What Happens After the Ambulance Leaves? The Psychological Gap in Emergency Care Across Asia

For emergency responders, that often marks the completion of a successful intervention. The patient has been stabilised, transported, and handed over for further care. The job is done.

But according to Thevanath Gunasekaran, Founder of PsyCore JB, registered counsellor, psychotherapist, and former emergency medical responder, that is often where another, less visible crisis begins.

Drawing on nearly a decade of frontline emergency and disaster response experience — alongside his current work supporting individuals, couples, and families through counselling and psychotherapy — Gunasekaran believes healthcare systems across Asia have become highly effective at saving lives, yet remain largely unprepared to support the psychological aftermath experienced by those left behind.

It’s a gap he believes deserves far greater attention.

The Emergency That Stayed With Him Long After the Ambulance Left

One emergency call has remained with Gunasekaran throughout his career.

His team responded to a middle-aged man who had collapsed at home. The atmosphere was chaotic. Family members were crying, voices overlapped, and panic filled every corner of the house.

The emergency team did exactly what they had been trained to do. The patient’s airway was secured, vital signs stabilised, and within minutes he regained consciousness before being transported to the hospital.

Clinically, it was a successful case.

Yet just before leaving, Gunasekaran glanced back.

The patient’s wife stood motionless in the corner. She wasn’t crying or speaking. She simply stared at the space where everything had unfolded.

No one was attending to her.

No one was acknowledging her.

The emergency team wasn’t either.

Not because they lacked compassion, but because the system had already moved on.

That moment, he says, stayed with him far longer than the emergency itself.

Emergency Medicine Prioritises Speed—But What Gets Left Behind?

Years spent working in emergency and disaster response taught Gunasekaran that hesitation can cost lives. Emergency responders are trained to think in protocols, make rapid decisions, and move efficiently from one patient to the next.

That is how emergency systems remain functional under immense pressure.

The COVID-19 pandemic only intensified that reality.

Emergency personnel were no longer responding to isolated incidents—they were operating inside a prolonged crisis. Calls were relentless, patients were isolated, families were distressed, and one emergency blended into the next.

The priority never changed.

Stabilise.

Transfer.

Move on.

There was rarely time for responders to pause, nor for families to process what had just happened.

Looking back, Gunasekaran does not believe the system failed.

Instead, he believes it functioned exactly as it was designed.

And that, he argues, is where the problem lies.

When Saving a Life Isn’t the End of the Crisis

Emergency medicine has traditionally measured success through outcomes that can be immediately observed.

The patient is breathing.

The bleeding has stopped.

The heart is beating.

The case is closed.

Everything else often becomes invisible.

Gunasekaran argues that survival is frequently the beginning—not the end—of a family’s crisis.

Shock, confusion, emotional disorientation and silent distress often emerge only after the immediate danger has passed.

Yet these experiences rarely fall within anyone’s responsibility.

There is seldom a structured handover for psychological well-being.

No protocol that acknowledges what families are experiencing in those first few minutes after an emergency.

Healthcare systems have become remarkably effective at preserving life, he says, but remain far less prepared to support people immediately afterwards.

Asia’s Invisible Psychological Blind Spot

Gunasekaran believes a significant gap exists between emergency medical intervention and psychological care.

Although psychological support services exist within many healthcare systems, access during everyday emergencies is often inconsistent or unavailable.

Families are frequently expected to process traumatic experiences on their own.

Through his current counselling work at PsyCore JB, he has observed that many people never truly leave these moments behind.

Instead, they carry them quietly for years.

Experiences left emotionally unprocessed rarely disappear.

They simply become part of how people experience future stress, grief, and uncertainty.

Psychological First Aid Exists—So Why Are Families Still Falling Through the Cracks?

Psychological First Aid (PFA) is well recognised within disaster response and humanitarian settings.

However, Gunasekaran believes most psychological trauma doesn’t begin during major disasters.

It begins during ordinary emergencies.

A cardiac arrest was witnessed by the family.

A sudden collapse at home.

A road traffic collision.

An unexpected death.

These events may never be classified as disasters, but for those involved, they permanently divide life into “before” and “after.”

They occur every day.

Yet structured psychological support during those crucial first moments often remains absent.

After Death, Who Takes Responsibility for the Living?

One question continues to shape Gunasekaran’s thinking.

When a patient dies, medical teams follow established protocols.

But who supports the family standing beside the bed?

Who ensures they understand what has happened? Furthermore, is anyone noticing when a family member becomes emotionally numb? Is someone staying long enough to help them regain a sense of orientation?

In many situations, the answer is no one.

Not because healthcare professionals lack empathy.

But because no part of the system formally owns that responsibility.

“The issue isn’t compassion,” he suggests.

“It’s ownership.”

Why This Challenge Is Especially Urgent Across Asia

Across much of Asia, emergency healthcare systems operate under extraordinary pressure.

Resources remain stretched.

Demand continues to grow.

Speed is understandably prioritised.

Economic pressures have further compounded the challenge. Many families now face financial uncertainty, caregiving responsibilities, and emotional strain before an emergency even occurs.

When a medical crisis happens, it rarely arrives in isolation.

It lands on top of existing stress.

At the same time, emotional distress continues to be managed quietly across many Asian societies, where cultural expectations often encourage resilience over emotional expression.

For Gunasekaran, this makes the moments immediately after an emergency even more significant.

The Missing Minutes That Could Shape Years of Recovery

Healthcare systems have clear pathways for emergency intervention.

They also have pathways for long-term psychological treatment.

What remains largely unaddressed is the space in between.

Gunasekaran believes these first few minutes after an emergency can significantly influence how individuals and families process trauma for years to come.

That “missing middle” deserves far greater attention than it currently receives.

Completing Emergency Care, Not Slowing It Down

Gunasekaran is careful to emphasise that this is not a call to slow emergency response.

Rather, it is a call to complete it.

Meaningful psychological support does not always require another specialist or lengthy intervention.

Sometimes it simply means remaining present for a few moments longer.

Acknowledging what has happened.

Explaining what comes next.

Recognising the family member who has fallen silent.

Helping people regain their bearings before responders leave the scene.

Small gestures may not alter clinical outcomes.

But they can fundamentally change how people remember one of the most traumatic moments of their lives.

Redefining Success Beyond Survival

The image of the woman standing silently in the corner has never left Gunasekaran.

Her husband survived.

Yet he remains uncertain whether anyone truly supported her.

He believes emergency medicine has understandably focused on one objective: saving lives.

The next evolution, however, may be recognising that survival alone is not the only meaningful outcome.

Final Thought: Designing Emergency Systems for the People Who Remain

As healthcare systems across Asia continue to modernise, conversations around innovation often focus on faster diagnostics, better equipment, artificial intelligence, and expanding access to care. These advancements are undoubtedly important.

Yet Gunasekaran argues that meaningful innovation should also consider the human experience surrounding every medical emergency.

The moments immediately after an ambulance departs may not appear in clinical performance metrics, but they often become lasting memories for patients and families alike.

If healthcare is ultimately measured by the lives it touches—not simply the lives it saves—then the psychological space between emergency response and recovery may be one of the next frontiers worthy of greater attention.

---

Editor’s note:

This feature is adapted from an original essay by Thevanath Gunasekaran reflecting on his experience in emergency medical response and his current work in mental health. To better serve NewInAsia’s readership, the original narrative has been expanded and edited into a thought leadership feature while preserving the author’s core perspectives and experiences.

Read the Chinese article here.