Dial E for emergency

From ambulances that might well be ICUs to bedside registration for emergency patients, there's hope for life after all.

When Pune resident Sanjay Gavand had an accident in the dead of the night, little did he know that one phone call would save his life "" a young girl who witnessed the accident dialed 1050, the Pune emergency number for medical services.

An ambulance arrived within 10 minutes and Gavand was administered emergency treatment on the spot, including the airway breathing circulation management test that revived his breathing.

He was discharged from the hospital two weeks later. The thought that crossed his mind was "" 1050 might have saved his elder brother and brother-in-law from the clutches of death, had it existed a few years ago.

Increasingly, more and more medical service providers, government officials as well as the general public are realising the urgency and importance of emergency medical service (EMS).

Where four years back there were only 12 advance life support ambulances being manufactured every year, now a single manufacturer is churning out eight a month.

The EMS movement in India started in 1999 and has witnessed steady development in the major metros as well as in Ahmedabad, Vellore, Bangalore, Hyderabad and Pune.

In Andhra Pradesh, for instance, the Emergency Management and Research Institute initiated a three-digit phone number "" 108 "" that gives people immediate access to the police, fire service and ambulance.

Dr Prasad Rajhans, former president of the Society for Emergency Medicine, India, says, "The EMS project requires that we develop well-equipped ambulances with well-trained manpower and a common national EMS access number that connects all hospitals."

The government and private sector are now working hand-in-hand to upgrade EMS in the country. Fortis Hospital set up 11 hospitals in one year with dedicated emergency departments and eight people per department norm, something that was lacking two years ago.

Dr Asif Ali of Fortis Healthcare says, "We have made a good start in emergency medicine though a lot is to be done. Now, more and more hospitals are recognising emergency medical departments and dedicating more ambulances to emergency."

Dr Anupam Sibal, group medical director, Apollo Hospitals, attributes the growth of EMS to the increasing awareness of the urgency of the need for emergency treatment. Since there is greater awareness, there is greater demand. People are also becoming acquainted with international emergency protocols, thus demanding better medical services.

In fact, the influx of people coming to the major centres from neighbouring smaller cities for medical services has played an important role in the development of a better emergency transport system.

"We are now conducting almost 10-12 emergency air rescues every month. This means that the pilots as well as the paramedics must be appropriately trained in advance life support," explains Sibal.

With EMS, more patients are receiving pre-hospital care (mainly ambulance service), thus bringing down mortality. In many hospitals, the concept of point care testing has been introduced.

This means that medical investigations, which were previously carried out in different medical departments, now take place in the emergency department of the hospital itself.

And a favourite Hindi film scene "" an emergency patient first needs to locate the emergency desk and get registered before a doctor even looks at him (unless of course the patient carries the power of the muscle "" a la Munnabhai!) "" is about to become a thing of the past.

Hospital management has led to the development of the concept of bedside registration, whereby emergency registration walks up to the patient.

The latest service joining the EMS bandwagon is Telemetry, a facility by which an ambulance can transmit all details of the patient it is carrying to the hospital and receive consultation from the doctors at the hospitals at the same time. By the time the patient arrives, the hospital is ready to receive him and doctors already have a medical plan charted out for the patient.

Dr Talat Halim, head of emergencies, NCR One, Max Hospitals says, "EMS is the product of teamwork. The basic idea is that the patient should not be shunted from one department to another. So, an EMS team immediately starts deciphering the problem and relevant doctors come into play at the same time. Moreover, today ambulances are used as mini ICUs and not merely transport vehicles.

But even with these developments, there is general consensus within the medical fraternity that EMS in the country still leaves a lot to be desired. A common three-digit number needs to be introduced across the country.

The road transport office should certify ambulances depending on the nature of equipment they carry (basic or advance cardiac life support), a paramedical council needs to be established in order to test and dispense licenses to medical service providers.

Rajhans, in fact, insists on the necessity of an EMS tax that allows the allocation of funds for the development of the service. "We have been involved in discussions with the central and state governments and the response has been positive," he reveals. The sooner that happens, the better.