Mumbai: Emergency Medical Services (EMS) are critical to providing timely care to those in need of immediate medical attention and transporting them to the nearest medical facility in case of road accidents, heart attacks, strokes and various other medical emergencies. EMS are broadly categorised 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 India’s Constitution ‘right to life’, if any hospital fails to provide timely medical treatment to a person results in a violation of a person’s ‘right to life’. Almost 23 per cent of all trauma is transportation-related in India, with 13,74 accidents and 400 deaths every day on roads. The rest of the 77.2 per cent of trauma is related to other events such as falls, drowning, agriculture-related, burns, etc. According to World Health Organisation (WHO), India has the highest snakebite mortality in the world estimated at 30,000 every year.
According to a study titled ‘Emergency and Injury Care at District Hospitals in India’ (This study was carried out with the financial support of NITI Aayog, Government of India, and conducted by the Department of Emergency Medicine, JPNATC, AIIMS) the country witnesses more than 150,000 road traffic-related deaths, 98.5 per cent ‘ambulance runs’ transporting dead bodies, 90 per cent of ambulances without any equipment/oxygen, 95 per cent of ambulances having untrained personnel, most ED doctors having no formal training in EMS, misuse of government ambulances and 30 per cent mortality due to delay in emergency care.
The study further highlights medical emergencies including road traffic injuries (RTIs) are one of the major leading causes of death in India. RTIs alone contribute to 1.5 lakh deaths annually. Approximately two persons died of heart attack every hour in 2015-16. Currently, non-communicable diseases alone account for ~62 per cent of deaths in India and communicable infections, maternal, and newborn account for ~27 per cent of deaths. Most of these deaths present as emergency conditions. In fact, as per one estimate, more than 50 per cent of deaths and 40 per cent of the total burden of disease in low-middle-income countries could be averted with pre-hospital and emergency care. The global total addressable deaths and disability-adjusted life years (DALYs) that can be averted amount to 24.3 million and 1023 million, respectively. In fact, in South-East Asia alone, 90 per cent of deaths and 84 per cent of DALYs are due to emergency and trauma conditions. The emergency care system in our country has seen uneven progress. Some states have done well, while others are still in the budding stages. Overall, it suffers from fragmentation of services from pre-hospital care to facility-based care in government as well as in the private sector. The system also suffers from the lack of trained human resources, finances, legislation and regulations governing the system. The absence of a standalone academic department since its inception is another factor for the current ails in the system.The need for EMS
The concept of emergency medical services in India is comparatively new. The nation has two different, yet overlapping publicly funded ambulance systems. They are recognised by helpline numbers, 108 and 102. The two ambulance systems have more than 17,000 ambulances across States/UTs. The allocated federal fund for ambulance services in 2013-2014 was $59 million.
“Emergency conditions such as acute coronary syndrome, stroke, respiratory diseases, maternal and pediatric emergencies and injuries are the leading causes of death and disabilities in India. Trauma is the leading cause of death among young, who often are the sole bread earner of the family,” noted Dr Randeep Guleria, Chairman-Institute of Internal Medicine and Respiratory & Sleep Medicine and Director-Medical Education, Medanta in his message for the study ‘Emergency and Injury Care at District Hospitals in India’.
Dr Guleria further added, “The landscape of emergency care includes timely access and acute care delivery to critically ill and injured patients. Premature death and disability-adjusted life years (DALYs) can be prevented by establishing a robust integrated emergency care system with definitive care.
Sharing his views on the need for emergency medical services, Dr Tushar Parmar, Chief Intensivist & Critical Care Coordinator – New Projects and Acting Head of Emergency Medicine, Sir HN Reliance Foundation Hospital shared, “In the last couple of years, we have seen a surge in communicable diseases such as COVID-19 and the role of emergency medicine in triaging and treating them with utmost care has been challenging. There is a persistent increase in footfall at every hospital and the primary caregivers are emergency department. In Mumbai, it’s approximately a 50 per cent rise in footfall after the peak pandemic time for other diseases and illnesses.”
EMS in India suffers from the fragmentation of services from pre-hospital care to facility-based care both in government and private hospitals. The system also suffers from the lack of trained human resources, finances, legislation, and regulations governing the system. The biggest challenge for EMS has been infrastructure and manpower. The majority of the hospitals that have been operating for years don’t have proper infrastructure for emergency services.
“We don’t have a proper infrastructure in most hospitals which have been running for ages. Newer hospitals are coming up with the concept of an emergency department (ED). But still, ED is considered a stop-gap arrangement rather than a proper department,” added Dr Parmar.”
India is one of the world’s most populous countries, and many of its citizens are unaware of the availability of emergency medical services in the country and the available emergency services aren’t adequate. Rural and remote regions suffer not only from the lack of awareness but also from the availability of primary healthcare services. These regions also are hard to reach and it becomes increasingly difficult to reach these patients and provide them with medical aid or to transport these patients within the ‘golden hour’ to medical facilities which are located far from these regions.
Need for emergency response infrastructure
Emergencies and accidents are a common sight in a vast country like India. The situation is worsened by the lack of proper infrastructure and trained emergency medical personnel.
Commenting on the need for an emergency response infrastructure, Prabhdeep Singh, Founder and CEO, StanPlus said, “In India, it takes an ambulance 45 minutes on average to get to a patient, and these kinds of delays frequently result in fatalities. This is why having a robust emergency response system in place, with advanced life support (ALS) ambulance and medical personnel on call, is critical.”
“In many parts of India, particularly rural areas, there are no hospitals or ambulance services available. Therefore, patients suffering from heart attacks often have to wait hours for medical assistance. One way to address this issue is by having a robust emergency response platform with all live-saving capabilities till the last pin codes of India. This way, if someone does suffer a heart attack, they can be quickly transported to a hospital for treatment,” added Singh.
Healthcare providers improving their EMS
EMS in India is still in its infancy phase but now many students are looking to pursue emergency medicine as a career option. Many organisations are also providing fellowship of the same still-growing branch with limited resources and understanding.
“Many new institutions are collaborating with institutes abroad for improving their clinical skills. Many emergency Indian organisations are also working for the same cause. The way we are developing I think the level of care is improving and it will be up to the standard of care,” shared Dr Parmar.
“Care of emergency and accident patients is of paramount importance in saving lives, preventing disability and achieving the intended health goals of the nation. However, accident and emergency services in India has witnessed uneven progress. Given its extraordinary importance, it is time that India embarks on creating a world-class, efficient, professional and integrated system, enabled by technology, for the care of any victim of an accident, emergency or trauma in any part of the country,” penned DR VK Paul, Member (Health) Niti Ayog in his foreword for the study ‘Emergency and Injury Care at District Hospitals in India’.
EMS in India has witnessed uneven progress, and some regions have done well while others are in the process of building better EMS infrastructure. Physical care and treatment cannot be replaced, building better infrastructure and improving caregiver experience and qualification will also be the key.
India may have to deal with this crisis for a few more years and over a period of time, the nation can build a robust emergency medical service system that caters to those in need across the length and breadth of the country by deploying technology and strengthing the healthcare and EMS infrastructure.