The presentation was done in an International Prehospital care workshop at SRMC-Chennai 2022

1. PRE-HOSPITAL
CARE
KERALA
EXPERIENCE : A
CASE STUDY
Dr. Venugopalan P P
Director , Emergency Medicine
Executive director ,Angels International foundation

2. BACKGROUND
• Need of pre-hospital care in India is a subject of top priority
• Government supported 108 ambulance network is working
in many states
• Thousands of registered ambulances are in the country ,not
involving patient care or ambulance care
• If we utilise their potentials also in the pre-hospital care and
disaster management - will be a huge resources
• PPP mode is one the financially viable model in country like
India

3. COMMUNITY
BASED
AMBULANCE
NETWORK
• ANGELS – Active Network Group
of Emergency Life Savers
• Established in Calicut ,Kerala Feb
18 , 2011 as PPP model of
community based Ambulance
Network
• Worked in 5 districts of Kerala with
600 ambulances in the network
• Central console and GPS tracked
ambulances belonging to various
operators

4. WHAT
ANGELS
MADE ?
• Easy access to prehospital care
• Change the status of ambulances from
dead body carrier lifesaving vehicles
• Taken the ambulances from post
hospital limb to pre-hospital care limb
• Initiated to equip ambulances with BLS
and ALS level
• Community based EMCT training
• Huge public awareness on emergency
medical care , Pre-hospital care and
disaster management

5. A GOOD OLD
THOUGHT
100:101:102
100
101
102
Call : 102 ,visit : www.angelsindia.org
Now 112
All services under
one access code

6. C
O
N
C
E
P
T
10-02-2023 6

8. ANGELS OPERATIONS
IN VARIOUS
DISTRICTS
• Biggest network in Ernakulam – 600 ambulances
• Kannur -100
• Malappuram – 70
• Wayanad 20
• Calicut -50
• Initially it was networked centrally – later
decentralized
• Receiving an average 20000 calls per day, 85%
prank, 300 to 400 call were real emergencies
• Average pick up time is 15 mts

9. HUMANITY HAD BEEN
HIGHLIGHTED
CONSOLE RUN BY PARAPLEGIC TRAUMA VICTIMS

10. TWO INTERNATIONAL AWARDS &
ONE NATIONAL AWARD

11. FIRST EMS ASIA INTERNATIONAL AWARD-2013 FOR BEST COMMUNITY- BASED
AMBULANCE NETWORK

12. MOCK DRILL
HELPED TO
SOME EXTEND
IN POST CRASH
MANAGEMENT

13. CALICUT AIRPORT MOCK DRILL –
ONE OF THE BIGGEST IN INDIA-
AIRPORT MOCK DRILL 2012 MADE
2020 PLANE CRASH MANAGEMENT
EASY
• Pre-mock drill training of 857 airport staff and 250 lay people in
and around airport
• Plane crash scenario of 200 passengers on board
• 3 Foam based most modern and highly powerful fire fighting
extinguishers to control fire
• 500 volunteers including doctors ,paramedic ,EMCTs, Nurses
and medical students participated
• 150 patients(Moulages) were transported to various hospitals
in Malappuram & Calicut districts
• 175 ambulances participated
• Post Mock drill analysis and reports to authorities
• Authorities made correction in many areas
• Mock drill made Calicut plane crash management more
streamlined

14. EM ROAD
SHOW 2013
• First time in EM India part of
EMCON 2013
• Huge EM Awareness
campaign
• Covered 14 districts in 14
days
• 102 shows covered both rural
& Urban Kerala
• Educating General public on
need of emergency care
• Covered rural & Urban Kerala
• Kerala Casualties were
changed grossly to
emergency departments
subsequently

15. Brown HA, Douglass KA, Ejas S, Poovathumparambil V. Development and implementation of a novel
prehospital care system in the State of Kerala, India. Prehosp Disaster Med. 2016;31(6):1-4
• Community based Prehospital care
system with upgradation of existing
facilities
• Amazing model of PPP
• Instrumental to save many lives

16. HOW DID
ANGELS
SYSTEM HELP
DISASTERS IN
THE STATE
The angels ambulance
system was successfully
used during Nippah,
Floods, Covid
Supported the 108
ambulance system during
Covid

17. OPERATION
NAVAJEEVAN-
KOZHIKODE
• Co-ordinated and systematic approach in 2018 Kerala
floods
• System operated through central console to deliver Medical
& Non- medical needs in Kozhikode district
• Acceptable model of Public –Private – Participation(PPP)
• Project enabled proper healthcare delivery and resource
utilization
• The exacerbation of the existing diseases like DM,COPD,
CAD, CKD , Asthma , Hypertension, Seizure diseases were
the one the major challenge ( Relief camp scenario )
• Project was duplicated in entire state subsequently and
later in 2019 flood as well

18. TRAINING OF AMBULANCE DRIVERS

19. EMCT – ASAP & COMMUNITY
EMCT

20. RELEASED
NATIONAL
EMS
PROTOCOL
2014

21. AMBULANCE
SUPPORT TO
OLD AGE

22. SUPPORT TO SABARIMALA DEVOTEES: 2012,2013 & 2014
PREVENTED AN AVERAGE 100 DEATHS AND ENSURED SAFE TRANSPORT OF SICK
AYYAPPAS

23. ANGELS WORLD GUINNESS RECORD IN HANDS ONLY CPR -16-
NOVEMBER 2019 AT KOCHI – TRAINED 26546 STUDENTS IN 8 HOURS

24. SETBACKS
• Angels faced huge financial crisis
• Angels was supported by UDF Government from 2011 to 14
• Government change in 2014 affected its daily works
• Angels is an organisation with 80G tax exception
• Angles also received support from Cochin refineries
• Difficult to get donations for the retrieval of trauma victims
from road
• 2018 – Kaniv 108 network established by Kerala Government
with 300 ambulances
• 2019 – Angles stopped ambulance networking

25. IMPACTS
Pre-hospital care awareness in the state
Ambulance operation is getting improved in terms quality to some extend
Casualty to ED conversion in the state up to 65 percentage
Bystander CPR rate and improved patient out come ( Need more studies to quantify )
Improved Golden hour care –Proven in Calicut Plane Crash

26. AMBULANCE FIELD IN KERALA
• Ambulance are getting all benefits as an emergency
vehicle
• 85 % of the ambulances are not involving patient
transport
• Irrational tariff rates
• Ambulance involved illegal , illicit and immoral activities
• Ambulance involved accidents
( 2018 : 21 people died 124 accidents in Kerala @ TOI
19th July )
• Money oriented ambulance mafia

27. CURRENT
STATUS
Angels continuing its
training activities
Kerala Road Safety
Authority has taken up the
project and planning to
network the 4000
Ambulance in Kerala state
This might come as a
reality shortly

28. LESSON LEARNT
• Community based ambulance networking is an excellent model and economically viable
• The over head cost of this project was 20 times less than the Government’s official project
like 108
• This model helps to pool and proper utilization of redundant recourses
• People may not contribute funds as doing in palliative care because people doesn't think
trauma care is a charity work
• Persistent funding was the main issue which faced in Angels operation

29. • Thanks a lot for the patient listening ….