EMS in India need not ape the west

Tags: Op-ed
EMS in India need not ape the west
COPING WITH CRISIS: In this 2010 file photo, a technician (C) of EMRI speaks on her mobile phone as she advises doctors of a patient’s condition in the rear of an ambulance enroute to hospital in Ahmedabad
With the several risks in driving, there are several accidents that occur on Indian roads; however, our country has consistently lacked support for a coordinated Emergency Medical Service (EMS) 911-like system for responding to medical emergencies until recently. The need for EMS in India is being realised and one initiative, that is, EMRI (Emergency Management and Research Institute) is the first of its kind to stand out. EMRI handles medical, police and fire emergencies through a 108 emergency service. In fact, EMRI operates a not-for-profit free service across Andhra Pradesh, Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh, Himachal Pradesh, Chhattisgarh, Uttar Pradesh and two Union territories of Dadra and Nagar Haveli and Daman and Diu.

The first good thing for Indian EMS is the partnership between EMRI and the school of medicine at Stanford University, US to train the country’s new corps of paramedics, the other being the backing of the Andhra government for EMRI. These two are the most needed ingredient for the success of Indian EMS operations at the very least. Although the advent of US — like EMS operations in India are brave initial steps in the right direction for seeing the setup of a customised Indian EMS system; yet, India should not lose the focus and effort needed in EM services to go beyond the US example. This is especially true when one considers that even after 40 years, the US EMS industry has yet to attain maturity and perfection.

Within the US alone, a number of reports have highlighted issues concerning EMS industry where the current system is reported to be overly risky, expensive and not saving as many lives as it might be designed to save (that is, cost-effective). For example, the 2007 fatal risk from ground EMS accidents in the US stood at 0.2 fatalities per million with crash fatality rate per mile being 10 times that of heavy trucks. For helicopter EMS operations (which is a growing service industry even in the US), accident rate in 2002 — 2005 was 5 accidents per hundred-thousand flight hours which is 3,000 times higher than that for the US air carrier industry. The 2008 fatal risk for helicopter EMS was 0.1 fatalities per million.

Comparing these statistics to other available, like for those of dying due to firearms, an educated risk expert would argue that the EMS operations look pretty safe and the risks in EMS are about the same as being killed by accidental bursting of a fire cracker. However, there is a catch here. The important fact is that these risks are calculated over the entire US population only because the number of personnel and patients involved in US EMS has never been tracked anywhere in the US (a pointer for India not to miss out upon). The main reasons for the increasing risks and slew of accidents involving US ground EMS operations are that in sharp contrast to other commercial transport vehicles, US ground EMS safety is not currently encompassed by either the US federal motor carrier safety administration (FMCSA) nor, formally by any other overseeing body. Similar is the story of helicopter EMS operations where there is the lack of US federal aviation administration’s (FAA) oversight of the helicopter EMS.

Then there are a number of other problems in the current US EMS system on how to check whether the people who called for a helicopter or ground EMS by calling “911” are not the ones that have non-life threatening injuries. As per a recent estimate, 69.3 per cent of trauma patients transported from the scene by helicopter EMS had “nonlife-threatening” injuries. Moreover, as some recent research has shown that the helicopter EMS has been found to reduce mortality with transport of patients with only serious trauma injuries, the transport of less serious patients might not help to make the helicopter or ground EMS cost-effective, that is, saving more lives for the same or less cost.

Although there is hope in the US that the new Obama administration would throw some light on these pressing issues with EMS operations, to ensure safety from crashes of both growing helicopter and ground EMS industry in the US what is needed is the strict FAA and FMCSA oversight of helicopter and ground EMS operations and protocols. Further, there is a need for US national transportation safety board (NTSB) to investigate the increasing ground ambulance accidents in US. If US ground EMS operations are serviced by mutual service agreements and operation protocols, this might somewhat reduce the growing costs for ground EMS industry as a whole. Yes, likewise it is desirable to enhance training for both pilots and support personnel (pilots rated for instrument flight) and the use of technology to improve pilot situation awareness and augment pilot vision in low visibility and poor weather conditions. To ensure that only patients with life threatening injuries are transported, it is suggested to use of related communication technology and training in both helicopter and ground EMS.

Although the US EMS industry still suffers from these plaguing problems, the problems concerning future gro­und and helicopter EMS operations in India could be even unique considering the burgeoning traffic on Indian roads, heavy traffic jams, and the much needed quickness of operations for emergency medical care. Thus, it is best advised that as Indian EMS operations take best from the west and become more widespread, our country does not make the same mistakes that have been widespread in the west concerning EMS operations.

(The writer is on the faculty of Indian Institute of Technology, Mandi, India)


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