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Model for Integrated Services for Evacuation of Casualties

CIDM12th Feb.2009

 Dr. G V Ramana Rao MD, DPH, PGDGM,ACLS, ITLS

Executive Partner, EMRI, Hyderabad

Structure of presentation• Responding individual emergencies – EMRI Way• MCI and DM – EMRI efforts• Evacuation of Casualties – NDMA – MPMCE & CIDM

• Model EoC

Changing the World

The experience of EMRI as India’s First and Only Professional Integrated Emergency Response Provider

• 300,000 emergencies occur per day (108 M p.a.) • 80% are at the bottom of the pyramid • 80% deaths occur in hospitals in the first hour• 4 M deaths p.a.

• Absence of 4 As• Access• Availability• Affectionate Care• Affordability

Emergency Scenario in India Until 2004

• To provide Free emergency response services for Medical, Police and Fire emergencies across India by 2010 in PPP (Public Private Partnership) framework

• To respond to 30 million emergencies and save 1 million lives annually by 2010

• To deliver services at global standards through Leadership, Innovation, Research & Training and Technology

• To be recognized as best-in-class

• With the following architecture of 9 elements

Vision

• EMRI a Non-profit

organisation

(commenced in 2005)

1. NPO

2. PPP(Public Private Partnership)

• EMRI architecture and performance led to the following PPP (Public Private Partnership) framework • Up to 95% of expenses by Government

(Public) • EMRI to contribute a minimum of 5% of

expenses towards costs of Leadership, Technology (Process, Medical & Research) and provide free IT solutions

• Management by EMRI to sustain long term performance at International quality and speed

Govt. ofA.P.

Govt. ofGujarat

Govt. ofMP

Govt. ofUttarakhand

Govt. of Tamilnadu

Govt. ofRajasthan

Govt. ofGoa

Govt. ofAssam

Govt. ofKarnataka

Govt. ofMeghalaya

Govt. ofPunjab

3. Leadership

• Is not Charisma, Public Relations, Showmanship

• Is performance consistent behaviour and trustworthiness

• Is Thinking, Doing and Communicating• Is setting Direction, Aligning and Motivating• Is creating an environment of continuous learning

• Learning doesn’t end with school or college • You must learn throughout you life - never cease to be a student

9

3.1 Partnerships

City of AustinUSA

National Emergency

Number Assocoation

911 NENA, USA

Singapore HealthServices

American Assoc of Physicians

Of Indian Origin (AAPI)

Shock Trauma Center,

USA

Stanford University,USA

American Academy for

Emergency Medicine in India

Carnegie Mellon University,

USA

Satyam ComputerServices

Rishmond Ambulance

Authority, USAGeomed Research

Public HealthFoundation of India

• Single toll free number ‘1-0-8’ accessible on land and

mobile phones

• Significance of 1-0-8 in 11 X 22 X 33

Sacred number in Hinduism in many ways (Pillars, Nama Japa, Krishna dances with 108 Gopies, Natraja dances in 108 poses)

Distance of the sun from the earth divided by the diameter of the sun

In Japan, at the end of the year a bell is chimed 108 times to finish the old year and welcome the new one. Each ring represents one of 108 earthly temptations a person must overcome to achieve Nirvana

Number of minutes cosmonaut Yuri Gagerin orbited earth during the first manned space flight

The number of stitches on a base ball

4. 1-0-8

• 24X7 Unique Emergency

Response Center staffed

with trained

Communication, Medical

and Police personnel

5. ERC

• Computer Telephony Integration

• Voice Loggers

• GIS / Maps

• GPS / AVLT

• Mobile Communication

• Application software for Sense, Reach and Care

• ePCR (Electronic Patient Case Record) Form

6. Technology

Sense Reach Careprev

entio

n

• Ambulance design based on best of class -

Indianized

7. Ambulance

S T R E T C H E R S

E X T R I C A T I O N T O O L S

AUTOLOADERWHEEL CHAIR

SCOOP

SPIINE BOARD

AIR LIFTING

AMBULANCE EQUIPMENT

MEDICAL EQUIPMENTSUCTION APPARATUS AUTOMATED EXTERNAL DEFIBRILLATOR

VENTILATOR VACUUM SPLINTS

• Medical Research • Effectiveness of interventions in

specific emergency conditions • Integration with hospital care• Innovations in interventions, capacities

and capabilities

• Systems Research - Best-practices in EMS / prevention of emergency• Processes• PCR• Prevention• Education and Training

• Operations research (Analytics)• Predict future state of healthcare,

disease incidence• Better utilization of resources• Reconfiguring processes

MR

SR

OR

8. Research

• Pre-hospital Care / Emergency

Medicine Training in

collaboration with Stanford

9. Training

• 12,300 + EMRI Associates

• 6,800 + Private Hospitals / Nursing homes (31% in AP and 15% in Guj - patients admitted in pvt hospitals)

• 2,000 Police / Fire Stations

• 368 M population covered in 9 States

• 91% calls taken in first ring

• 8,950 emergencies handled (3.3 Million annualized)

• 1,582 Ambulances - 6 trips a day

• < 10 minutes (2/3rd of RTA and Cardiac) ambulances reached

• < 15 minutes (73% of urban) and < 25 minutes (68% of rural) Ambulances reached

• 100% virtual handholding (in ambulance) by EMTs and physicians

• 130+ lives were saved (51,000+ till now) and 8,820 victims received timely, high-quality pre-hospital care

a

Andhra Pradesh

Gujarat

Sikkim

Karnataka

Orissa

Haryana

Punjab

Himachal Pradesh

Uttar Pradesh

Chattis

garh

Jharkhand West Bengal

Bihar

Arunachal Pradesh

Meghalaya

Tripura

Manipur

Nagaland

Mizoram

Uttarakhand

Madhya Pradesh

Tamil Nadu

Kerala

Jammu & Kashmir

Maharashtra

RajasthanAssam

Goa

Delhi

Today at EMRI

Medical Emergency % of Total

Rural%

Female%

AgeYrs

Pregnancy related 21 82 100 22Injuries 16 48 19 32Acute Abdomen 15 78 42 37Suicide related 5 75 46 28Cardiac related 5 65 43 44

Respiratory related 4 63 38 45

Medical Emergencies - AP

Medical Emergency % of Total

Rural%

Female%

AgeYrs

Pregnancy related 34 91 100 23Injuries 18 60 21 29Cardiac related 5 61 39 51Respiratory related 5 59 37 51

Acute Abdomen 4 78 42 37

Suicide related 1 65 41 26

Medical Emergencies - Gujarat

Follow-up after 48 hours - AP

Discharged 70 %

Stable and still in Hospital 27 %

Critical and still in Hospital 1 %

Expired 2 %

Robbery – Thief requested wife to dial 108 after 10 minutes to take the injured husband to hospital

3 Hour Neonate (Baby Girl) Buried

Firing - Between Army Commanders and Naxalites

Cyclist– Fell on road divider rod

Extraordinary Performance fromOrdinary People

Pre-Hospital Care Process-EMRI

• Pre- Arrival Instructions (PAI)• Pre-Hospital EMT Care – Standing Orders • On-Line Medical Direction by ERCP• PCR Documentation

EMRI MCI and DM

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EMERGENCY MANAGEMENT INFRASTRUCTURE CAN ALSO BE LEVERAGED IN DISASTER

MANAGEMENT SITUATIONSMay 18 blasts, Hyderabad “EMRI took off a lot of the

burden from our shoulders by arriving on time and taking up the responsibility of getting the injured persons to hospitals.”

- Government of Andhra Pradesh

“I reached the hospital on the 108 ambulance… the person on the ambulance removed a splinter from my arm”

- Victim

• Bomb blasts at Mecca Masjid area in Hyderabad injuring 40 and killing 12

• EMRI deploys ambulances immediately after the first call

• Victims transported by EMRI to local private and government hospitals with treatment on the way

– Bihar floods / Ahmedabad blasts

Disaster and Post-Disaster experiences

Learning in simulated environment

Interaction with Dr. APJ Kalam

Thank you

www.emri.in

MCI- Important Roles – On site and Transportation

• Ambulance Incidence Officer (AIO)• Triage Officer(TO)• Treatment Area Supervisor (TAS) • Treatment Area Officer (TAO)• Logistic Officer (LO)• Equipment Officer (EO)• Ambulance Parking Officer (APO)• Ambulance Loading Officer (ALO)• Safety Officer (SO)• Public Information Officer (PIO)

MCI workshop

Essential elements for IAN• Strategy partnerships • Strategic support – technology, training and research• Size and scale • SOP• Skills set• Surface ambulances • Site experiences• Simulation• SLA

Evacuation of Casualties – NDMA- MP-MPE-

Major Recommendations – Ambulances Reference NDMA EMRIResponse time

-Maintain minimum ( Golden hour)

Urban 14mts; Rural – 21mts<10mts – 2/3 of RTA & cardiac.

Medical Equipment

For resuscitation, Essential drugs,

Stretchers

2-way communication

Spine board/ CPR skills;106 drugs under medical directions; Collapsible / Scoop /Pediatric / Chair stretchers; Cell phones.

Support Staff

Well versed with equipment usageQuality checks

Yes (training)

Yes (OE wkly visits; Qrtly. Checks by quality teams)

SOPs Maintenance of vehicles Yes including preventive maintenance, repair/accident processes etc.(Fleet managers)

Evacuation of Casualties – NDMA- CIDM-

Medical Emergency Plans Reference CIDM EMRIDistrict Off-site Plan

Mock drills Yes

Dedicated institutes for CDM

To be identified / established Can be seriously considered for training and research.

Community awareness

Develop mechanism –kits. VoiCE program

SOPs To be laid out – Decontamination; risk and resource inventory, proper casualty chemical treatment kits,

can cascade and provide

Integrated EoC Services -EMRI and NDMA

• Computer – Cellphone Integration (CTI)• Ambulance network• Community Awareness (VoiCE)• Preparedness &Mock Drills (Medical/Police/Fire/ Railways)• First Responders (> 3000 trained and handbook)• Emergency Medical Technicians and Paramedics (PGPEC)• Standard Operating Protocols (SO,MD,CCPs,MCI)• Hospital Network (>6000 MoUs)• Documentation (Pre-hospital Care Record PCR)

Evacuation of Casualties

• Decontamination• Triage• Resuscitation• Treatment• Transport

Conclusion

• EMRI can significantly contribute in EoC in an in MCE and CIDM with relevant and specialized support from NDMA and thereby model Integrated Services for Evacuation of Casualties.

Thank you

www.emri.in