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Mumbai: Emergency Medical Services (EMS) are critical in providing timely care to those who require immediate medical attention and transport to the nearest medical facility in case of road accidents, heart attack, stroke and various other medical emergencies. EMS are broadly categorized into basic life support (BLS) and advanced life support (ALS).
The provision of emergency services is enshrined in the Indian constitution. According to Article 21 of Indian Constitution “right to life”, failure of any hospital to provide timely medical treatment to a person results in violation of “right to life”. Almost 23 percent of all trauma in India is transport-related, with 13.74 accidents and 400 deaths every day on the roads. The remaining 77.2 percent of trauma is related to other events such as falls, drowning, agriculture, burns, etc. According to the World Health Organization (WHO), India has the highest snakebite mortality in the world estimated at 30,000 every year.
According to a study titled “Ambulance and Injury Care in District Hospitals in India” (this study was funded by NITI Aaiog, Government of India and conducted by the Department of Emergency Medicine, JPNATC, AIIMS) the country witnesses more than 150,000 deaths of road traffic cases, 98.5 percent of ‘ambulances’ transporting dead bodies, 90 percent of ambulances without any equipment/oxygen, 95 percent of ambulances have untrained staff, most ED doctors have no formal emergency training, misuse of state ambulances and 30 percent of mortality due to delays in emergency care.
The study further highlights medical emergencies including road traffic injuries (RTIs) which are one of the major leading causes of death in India. RTIs alone contribute to 1.5 million deaths annually. Around two people died of a heart attack every hour in 2015-16. Currently, non-communicable diseases alone account for about 62 percent of deaths in India, and infectious maternal and neonatal infections account for about 27 percent of deaths. Most of these deaths are emergencies. In fact, according to one estimate, more than 50 percent of deaths and 40 percent of the total burden of disease in low-middle-income countries could be prevented with pre-hospital and emergency care. Total global addressable deaths and preventable disability-adjusted life years (DALIs) are 24.3 million and 1023 million, respectively. In fact, in Southeast Asia alone, 90 percent of deaths and 84 percent of DALIs are due to emergencies and trauma. The emergency aid system in our country is showing uneven progress. Some countries have done well, while others are still in the development phase. Overall, it suffers from fragmentation of services from pre-hospital care to care in government and private sector facilities. The system also suffers from lack of trained human resources, finance, laws and regulations governing the system. The absence of an independent academic department since its inception is another factor for the current problems in the system.Need for EMS
The concept of emergency medical care in India is relatively new. The nation has two distinct but overlapping publicly funded EMS systems. They are identified by the helpline numbers, 108 and 102. The two ambulance systems have more than 17,000 ambulances across the states/UTs. The federal funding allocation for emergency services in 2013-2014 was $59 million.
“Emergencies such as acute coronary syndrome, stroke, respiratory diseases, maternal and child emergencies and injuries are the leading causes of death and disability in India. Trauma is the leading cause of death among young people, who are often the sole breadwinners in the family,” noted Dr. Randeep Guleria, Chairman of the Institute of Internal Medicine and Respiratory and Sleep Medicine and Director of Medical Education, Medanta in his message for the study “Emergency and care of injuries in district hospitals in India’.
Dr. Guleria further added, “The emergency landscape includes timely access and delivery of acute care to critically ill and injured patients. Premature death and disability-adjusted life years (DALIs) can be prevented by establishing a strong integrated emergency and terminal care system.
Sharing his views on the need for emergency medical care, Dr. Tushar Parmar, Chief Intensivist and Coordinator of Intensive Care – New Projects and Acting Head of Emergency Medicine, Sir HN Reliance Foundation Hospital, said, “In the last few years, we have seen an increase in infectious diseases such as COVID-19 and the role of emergency medicine in triaging and treating them with utmost care is challenging. There is a steady increase in the number of people in every hospital, and the primary caregivers are the emergency department. In Mumbai, that’s roughly a 50 percent increase in the number of people since the peak of the pandemic for other illnesses and diseases.
EMS challenges
EMS in India suffers from fragmentation of services from pre-hospital care to institutional care, both in government and private hospitals. The system also suffers from lack of trained human resources, finance, laws and regulations governing the system. The biggest challenge for EMS was infrastructure and manpower. Most hospitals that have been operating for years do not have the proper infrastructure for emergency services.
“We don’t have proper infrastructure in most of the hospitals that have been working for years. Newer hospitals are coming up with the concept of an emergency department (ED). But still, ED is seen as a hurdle and not a proper department,” added Dr. Parmar.
India is one of the most populous countries in the world, and many of its citizens are not aware of the availability of emergency medical services in the country, and the available emergency services are not adequate. Rural and remote regions suffer not only from a lack of awareness, but also from the availability of primary health care services. These regions are also difficult to reach and it is becoming increasingly difficult to reach these patients and provide them with medical assistance or to transport these patients in the “golden hour” to medical facilities located far from these regions.
The need for emergency infrastructure
Emergencies and accidents are a common sight in a vast country like India. The situation is exacerbated by the lack of adequate infrastructure and trained emergency medical personnel.
Commenting on the need for emergency infrastructure, Prabhdeep Singh, Founder & CEO, StanPlus said, “In India, an ambulance takes an average of 45 minutes to reach a patient, and such delays often lead to deaths. That’s why it’s critical to have a strong emergency response system, with advanced ambulance (ALS) and medical personnel on call.”
“In many parts of India, especially in rural areas, there are no hospitals or emergency services available. This is why heart attack patients often have to wait hours for medical help. One way to help solve this problem is to have ambulances on standby at public events or concerts. This way, if someone has a heart attack, they can be rushed to a hospital for treatment,” Singh added.
Healthcare providers are improving their EMS
EMS in India is still in its infancy, but now many students want to pursue emergency medicine as a career option. Many organizations also provide scholarships to the same branch which is still growing with limited resources and understanding.
“Many new institutions collaborate with institutes abroad to improve their clinical skills. Many Indian emergency organizations are also working towards the same goal. “The way we’re developing, I think the level of care is improving and it’s going to be up to the standard of care,” said Dr. Parmar.
“The care of emergency and emergency patients is of paramount importance to saving lives, preventing disability and achieving the nation’s health goals.” However, accident and emergency services in India have seen uneven progress. Given its paramount importance, it is high time that India moves to create a world-class, efficient, professional and integrated technology-enabled system for the care of every victim of accident, emergency or trauma in any part of the country,” wrote DR VK Paul, member (health) Niti Aiog in his foreword to the study “Emergency and Injury Management in District Hospitals in India”.
EMS in India has witnessed uneven progress, with some regions doing well while others are in the process of building better EMS infrastructure. Physical care and treatment cannot be replaced, building better infrastructure and improving the experience and qualifications of carers will also be key.
India may have to deal with this crisis for a few more years and over a period of time, the nation will be able to build a robust emergency medical system that serves those in need across the country by deploying technology and strengthening healthcare and emergency infrastructure.
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