The Sindh Integrated Emergency & Health Services (SIEHS) 1122 center located in Karachi, Islamic Republic of Pakistan, has a great deal to celebrate. As the only Medical Priority Dispatch System™ (MPDS®) operating communication center in Pakistan and one of only a handful in the Middle East, they began their implementation journey in 2009 after the government acquired a private ambulance service and expanded it into a corporate setting.
As described by their CEO, Brig. Tarique Quadir Lakhiar, in a US NAVIGATOR video presentation, the SIEHS center began with only 41 ambulances that were insufficient to respond to the 47.9 million people they serve, representing only a portion of the 56.2 million people in the Sindh province. Utilizing the MPDS allowed the SIEHS center to provide consistent, prioritized responses to meet critical needs and slowly earn the trust of the public in the 5th most populous country in the world. 
Through years of focused effort, the SIEHS operations grew from 71 calls per day to a staggering 10,000. They now have a fleet of 500 state-of-the-art ambulances (with hopes for future growth), and they’ve recently introduced their first fleet of 25 rapid response bikes.
The new rapid response bike program expedites medical responses to provide paramedic assistance and stabilize a patient’s condition prior to ambulance arrival, especially in areas that are difficult to reach within the service area of 54,407 square miles. To effectively manage emergencies across Sindh, SIEHS has established two central control rooms: one serving urban areas like Karachi and the other for interior Sindh.
SIEHS’ efforts have been unquestionably valuable in the number of lives impacted, yet they continue to focus on their journey forward. This drive led them to pursue the elite status of accreditation, beginning the process in 2022.
Accreditation, recognition, and reception
Dr. Zeeshan Noor Shaikh, SIEHS Chief Technical Officer, explained that even with the great progress made in their center, they felt they needed to prove themselves to the government and to the community they serve.
“We have heard continuous complaints from the community stating that we take too much time asking too many questions,” Dr. Shaikh said. “Utilizing the MPDS protocols and being recognized as a leader in our field through accreditation has helped us answer those concerns and prove our capability. Our inquiries are not unnecessary delays; they are directed by a global system.”
Mr. Umair Maqbool, Assistant Manager over Research Development and Education, pointed toward the importance of formal recognition as one reason for beginning the ACE process.
“The Accreditation process involved a meticulous 20-point evaluation where we shared detailed insights into our emergency call handling, workforce capabilities, and quality assurance standards,” he said. “We submitted 452 monthly case assessments through rigorous audits to assess our operational compliance and procedural adherence.”
The SIEHS center consistently met compliance requirements despite facing a few operational challenges they undertook as a team, according to Ms. Seema Sarfraz, Assistant Manager over Monitoring, Evaluation, Accountability and Learning.
“Our two main languages in the province are Sindhi and Urdu (though Pashto, Punjabi and English are also spoken), and our center offers assistance in both main languages,” she said. “We have EMDs who speak both Sindhi and Urdu, though we had to translate some portions of protocol while awaiting an official translation of Urdu (now completed).”
In January of 2023, the SIEHS center received confirmation that they had officially achieved ACE status, becoming the 315th Medical ACE in the world and only the second ACE in the Middle East. The news came just in time to recognize this achievement before the Middle East NAVIGATOR conference that week.
However, the SIEHS employees did not fully realize the significance of their ACE designation for more than a year until they came to US NAVIGATOR in Washington, D.C., in April 2024, where their ACE success was honored on stage in front of all conference attendees.
Brig. Lakhiar was there to accept the recognition along with the top brass SIEHS employees including Dr. Shaikh; Mr. Lutaf Ali Mangrio, Director of Operations; and Mr. Aftab Ibrahim, Deputy General Manager.
SIEHS ambassadors presented mementos and Ajraks (textile block-printing shawls) to the IAED™ and PDC™ Presidents—Jerry Overton and Brian Dale—and their teams, embodying the rich heritage and tradition of Sindhi culture.
Dr. Shaikh was one of those surprised by their reception in the United States. “None of us in Pakistan knew the importance of being an ACE,” he said. “The other ambulance services don’t even know about the MPDS, nor does anyone recognize the achievement.”
Employee impact
Becoming an ACE is a great accomplishment, and Brig. Lakhiar recognizes the importance of the individuals behind it.
“The team—the people sitting there taking the calls and responding—have no pains for themselves,” Brig. Lakhiar said. “They have to pacify the patient, caller, and family, and help them understand our responses. They don’t take nearly enough breaks, and they put their own needs to the side to respond to the caller. They are real people.”
Managing an incredibly high call volume with both efficiency and accuracy is an overwhelming mental challenge, especially while addressing distressed callers. For that reason, SIEHS has been implementing opportunities for their employees to connect with counseling services and to find ways to disconnect from the emotions of emergency management.
“We conduct detailed debriefing sessions that provide valuable opportunities for reflection and improvement,” Mr. Maqbool said. “We also place a strong emphasis on mental health, offering a series of workshops dedicated to various aspects of mental well-being, including managing stress, improving resilience, and maintaining overall mental health.”
According to Ms. Sarfraz, formally recognizing and awarding the Emergency Dispatchers with the best call evaluations has become a priority for the SIEHS center and their 70 EMDs, prioritizing their professional development and expressing appreciation for their value to the public. The center also shares impactful stories of positive patient outcomes on their social media page to recognize the lifesaving efforts that begin at the console. Their EMDs have become known for delivering care with compassion and efficiency.
Recent concerns
In early summer, the SIEHS center faced the effects of a widespread heat wave with temperatures above 113°F (45°C), which feels more like 120°F (49°C) due to added humidity, affecting patients and staff alike. Dr. Ali Kashan, Head of Operation Services, explained that experience has defined their strategy for dealing with heat exposure, learning from prior casualties.
“We have to take care of the patient, and we have to take care of our staff,” he said. “They are out there, exposed to the elements in hot, humid situations. We allow them to rest after dealing with heat situations. We provide plenty of IVs and hydration, and, with these precautions, we can avoid detrimental effects.”
Spreading the word to the community is yet another goal to adequately serve the population through education and prevention, which is why SIEHS publicizes these tips through community outreach veins along with mental health awareness, trainings, education, and blood donation opportunities.
SIEHS wants their citizens to know that when help is needed, they send it with hope. Dr. Shaikh said, “EMDs often say, ‘Hope is on the way. Do not surrender. We will be there.’”
