Emergency Medical Services
In India, emergency medical service is regarded as an evolving discipline in the field of healthcare. Even though EMS made quite a progress, the need for a well-equipped and coordinated EMS system to respond to emergencies still remains a distant reality.
The World Health Organisation (WHO) in its report on emergency medical cases indicates that by 2020 road crashes will be a major killer in India, accounting for 546,000 deaths. Although India has only one per cent of the world’s motor vehicles, it still accounts for six per cent of the total global Road Traffic Accidental (RTA) deaths. Moreover, registered deaths due to other medical emergencies such as stroke, cardiac arrests, natural calamities and terrorist attacks are also mounting.
In India 98.5 per cent ambulances are used for transporting dead bodies, 90 per cent of ambulances are devoid of oxygen equipment, 95 per cent ambulances have untrained personnel, most ED doctors having no formal training in EM, there is misuse of government ambulances and 30 per cent mortality has been reported in recent times due to delay in care.
The current EMS faces an acute shortage of trained clinicians, paramedics and nurses; lack of government regulation and fragmented services holds back the growth of EMS in India. These issues have been highlighted several times by emergency medicine specialists before. The lack of investment in the field stands as the biggest road block to the progress of EMS.
It is important to have legislation in place which will make it mandatory for every state and major cities to implement EMS and also make it possible for paramedics to give basic life support management during emergency and transport, and that the hospitals should admit the patient irrespective of their financial status.
Setting up an Ideal Emergency Unit
Dr Khusrav Bajan, Consultant Physician & Intensivist, Department of Medicine and Critical Care at Hinduja Hospita says: An ideal emergency unit is the one, which has a multi-disciplinary approach. It should be located in a separate block or area and should be directly accessible to patients. The department should include specialists in medicine such as surgery, pediatrics and orthopedics. The whole unit should be divided into zones. The first is the triage zone which is divided into three categories, namely:
a) Acute Care – It caters to the stable, walking and wounded patients
b) Urgent Care – Here patients who are unstable and need to be attended within half an hour are treated
c) Emergent Care – Here patients who are critical and need attention immediately catered to.
Systematic Triage System: The basic step for specialized emergency care is the implementation of triage. Triage, commonly known as sorting, sifting or selecting, is considered as a simple front line categorization mechanism in hospital-based emergency departments (EDs). This facilitates the ability to treat as many patients as possible when resources are insufficient in case of an acute emergency.
Set Standardized Protocols: Reformation in the current legislation’s related to emergency medicine in India is the need of the hour. The Paramedical and Physiotherapy Central Councils-Bill, 2007 and the addition of EMS in the National Rural Health Mission (NRHM) fund is not enough. The Government needs to work in sync with the MCI and NBE to bring in a EMS system that is systematic and well coordinated.
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