Emergency Medical Systems in India Posted by webmaster
on July 18 2007
India has experienced rapid growth in most conventional fields of Medicine and presently enjoys the availability of expertise, well trained personnel and state-of-the art equipment. However, Emergency Medicine and its close ally, Emergency Medical Systems i.e. pre-hospital care, have suffered a prolonged phase of hibernation.
By and large, ambulances continue to ply between medical institutions, carrying stable patients on inter-hospital transfer errands or to the homes of the deceased as glorified hearses. These ambulances were driven by drivers, who had no formal training as ambulance officers. Other than the major metropolitan cities there are no organized EMS systems and mostly are operated by private agencies as a business.
Pre-hospital care has been a slow but progressive development in the major cities of India and is clearly spreading to smaller towns.
The Government of India has established the golden quadrilateral, a well-planned four-lane highway connecting the four major directions of India. Along this highway, First Aid stations have been erected and are equipped with an Ambulance with basic facilities and with a driver. The drivers undergo basic training in first-Aid and their goal is to expedite transfer of patients from the Accident site to the nearest Government Hospital or to the medical centre of the victims preference. The system has been operational since the beginning of 2006, and authentic date is yet to be published.
From the perspective of an emergency physician, I am pleased that rapid transport systems have been established. However, emergency medicine is not yet a recognised specialty in India and there are no recognised training programmes for physicians as well as pre-hospital personnel.
It is important to remember that Trauma is just but a part of Emergency care. Non-Trauma emergencies comprise of 70-95% of all medical Emergencies experienced by the society. Therefore, the quality of care rendered to these victims of trauma as well as medical emergencies in poorly organised and inefficiently functioning emergency departments is not expected to significantly improve the overall morbidity and mortality of patients. In other words, it is superfluous to develop EMS without concurrent development of the standard of Emergency Departments.
In 1994, India witnessed the advent of the first formal Accident and Emergency Department at the Christian Medical College Vellore. Subsequently, teaching institutions in Bangalore, Chennai and the Apollo group of corporate hospitals started to formulate Emergency Departments. The first training program in Emergency Medicine was a 1-year Fellowship program started at CMC Vellore in 1997. The trend remained so until Ramachandra Medical College in Chennai, a deemed University, started a 3-year MD in Emergency Medicine, inspite of the fact that the specialty was not yet formally recognised by the Medical Council of India. This bold move has sent clear signals to the country that the need of the hour has been identified and yet not accepted by the Medical Council of India.
The Society of Emergency Medicine India (SEMI) was started in 1998 and this organisation is a group of physicians either working in emergency departments or patrons of emergency care. Associated with this organisation was the development of pre-hospital personnel which was initiated in the private sector medical institutions at Hyderabad, Chennai, New Delhi, Bombay and Pune. The process of development of such training institutions has progressed significantly and the latest addition is The Emergency Management and Research Institute (EMRI) in Andhra Pradesh.
The first National Workshop for pre-hospital Care personnel was during the National Conference of Emergency Medicine in 2005 and the response and turnout was overwhelming.
I am optimistic that India is now at the threshold of a new era of Emergency Medical Care. My recommended strategy for the government is to adopt a 3-pronged approach and all issues to be concurrently and synchronously developed:
a) Recognise the specialty of Emergency Medicine and implement postgraduate training in this specialty in medical colleges under the Medical Council of India. This would then ensure that Emergency Departments in all teaching institutions and District level Goivernment hospitals are staffed by full-time fully trained Emergency Medicine specialists.
b) Recognise the need and the existence of pre-hospital personnel. This would ensure that Government EMS systems would be staffed by trained Ambulance Officers and not drivers.
c) Formulate a single telephone number and bring all EMS systems under 1 umbrella so that the public would prefer to utilise their services rather than use private vehicles and public transport systems to bring unstable patients to the hospitals for Emergency Care.
It is my fond hope that Emergency Medicine as well as EMS would be subjected to a major thrust by the government in order to improve the quality of Emergency Care in our country.
Prof. Suresh S. David MS (Surg) MPhil FACEM CMC Vellore 632 004
very well written article. i would add one more prong to the strategy u have suggested- regulation/improvement of simple road traffic rules amongst the common man- afterall injury prevention is as important as injury treatment.
