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 

Disease burden (Daly’s) for ten leading causes
YEAR 1999	Year 2020
Disease or injury	Disease or injury
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

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.