Ems in India Hopes &Aspirations 2020

EMS Asia 2014 ;Goa ; October17,18&19

Dr.Venugopalan P PDA,DNB,MNAMS,MEM[GWU]Director, Emergency Medicine , Aster DM Healthcare LtdDeputy Director ,MIMS Academy Founder and Executive Director –ANGELS PG Teacher ,DNB Program in Emergency Medicine

Ground reality

Total 3.57 lakhs (0.35 million) accidental deaths were reported during the year 2009 with the Male-Female victim ratio of 77 : 23.

J Emerg Trauma Shock. 2012 Jan-Mar; 5(1): 49–54. doi: 10.4103/0974-2700.93113PMCID: PMC3299154

EMS Asia 2014 ;Goa ; October17,18&19

Road accidents (37.9%), railway accidents, and rail-road accidents (7.8%), poisoning (8.0%), drowning (7.7%), sudden deaths (7.4%), and fire accidents (7.0%).

Most of the victims of accidents were aged between 15 to 44 years. This group of people has accounted for nearly two-third (60.7%) of all persons killed in accidents in the country

EMS Asia 2014 ;Goa ; October17,18&19

• Many of them die for want of timely EMS.• Thousands of these accident victims could

have been saved if timely medical intervention were available to them.

• Need of quality EMS in India is an unmet need of the masses.

J Emerg Trauma Shock. 2012 Jan-Mar; 5(1): 49–54. doi: 10.4103/0974-2700.93113PMCID: PMC3299154

EMS Asia 2014 ;Goa ; October17,18&19

Mumbai Study

• The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%)

• Helped by the police (89.7%)• Almost immediately after rescue, the victim

begins transport to the hospital• No one waits for the EMS ambulance to arrive, as

there is none• A taxi cab is the most popular substitute for the

ambulance (39.3%).Prehosp Disaster Med. 2010 Mar-Apr;25(2):145-51.Where there are no emergency medical services-prehospital care for the injured in Mumbai, India.Roy N1, Murlidhar V, Chowdhury R, Patil SB, Supe PA, Vaishnav PD, Vatkar A.

Healthcare delivery system

CHCCommunity Health center

PHCPrimary Health Center

SCSub Centers 1 ,46 ,036

23, 458

4, 276

District hospital , Medical colleges ,Specialty centers

AS

REFERING

units

EMS Asia 2014 ;Goa ; October17,18&19

• National Family Health Survey – III, • Private medical sector remains the primary source of healthcare for the majority of households in both urban areas (70%) and rural areas (63%). • Even the quality of private sector is also questionable.

: http://www.ncrb.nic.in/CD-ADSI2009/ADSI2009-full-report.pdf

EMS Asia 2014 ;Goa ; October17,18&19

Emergency Medical Services

• EMS is thus provided in two forms Pre-hospital services Treatment to inpatients. • EMS is an essential part of the overall

healthcare system as it saves lives by providing care immediately.

Potluri P. Emergency services in India- Counting on betterment. A transition in progress. Editorial Section. [Last assessed on 2011 Jan 25];Asian Hospital and health care Management magazine. 2009 18 Available from: http://www.asianhhm.com/healthcare_management/emergency_services_india.htm

EMS Asia 2014 ;Goa ; October17,18&19

Intra Hospital Transfer facility

EMS Asia 2014 ;Goa ; October17,18&19

India

• Life and death are equally importance

EMS Asia 2014 ;Goa ; October17,18&19

Pre-Hospital care Categories

Franco –German Model

Anglo-American Model

Field treat &

Stabilize

Scoop &

Run

Indian diversities influence EMS

Regional

Geographical

EmotionalFinancial

Cultural

Political

Individual

People EMS Asia 2014 ;Goa ; October17,18&19

INDIA

EMS

Indian EMS

• Auto rickshaw & Jeep drivers –Across Country • EMRI [ Emergency Research Institute ] –

Hyderabad -2005 • Life foundation -EMS India – Vadodhara 2002• Centralized Ambulance Transport

Services[CATS]- Delhi 2000• Ambulance Access for All [AAA] – Mumbai 2002

E Sarlin,Kumar Alagappan ;International EMS development :EMS-A practical global guide book;2010 PMPH-USA

NRHM-National Rural Health Mission 108

• National Government project • 108 – National level access number • Fully funded by NRHM • Brand new fully equipped Ambulances [INR

40,00,000/-or USD 90,000 per vehicle ]• Advance Life support level • 100% free services • Adopted in many states

National Rural Health mission

ANGELSNew initiativesKerala

www.emsindia.in

Active Network Group of Emergency Life Savers [ANGELS]

WHO recommendation “Using pre-existing EMS systems as corner

stone of any attempt to improve upon pre-hospital services as opposed to trying to build a new system from scratch”

http://www.who.int/violence_injury_prevention/publications/services/04_07_2005/en/

ANGELS

• Stated with 50 GPS/GPRS Networked ambulances

• Access through 102 • Public –Private –Participation model • Upgrading & Empowering the existing system

www.angelsindia.org

2011 February 18 Dr. APJ Abdul Kalam

Launched the Human innovation at Calicut , India

ANGELS

• First response provider course • EMCT- Emergency Medical Care Technician

training • Categorization of Ambulances – BLS and ALS• Awareness campaign• Extensive Media Support• Meaningful community participation

www.angelsindia.org

Angels

• District level Administrative body• Ensured the availability of ambulances -102• Changed the attitudes – from dead body

carries to Primary emergency life savers • Extended to five districts within one year with

addition of 200 ambulances • Pivotal role in the regions disaster

management

www.angelsindia.org

Angels –Console

• At Institute of Palliative care

• Operated by Traumatic Paraplegic

• Donations and memberships

• Non-profitable Charitable society and Trust

www.angelsindia.org

Emergency Medical care

EMC

On Site Care

En-Route Care

Destination Care

ANGELS

108 versus 102 NRHM -108 ANGELS -102

Initial cost INR 15,00,00,000/-[USD3,33,000]

INR15,00,000/- [USD 33,000]

Recurring cost per month INR 25,00,000/- [USD56,250]

INR 50,000/-[USD1100/-]

Staffing Driver, Male Nurse Driver /EMCT Doctor over Phone

Ambulance Type ,Number ALS, New 25nos

BLS & ALS, Existing250 nos

Service area Trivandrum Metro[30.66 sq km]30,00,000 population

Five districts in Kerala[15,471 sq km ]1,20,40,847 population

Cost to Patient Free Subsidized rates, Free for trauma and destitute

Mode of operation Government Public-Private Participation

INR –USD conversion @ 45 INR=1 USD

Project appropriate for less resourceful countries

• Based on WHO recommendations• Empowering the existing facilities • Total community based movement• Unimaginably low cost • Human innovation

First Asian EMS Award conferred by the Asian EMS Council received at Singapore

13/04/2023 26

AIIMS EMS-IEH 2013 AWARD

• Conferred by the supreme authority of medical care in India received from AIIMS Director Dr. M C Misra.

13/04/2023 27

American Academy of Emergency Medicine in India-Lifeline Foundation (AAEMI-LLF) AWARD

Received at EMCON 2013 at Vythiri.

13/04/2023 28

AMBULANCE SERVICES at your fingertips-

24 hour service to take patients to hospitals

Networking ambulance services through the toll free number 102

Equipping and upgrading ambulances to BLS and ACLS levels.

13/04/2023 29

Training Ambulance drivers

Saved several lives ! Yet to save many.....

Empowerment

Scientific trauma care support

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• So far up to 60,000 public both in rural and urban areas were trained in various parts of Kerala

• The doctors and nurses of 8 hospitals in Kozhikode district

• The entire staff of Calicut international airport were given FRPC training in 2011.

Public awareness and training

Sabarimala • Volunteers at Sabarimala were trained by ANGELS 2013 .

• Sanjeevani Task force • Five day training was

conducted from May 12th to 17th at Trivandrum in association with UNDP and Trivandrum Corporation for nearly 250 lay public from selected wards.

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Sabari -Sanjeevani Task force

Reduced death rate by 50 percentage

First response provider Training

Medical students

250 Fresher's in 2013 & 2014

Great support from Principal, KSSM, PTA, Other top officials

Mass BLSULCCS

Another Mega show500 Labourers of ULCCS at

VadakaraAs part of forming a Disaster

Management Force

BLS for Top level Government officials

District Collector

PUBLIC BLS TRAININGS by EMCT volunteers

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Emcon road show – 102 awareness program across state

Back seater Helmet awareness program

EMERGENCY MEDICINE CRASH COURSES

EMCT • Back bone of ANGELS• School going students to

senior citizens• School dropouts to post

graduates

• Disciplined • 4 batches completed• 5th to start soon.

Strengthening Primary care

Rural Emergency medicine initiatives

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• Rural

• emergency

Major Mock drills

• Calicut Airport

• Corporation – Beach

• Collectorate

• Vatakara

• RAKSHAK

AIRPORT

COLLECTORATEmock drill

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Media support

Mock drill evaluation

RAKSHAK 2013Air Port Coast guardPort trust Police Fire force

13/04/2023 50

Another major work by Angels

DISASTER RESCUE OPERATIONS • Land slid

Pullurampara, Kozhikode

• Tanker lorry blast Chala, Kannur

• Major Bus accident , Malappuram

Media support

VAYOMITRAM• KERALA SOCIAL SECURITY

MISSION

• Since 15th July 2012

Angels innovations

• Emergency Medical Care Technicians Training

• First response provider course

• Rural emergency medical care initiatives

• Emergency Medicine Crash course

• App based networking

EMS Asia 2014 ;Goa ; October17,18&19

Angels Bike Emergency Rescue Team

• First batch launched with 25 volunteers

• Second batch training started 150 volunteers

• Target to train 20000 volunteer by 2nd October 2016

• 12 modules to complete in 3 months

• Act as first responders • Networks through mobile

apps EMS Asia 2014 ;Goa ; October17,18&19

ABERT vision

• No matter whether an ABERT volunteer saved somebody …

• If 20000 ABERT volunteers follow proper road culture and safe driving principle will bring down accident rate to 30 to 40 percent

• ABERT focus on college students and youth

EMS Asia 2014 ;Goa ; October17,18&19

Angels Papers • Ambulance driver’s

psychosocial issue – Best oral presentation at EMCON 11

• Angels rural emergency project –Best oral in EMCON12

• Angels structure and function –Best Poster EMCON 12

Angels Challenges

• Funding• Drivers attitude • People attitude • Ambulance Mafia • Non Standardized

charging patterns

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474 out 524 were prank

Calls in ANGELS console

‘A Deccan chronicle Report’

Angels influences

• EM moved out of boundaries of hospitals

• Huge EM movements in Kerala

• 4 MD programs• 4 MEM programs• DNB 32 seats in Kerala• Government initiatives in

EM • Lot of pre hospital life

savings

OPALS study

• 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar

• GCS less than 9, survival rate was lower in the advanced life-support phase (50.9% v. 60.0%; p = 0.02)

[Adjusted odds of death for the advanced life-support v. basic life-support phases were non significant (1.2, 95% confidence interval 0.9–1.7; p = 0.16]

CMAJ. 2008 April 22; 178(9): 1141–1152. doi: 10.1503/cmaj.071154

OPALS study

• Full advanced life-support programs did not decrease mortality or morbidity for major trauma patients

• During the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9.

CMAJ. 2008 April 22; 178(9): 1141–1152. doi: 10.1503/cmaj.071154

OPALS study

• Concludes that emergency medical services should carefully re-evaluate the indications for and application of pre-hospital advanced life-support measures for patients who have experienced major trauma

CMAJ. 2008 April 22; 178(9): 1141–1152. doi: 10.1503/cmaj.071154

Conclusion

• Quality oriented pre-hospital care is the essential component of an integrated emergency medical care system

• We should formulate a national pre-hospital care plan with realistic , affordable & community based approach suitable for the regions

Conclusion

• When introducing advanced systems , the cost effectiveness and outcome in patient care should also be emphasised

• No role for fascinations. Hidden dangers in the medical market may mislead the providers while setting up the programs

• Kerala model is an hope while aspiring 2020 EMS

Thank you so much …..

www.drvenu.net , www.emergencymedicinemims.com

EMS Asia 2014 ;Goa ; October17,18&19

www.drvenu.net EMS Asia 2014 ;Goa ; October17,18&19