Thursday, July 5, 2018

EMS Services In India: The Way to Rise to Global Standards

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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