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EMS Asia presentation at Goa 19/10/14
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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
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
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
• 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
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.
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
• 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
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
Intra Hospital Transfer facility
EMS Asia 2014 ;Goa ; October17,18&19
India
• Life and death are equally importance
EMS Asia 2014 ;Goa ; October17,18&19
Pre-Hospital care Categories
Franco –German Model
Anglo-American Model
Field treat &
Stabilize
Scoop &
Run
Indian diversities influence EMS
Regional
Geographical
EmotionalFinancial
Cultural
Political
Individual
People EMS Asia 2014 ;Goa ; October17,18&19
INDIA
EMS
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
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
ANGELSNew initiativesKerala
www.emsindia.in
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/
ANGELS
• Stated with 50 GPS/GPRS Networked ambulances
• Access through 102 • Public –Private –Participation model • Upgrading & Empowering the existing system
www.angelsindia.org
2011 February 18 Dr. APJ Abdul Kalam
Launched the Human innovation at Calicut , India
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
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
Angels –Console
• At Institute of Palliative care
• Operated by Traumatic Paraplegic
• Donations and memberships
• Non-profitable Charitable society and Trust
www.angelsindia.org
Emergency Medical care
EMC
On Site Care
En-Route Care
Destination Care
ANGELS
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
Project appropriate for less resourceful countries
• Based on WHO recommendations• Empowering the existing facilities • Total community based movement• Unimaginably low cost • Human innovation
First Asian EMS Award conferred by the Asian EMS Council received at Singapore
13/04/2023 26
AIIMS EMS-IEH 2013 AWARD
• Conferred by the supreme authority of medical care in India received from AIIMS Director Dr. M C Misra.
13/04/2023 27
American Academy of Emergency Medicine in India-Lifeline Foundation (AAEMI-LLF) AWARD
Received at EMCON 2013 at Vythiri.
13/04/2023 28
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.
13/04/2023 29
Training Ambulance drivers
Saved several lives ! Yet to save many.....
Empowerment
Scientific trauma care support
13/04/2023 32
• 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
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.
13/04/2023 34
Sabari -Sanjeevani Task force
Reduced death rate by 50 percentage
First response provider Training
Medical students
250 Fresher's in 2013 & 2014
Great support from Principal, KSSM, PTA, Other top officials
Mass BLSULCCS
Another Mega show500 Labourers of ULCCS at
VadakaraAs part of forming a Disaster
Management Force
BLS for Top level Government officials
District Collector
PUBLIC BLS TRAININGS by EMCT volunteers
13/04/2023 39
Emcon road show – 102 awareness program across state
Back seater Helmet awareness program
EMERGENCY MEDICINE CRASH COURSES
EMCT • Back bone of ANGELS• School going students to
senior citizens• School dropouts to post
graduates
• Disciplined • 4 batches completed• 5th to start soon.
Strengthening Primary care
Rural Emergency medicine initiatives
13/04/2023 44
• Rural
• emergency
Major Mock drills
• Calicut Airport
• Corporation – Beach
• Collectorate
• Vatakara
• RAKSHAK
AIRPORT
COLLECTORATEmock drill
13/04/2023 47
Media support
Mock drill evaluation
RAKSHAK 2013Air Port Coast guardPort trust Police Fire force
13/04/2023 50
Another major work by Angels
DISASTER RESCUE OPERATIONS • Land slid
Pullurampara, Kozhikode
• Tanker lorry blast Chala, Kannur
• Major Bus accident , Malappuram
Media support
VAYOMITRAM• KERALA SOCIAL SECURITY
MISSION
• Since 15th July 2012
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
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
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
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
Angels Challenges
• Funding• Drivers attitude • People attitude • Ambulance Mafia • Non Standardized
charging patterns
EMS Asia 2014 ;Goa ; October17,18&19
474 out 524 were prank
Calls in ANGELS console
‘A Deccan chronicle Report’
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
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
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
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
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
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
Thank you so much …..
www.drvenu.net , www.emergencymedicinemims.com
EMS Asia 2014 ;Goa ; October17,18&19
www.drvenu.net EMS Asia 2014 ;Goa ; October17,18&19