EMS Asia presentation at Goa 19/10/14

1. Ems in India Hopes
&Aspirations 2020
Dr.Venugopalan P P
DA,DNB,MNAMS,MEM[GWU]
Director, Emergency Medicine , Aster DM Healthcare Ltd
Deputy Director ,MIMS Academy
Founder and Executive Director –ANGELS
PG Teacher ,DNB Program in Emergency Medicine
EMS Asia 2014 ;Goa ; October17,18&19

2. 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: 10.4103/0974-2700.93113
PMCID: PMC3299154
EMS Asia 2014 ;Goa ; October17,18&19

3. 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

4. • 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: 10.4103/0974-2700.93113
PMCID: PMC3299154
EMS Asia 2014 ;Goa ; October17,18&19

5. 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.

6. Healthcare delivery system
District hospital , Medical colleges ,
Specialty centers
Community Health center CHC
Primary Health Center PHC
SC
4, 276
23, 458
Sub Centers 1 ,46 ,036
EMS Asia 2014 ;Goa ; October17,18&19

7. • 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

8. 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

9. Intra Hospital Transfer facility
EMS Asia 2014 ;Goa ; October17,18&19

10. India
• Life and death are equally importance
EMS Asia 2014 ;Goa ; October17,18&19

11. Pre-Hospital care Categories
Franco –German
Model
Field treat
&
Stabilize
Anglo-American
Model
Scoop
&
Run

12. Indian diversities influence EMS
Regional
Geographical
Emotional
Financial
Cultural
Political
Individual
EMS Asia 2014 ;Goa ; October17,18&19

13. INDIA
EMS

14. 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

15. 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

16. ANGELS
New
initiatives
Kerala
www.emsindia.in

17. 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/

18. ANGELS
• Stated with 50 GPS/GPRS Networked
ambulances
• Access through 102
• Public –Private –Participation model
• Upgrading & Empowering the existing system
www.angelsindia.org

19. 2011 February 18
Dr. APJ Abdul Kalam
Launched the Human innovation
at Calicut , India

20. 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

21. 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

22. Angels –Console
• At Institute of
Palliative care
• Operated by
Traumatic Paraplegic
• Donations and
memberships
• Non-profitable
Charitable society
and Trust
www.angelsindia.org

23. Emergency Medical care
On Site
Care
En-
Route
Care
Destinatio
n Care

24. 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, Existing
250 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

25. Project appropriate for less resourceful
countries
• Based on WHO recommendations
• Empowering the existing facilities
• Total community based movement
• Unimaginably low cost
• Human innovation

26. First Asian EMS Award conferred by
the Asian EMS Council received at
Singapore
20-10-2014 26

27. AIIMS EMS-IEH 2013
AWARD
• Conferred by the supreme
authority of medical care
in India received from
AIIMS Director Dr. M C
Misra.
20-10-2014 27

28. American Academy of Emergency Medicine in
India-Lifeline Foundation (AAEMI-LLF) AWARD
Received at EMCON 2013
at Vythiri.
20-10-2014 28

29. 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.
20-10-2014 29

30. Training Ambulance
drivers

31. Saved several lives !
Yet to save many.....
Empowerment

32. Scientific trauma
care support
20-10-2014 32

33. Public awareness and training
• 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.

34. 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.
20-10-2014 34

35. Sabari -Sanjeevani Task force
Reduced death rate by 50 percentage

36. First response
provider Training
Medical students
250 Fresher's in 2013 & 2014
Great support from Principal,
KSSM, PTA, Other top
officials

37. Mass BLS
ULCCS
Another Mega show
500 Labourers of ULCCS at
Vadakara
As part of forming a Disaster
Management Force

38. BLS for Top level Government officials
District Collector

39. PUBLIC BLS TRAININGS by
EMCT volunteers
20-10-2014 39

40. Emcon road show –
102 awareness program
across state

41. Back seater Helmet awareness
program

42. EMERGENCY MEDICINE
CRASH COURSES

43. EMCT
• Back bone of ANGELS
• School going students to
senior citizens
• School dropouts to post
graduates
• Disciplined
• 4 batches completed
• 5th to start soon.

44. Strengthening
Primary care
Rural
Emergency
medicine
initiatives
• Rur
20-10-2014 44
al
• e
mer
ge
nc
y

45. Major Mock
drills
• Calicut Airport
• Corporation – Beach
• Collectorate
• Vatakara
• RAKSHAK

46. AIRPORT

47. COLLECTORATE
mock drill
20-10-2014 47

48. Media support

49. Mock drill
evaluation

50. RAKSHAK 2013
20-10-2014 50

51. DISASTER RESCUE
OPERATIONS • Land slid
Pullurampara, Kozhikode
• Tanker lorry blast
Chala, Kannur
• Major Bus accident ,
Malappuram

52. Media support

53. VAYOMITRAM
• KERALA SOCIAL SECURITY
MISSION
• Since 15th July 2012

54. 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

55. 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

56. 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

57. 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

58. Angels Challenges
• Funding
• Drivers attitude
• People attitude
• Ambulance Mafia
• Non Standardized
charging patterns
EMS Asia 2014 ;Goa ; October17,18&19

59. 474 out 524
were prank
Calls in ANGELS
console
‘A Deccan chronicle
Report’

60. 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

61. 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

62. 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

63. 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

64. 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

65. 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

66. Thank you so much …..
EMS Asia 2014 ;Goa ; October17,18&19
www.drvenu.net , www.emergencymedicinemims.com

67. EMS Asia 2014 ;Goa ; October17,18&19
www.drvenu.net