48

Emergency care of VIPs: Need for a protocol

The All India Institute of Medical Sciences(AIIMS) being a premier medical institutioncarries the obligation to provide medical cover-age to VVIPs (Very very important persons) aswell as VIPs. The Institute has a protocol forthe management ofVVIP medical emergenciesbut none for VIPs. Moreover, I have been toldthat the VVIP management protocol shouldnot be invoked for VIPs. VIPs visit a hospitalmuch more frequently than VVIPs and Isuggest that to streamline functioning ourhospital should have a protocol for theiremergency care.

Here is a scenario that is commonly witnessedduring the visit of a VIP to the emergencyservice of AIIMS. The hospital authorities areinformed that a VIP is being brought from anearby state. A private room is kept ready, theemergency staff are told that the concernedconsultant should be called as soon as thepatient arrives. The VIP patient then arrivesalong with at least 20 attendants. Though thepatient is walking and does not require anyemergency treatment, his entourage stays withhim inside the limited space of the emergencyroom. This not only disrupts the routine casualtyactivity but hampers the care of other patients.

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THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 8, NO.1, 1995

The VIP is, according to me, anyone whohas, by virtue of his fame or the level of publicinterest in him, the capacity to substantiallydisrupt routine patient care. He may be aminister, senior bureaucrat, local politicianor even a businessman well known to theauthorities. Most problems arise not becauseof the VIP himself but because his entouragehas unreasonable expectations, makes im-possible demands and takes the efforts of thetreating doctors for granted.

VIPs are here to stay and their managementand that of other patients can be made muchmore efficient if we pay attention to a fewdetails.

l.It must be made explicit to everybody work-ing in the casualty department exactly who isin charge.2.The clinican should follow standard clinicalprocedures in the evaluation and managementof the medical problem of the VIP. He or sheshould not allow himself to get entangled withadministrative issues or be swept away by theVIP's aura.3.While making clinical decisions it is probablysafest to give the benefit of doubt to the patient,i.e. pander a little to his whims but the physicianshould not ask for too many consultations justto protect himself. There is a well known

phenomenon of senior faculty members, whoare usually not seen around the casualty depart-ment, interfering with the work of the casultyteam so that the VIP registers their presence.4. The VIP's personal security guards shouldhave close and effective liason with the hospitalsecurity staff so that all those who are notneeded in the emergency department are keptout. This will minimize the circus-like atmos-phere that is quite often generated by powerfulclinical administrators, physicians and otherpersonnel who get attracted towards theemergency room.5. Though hospitals have their own designatedspokesmen to brief the press about the medicalproblems of a VIP, the primary responsibilityof the casualty team is to safeguard the patient'sprivacy. The other patients or hospital staffhave no right to know the medical details ofthe VIP and they must not be divulged evenin a casual manner.6. It is against fundamental medical ethics tocare for one patient at the cost of others. Thephysician incharge should see that the human.and material resources are evenly distributed.

30 November 1994 L. R. MurmuDepartment of Emergency Medicine

All India Institute of Medical SciencesNew Delhi

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