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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
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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
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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
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• 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
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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.
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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
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• 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
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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
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Intra Hospital Transfer facility
EMS Asia 2014 ;Goa ; October17,18&19
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India
• Life and death are equally importance
EMS Asia 2014 ;Goa ; October17,18&19
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Pre-Hospital care Categories
Franco –German Model
Anglo-American Model
Field treat &
Stabilize
Scoop &
Run
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Indian diversities influence EMS
Regional
Geographical
EmotionalFinancial
Cultural
Political
Individual
People EMS Asia 2014 ;Goa ; October17,18&19
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INDIA
EMS
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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
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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
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ANGELSNew initiativesKerala
www.emsindia.in
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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/
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ANGELS
• Stated with 50 GPS/GPRS Networked ambulances
• Access through 102 • Public –Private –Participation model • Upgrading & Empowering the existing system
www.angelsindia.org
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2011 February 18 Dr. APJ Abdul Kalam
Launched the Human innovation at Calicut , India
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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
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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
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Angels –Console
• At Institute of Palliative care
• Operated by Traumatic Paraplegic
• Donations and memberships
• Non-profitable Charitable society and Trust
www.angelsindia.org
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Emergency Medical care
EMC
On Site Care
En-Route Care
Destination Care
ANGELS
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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
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Project appropriate for less resourceful countries
• Based on WHO recommendations• Empowering the existing facilities • Total community based movement• Unimaginably low cost • Human innovation
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First Asian EMS Award conferred by the Asian EMS Council received at Singapore
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AIIMS EMS-IEH 2013 AWARD
• Conferred by the supreme authority of medical care in India received from AIIMS Director Dr. M C Misra.
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American Academy of Emergency Medicine in India-Lifeline Foundation (AAEMI-LLF) AWARD
Received at EMCON 2013 at Vythiri.
13/04/2023 28
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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.
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Training Ambulance drivers
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Saved several lives ! Yet to save many.....
Empowerment
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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
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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
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First response provider Training
Medical students
250 Fresher's in 2013 & 2014
Great support from Principal, KSSM, PTA, Other top officials
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Mass BLSULCCS
Another Mega show500 Labourers of ULCCS at
VadakaraAs part of forming a Disaster
Management Force
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BLS for Top level Government officials
District Collector
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PUBLIC BLS TRAININGS by EMCT volunteers
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Emcon road show – 102 awareness program across state
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Back seater Helmet awareness program
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EMERGENCY MEDICINE CRASH COURSES
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EMCT • Back bone of ANGELS• School going students to
senior citizens• School dropouts to post
graduates
• Disciplined • 4 batches completed• 5th to start soon.
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Strengthening Primary care
Rural Emergency medicine initiatives
13/04/2023 44
• Rural
• emergency
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Major Mock drills
• Calicut Airport
• Corporation – Beach
• Collectorate
• Vatakara
• RAKSHAK
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AIRPORT
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COLLECTORATEmock drill
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Media support
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Mock drill evaluation
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RAKSHAK 2013Air Port Coast guardPort trust Police Fire force
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Another major work by Angels
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DISASTER RESCUE OPERATIONS • Land slid
Pullurampara, Kozhikode
• Tanker lorry blast Chala, Kannur
• Major Bus accident , Malappuram
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Media support
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VAYOMITRAM• KERALA SOCIAL SECURITY
MISSION
• Since 15th July 2012
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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
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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
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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
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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
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Angels Challenges
• Funding• Drivers attitude • People attitude • Ambulance Mafia • Non Standardized
charging patterns
EMS Asia 2014 ;Goa ; October17,18&19
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474 out 524 were prank
Calls in ANGELS console
‘A Deccan chronicle Report’
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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
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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
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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
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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
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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
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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
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Thank you so much …..
www.drvenu.net , www.emergencymedicinemims.com
EMS Asia 2014 ;Goa ; October17,18&19