By Mr. Manish Sacheti, CFO, Ziqitza Healthcare Ltd (ZHL)
India, despite being the
second most populated country in the world, continues to have an EMS system
that is largely fragmented and disjointed. There is an urgent need for a
dedicated medical body that standardises emergency medical services in the
country by providing guidelines for its training and operations. The
accessibility of EMS services also remains low in several parts of the country,
owing to the lack of awareness about emergency numbers like 108, 102, or 1298,
operated across different states, by several companies, including Ziqitza
Healthcare Limited (ZHL).
In addition to that, the
responsiveness of most ambulance services in India is yet to be up to global
standards, with affordability, dispatch, and transport capabilities being a
concern. There is also an urgent need to regulate EMS education standards in
the country across courses like Paramedic, Prehospital Trauma Technician,
Emergency Medical Technician-Basic/Advanced, Diploma Trauma Technician, and
Postgraduate Diploma in EMS, to meet the growing need for trained, EMS
professionals in the country. Government of India has taken the first step
towards standardisation by notifying AIS-15, this notification has standardised
Ambulance vehicles. Similar standardisation of training for manpower and
protocols of service is required.
There is a lot that we can
learn from EMS services in countries like the USA, UK, and Japan, implementing
which, we can move closer towards a more efficient emergency medical service
setup in India. In the United States, for instance, emergency medical services
have been integrated with the fire department and the police department into a
Public Safety Answering Point (PSAP). Government of India is rolling out the
PSAP concept as the 112 project under the Ministry of Home.
Ambulances are typically
divided into three categories, including type I ambulances, based on the
chassis-cabs of light duty pickup-trucks, type II ambulances, based on modern
passenger/cargo vans, and type III ambulances, based on chassis-cabs of light
duty vans. Additional duty versions of the type I and type II ambulances are
also operated, to be dispatched in times of mass catastrophes and increased
need for medical assistance. The ambulances are manned by a medical director or
board-certified physician, overseeing the paramedics on board, and follow the
Anglo-American model of bringing the patient to the hospital, instead of the
Franco-German model of bringing the hospital to the patient. As a result, they
are designed to be fast, easily manoeuvrable, and reach the crisis site in the
shortest time.
However, in many countries
following the Franco-German model, advancements in clinical technology have
allowed medical and trauma emergencies to be stabilised on the spot, before
transport to the hospital. Ambulances are equipped with highly trained
paramedics and medical professionals, who can administer controlled medications
like morphine and epinephrine, perform invasive procedures like endotracheal
intubation and placement of intravenous lines, and even make complex clinical
judgments or pronounce death, at the scene of the emergency itself. This model
is not advisable in India as the Drug and Cosmetic Act has strict regulation on
who can administer controlled medications, and The Narcotic Drugs and Psychotropic
Substances Act, 1985 places severe restrictions on medications like
morphine.
Additionally, technologies
like electronic mapping, Global Positioning System (GPS), Automatic Vehicle
Location (AVL), and decision support software like AMPDS, have helped reduce
response time and increase efficiency. Dispatchers are also provided extensive
training, to allow them to prioritise incoming calls based on urgency and
severity, and provide medical guidance and assistance over the telephone, until
the ambulance reaches the scene. The evolution of medical technology has also
helped in the development of multifunctional compact monitoring systems, which
make the job of monitoring patients a lot easier, in an uncontrolled
environment.
In light of this, one of
the most burning needs of the hour in India is improved road infrastructure, as
is evident from the annual statistics of deaths from accidents in the country.
For instance, more than 150,000 people die each year in traffic accidents, with
a death occurring from road accidents once every four minutes. The delays in
response time, or in reaching the hospitals, due to poor road conditions,
inefficient traffic management, and more, remain one of the biggest reasons for
these deaths. However, this can only be remedied through the adoption of a more
efficient traffic management system and the diligence of the municipality
department of the respective cities.
On the other hand, public
private partnerships, in the EMS sector, and the healthcare industry, at large,
can also help improve the standard of care provided, and its efficiency,
thereby helping bring down the death rates. The advanced infrastructural
capabilities, technological superiority, and high standard of services of
private organisations, will help bring up the quality of EMS services in the
country, while being regulated by the government, which ensures the
accountability and affordability of the services.
There is also an urgent
need for trained manpower in the EMS sector, which can help improve the survival
rates of patients and victims, at the scene of the accident, or on the way to
the hospital. An influx of highly skilled medical professionals in the sector
is an urgent need, for which, many more premier medical institutions need to be
set up in the country. The majority of state run ambulances in the country
still lack advanced life-support facilities such as defibrillators,
ventilators, life-saving drugs, and more, which are critical for stabilising
the patient, and saving their lives, in the process. An increase in the
government’s budgetary allocations for the EMS sector will, thus, help in the
implementation of advanced technology and infrastructural improvements,
equipping ambulances with facilities that can increase the patient’s chances of
survival until they reach the hospital.
Furthermore, boat
ambulances, operated in several countries including USA and the UK, can also
help reduce the response time and solve problems of accessibility, in Indian
cities. In fact, not only can they cover vast distances in a short period of
time, in coastal and riverine areas. Bike ambulances have found tremendous
success in Mumbai, and should certainly find favour with more cities, to
provide swift medical assistance to patients, unhindered by traffic congestions.
Workshops and campaigns to
raise awareness about EMS services, and the establishment of an integrated
emergency number for it, in the likes of 911 in USA, is also an immediate need,
as it will increase accessibility, considerably. A go-to emergency number,
serviced by trained operatives who can immediately dispatch ambulances with
modern facilities and professional paramedics, will centralise the sector and
increase efficiency. ZHL’s partnerships with state governments, in this regard,
can help streamline emergency services to a large extent. With their slew of
highly trained medical professionals, experienced drivers, and 24/7 helpline
systems, ZHL hopes to eventually be able to bring down the number of deaths
from accidents in the country, to a large extent, and raise the standards of
EMS services in the country.
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