng and his team proposed a broader, five-year Operational Masterplan in 2013 to raise clinical skills within the SCDF and allow for the use of data analytics, for better EMS outcomes. On the ground, ambulance services were also enhanced in terms of manpower, training and logistics.

To help Paramedics perform even better, training programmes at the Civil Defence Academy have been revised and, this year, MHA awarded its very first SCDF-Paramedic Scholarship. These changes will help groom more EMS leaders and build a system whereby Paramedics can lead the development of their profession. 

“The thing about being a Paramedic is that the job has a very high degree of internal motivation,” said Dr Ng. “Our Paramedics do it because they want to help people. That’s what keeps them going, and the public is beginning to recognise their value.”

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Frontline lifesavers: Recent initiatives have helped raise the training, skills and career prospects of the SCDF’s Paramedics. PHOTOS: Desmond Ang, SCDF

Understanding What's Wrong and Taking Considered Risks
With its focus on building up the SCDF’s lifesaving capabilities, the Operational Masterplan set the tone for innovations such as the myResponder app in April 2015, the Save-A-Life Initiative in August 2015 and the EMS Tiered Response System in April 2017. 

This year, Dr Ng embarked on a new challenge as CMO for the Home Team. He now leads the Home Team Medical Services Division, where the impetus for transformation is as urgent as ever. “Medical Science changes in leaps and bounds, and our medical capabilities cannot be static,” he said. “There’s always a need to incorporate new processes and technologies, as well as to develop medical leadership for the Home Team.” 

Dr Ng’s team is now working with the Singapore Police Force to build a framework for tactical medicine skills, as well as reviewing correctional healthcare services for the Singapore Prison Service. Another focus area for the team is occupational health. “Looking after the occupational health of our officers is no different from having our firefighters or Police officers wear protective gear,” said Dr Ng. “Even as we maintain our operational tempo, we must look after our officers as they perform their duties.” 

If there’s a common factor in how Dr Ng has driven change, it’s his reliance on instincts forged in the Emergency Room. “It’s about looking at a problem, understanding what’s wrong and taking considered risks,” he said. “If we wait until the information we have is perfect, our solutions may not be relevant. We have to be comfortable with uncertainty to do this, but looking back, the pace at which we’re innovating has been breath-taking.”

An Emergency Physician by training, Dr Ng Yih Yng is the CMO of the Home Team. Before taking on this appointment, he served as the CMO of the SCDF from 2012 to 2018, and was is in charge of the professional aspects of the EMS system. From 1999 to 2011, Dr Ng served in the SAF in a series of staff and clinical appointments. He completed his basic medical education at NUS, is a Member of the Royal College of Surgeons of Edinburgh, and has a Masters in Public Health and Business Administration from Johns Hopkins University.
© 2019 Ministry of Home Affairs, Singapore. All Rights Reserved.

  1. by Mike Tan
  2. 19 October 2018
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