HELPING HAND
Emergency Care, Risk & Disaster Management in Kashmir
Public health challenge
Hidden epidemics & there after role of EMERGENCY MEDICAL SERVICE
The concept of EMS is very new in our part of world but unfortunately in
Jammu and Kashmir it’s still at conceptual stage.
The need has been felt primarily because of conflict and now
a new Public Health challenge has come up which has taken shape what I call it
“hidden epidemic “in J&K that is RTA (Road traffic accidents).
In state of Jammu and Kashmir In the present
times, injuries are the most serious health problem facing the community
whether measured in premature deaths for families , rupees costs, hospital
visits, , or lost productive years of life. Though the means for preventing
many injuries and reducing the resulting disability or death are available yet
they are often ignored.
In
addition to the direct costs of injuries and deaths, the increase in the number
of vehicles has other serious health implications as well as wider social,
economic and environmental impacts. These “hidden epidemics” receive relatively
little attention of policy makers and society.
The epidemic of road traffic injuries is still in
its early stages, but it threatens to grow exponentially unless there is swift
action to counter this problem The trend of injuries has changed over the last
few years in Kashmir, with Road Traffic Accidents (RTA) have overtaken
militancy related incidents.
In recent years more deaths and injuries have
been recorded as being caused by RTA than militancy acts.Limited data
available in the state, clearly depicts, that we have been caught by new public
health challenge as we had 1896 deaths and 2193 injuries as compared to 5060
deaths and 40497 injuries from RTA alone, which should have pressed panic
button among policy by now makers and come up with comprehensive
EMS system scientifically customized to need of locals
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Disease burden (Daly’s) for ten
leading causes
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YEAR 1999
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Year 2020
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Disease
or injury
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Disease or injury
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1. Lower respiratory infections
2.HIV/AIDS
3. Depression
4. Perinatal conditions
5. Diarrhoeal diseases
6. Chronic obstructive
7. Ischemic heart
8. Infections
9. Road traffic
10. Pulmonary disease
|
1. Ischemic heart
2. Uni polar major
3. Road traffic injuries
4. Cerebro -vascular
5.Pulmonary
disease
6. Lower respiratory
7. Tuberculosis
8. War
injuries
9.Diarrohoea diseases
10 .H.I.V
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It is terms like ‘The
Golden Hour’ and the ‘Platinum
Ten Minutes’ that typify the importance of Emergency Medical Services (EMS) all over
the world. It is a well-accepted fact that a patient who receives basic care
from trained professionals and is transported to the nearest healthcare
facility within 15-20 minutes of an emergency has the greatest chance of
survival.
EMS is an essential part of the overall healthcare system as it saves
lives by providing care immediately. It’s this recognition that has led to
research and development in EMS.
Over the years several advancements have been made and research is
underway to create services that provide medical assistance to patients at the
earliest. However, the state of EMS varies drastically from developed to
developing countries like India.
In spite of the development in the healthcare sector over the past
decade, India is yet to create a single, comprehensive EMS that can be accessed
throughout the country
As compared to developed countries with proper emergency systems in
place, there is no single system which could play a major role in managing
emergency medical services in India.
There is a fragmented system in place to attend the emergencies in
the country. 102 is the emergency telephone number for ambulance in parts of
India. There are different emergency numbers in India’s 28 states and seven
Union Territories. Hospitals in the country provide different telephone numbers
for ambulance services. Clearly, India is in need for proper emergency medical
service that can be accessed from anywhere in the country.
The existing fragmented system falls terribly short of meeting the demand
that could provide emergency care with equity of access. In a bid to address
this problem,
The Silvering lining being ,in recent EMS congress held in DELHI where
in it was decided to setup a committee for having a national ambulance code for
country although there are few organisations which are running successfully
The Centralized Accidents and Trauma Services (CATS) was set up by the Delhi
Government in the early 1990s. Unfortunately, it didn't succeed
despite having a toll free number (102) that was made available through
More recently, NGOs and hospitals have come forward to provide their own
EMSs. There have been considerable efforts by states across India to develop
emergency services. Organisations like Emergency Management and Research
Institute (EMRI) otherwise struggling EMS system.
EMRI was founded in 2005. To begin with, its operations were limited to
Hyderabad and Andhra Pradesh with a vision of responding to 30 million
emergencies and saving 1 million lives a year. EMRI handles medical, police and
fire emergencies through its 108 emergency service.
EMS is activated by a universal, centralized, enhanced ’ dispatching
system run by the SCDF utilizing Computer Aided Dispatch, Medical Dispatch
Protocols, Global Positioning satellite (GPS), Automatic Vehicle Locating and
tracking devices (AVLT) Systems and Road Traffic Monitoring Systems. They are
able to provide basic life support and defibrillation and some advanced life
support treatments like laryngeal mask airway insertion, intravenous fluid,
adrenalin,
Emergency services in most of these countries are regulated by
statutory legislation's or acts, which helps to maintain the standards of the service in
terms of ambulance standards, manpower training and recruitment, emergency
rescue dispatch, first response and subsequent patient handling.
Emergency Services in India Counting on betterment
Ambulance service is vital component of EMS it’s no longer just a vehicle but service as Savior it has to
deal with life and death ,such able to tackle a minor ailment and major disaster. Ambulance services
are part of the first line in the continuum of health care. They respond to
medical emergencies and accidents, and ‘treat and transport’ or ‘treat and
leave’ patients.
The primary role for Ambulance Service is to meet emergency pre-hospital
care needs, including telephone triage, dispatch and communications activities
to support the emergency work, to be fully effective, and the handover from the
Pre-hospital care phase of treatment to other health care providers needs to be
seamless.
India requires a better emergency medical service to meet the growing
number of emergencies. What exists currently in the form of fragmented services
across the country falls way short of meeting the requirements.
The prearranged emergency services currently operate via an emergency services
contact system with dedicated telephone one country one number, missing in the
current system, and one that will be needed, is a body to regulate the EMS in
the country.
EMRI in Hyderabad claims saving 55,000 lives in one year ,but there is no
way to validate these claims and introduce corrective measures.
Awareness
Awareness of the available services and preparedness are mandatory among
the general public for the success of an EMS service. People also need to take
initiative in knowing about the services being provided by available EMS.
Indeed, an EMS that people are not aware of is as good as non-existent.
One of the reasons for the reportedly success of EMRI is that 108 is widely
recognised and has a great recall among citizens. “People’s participation is as
important as blood donation and such cooperation is an important aspect of
emergency medical relief service
The demand for legislation for EMS has been rising steadily in India.
Supporters of such legislation opine that it would mandate a common access
number, formation of an EMS council, trained paramedics, gradation of ambulance
and hospitals, network of hospitals and define physical and human resources
needed for the service. This could help save lives by making access easy for
all the patients. Methods, technology, personal skills need to be standardised with
formation of legislation in emergency services to provide protection for the
providers.
Conclusion
The importance of a reliable EMS cannot be overemphasized especially in India
where the government has the responsibility of caring for a majority of the
population. It can be argued that a nation of a billion people has been
deprived of a decent EMS for too long now and it is high time the government
takes definitive action. The success of a few services is evident enough of the
need for EMS and what it will take to ensure that it works as expected. In a
healthcare system that is sprouting and experiencing the benefits of involving
private players, a public-private partnership framework could be the right way
forward for policy-makers. At a time when the emphasis on preventing damage is
greater than ever, the provision of pre-hospital care will be the key to ensure
that lives are not lost due to avoidable circumstances.
Scope of EMS in Kashmir:
Only silver lining is this gloomy scenario is the Department of Health
Kashmir has conceptualized a comprehensive EMS project wherein they have divided Kashmir
division in three zones north, south and central Kashmir.
They plan to setup ERTC`s (Emergency Room Trauma Centres) and where
in the proposed centres will be “the state of the art “trauma centres with
all Operative and diagnostic facilities will be available and
the staff will be trained and certified in BLS (Basic life support), ALS (Advance life support) ACLS (Advance cardiac life support & ATLS
(Advance trauma life support) which is international requirement now days to
work in any good hospital.
The studies have proved the doctors and paramedics trained in these
protocols defiantly make difference between life and death.
They have also proposed to set up Ambulance services confirming to
international norms to be accompanied by trained EMT (paramedic) and
driver with all required necessary equipment's and Drugs
besides extrication kits and AED (automatic external defibrillator) with the
response time of 10 minutes.
Patients attended by these proposed 108 EMS Ambulance`s will be
transported to these ERTC centers for further treatment and if they
need advance medical care at tertiary care hospitals they will
transported in ALS /critical ambulance, Which surely will help in saving lives.
