From first aid to transport: The essentials of emergency medical care

Saving millions of lives would have been possible if India had a robust emergency medical response system (EMS). The EMS infrastructure in the country is still far from appropriate. A July 2021 study conducted by the country’s premier health institute — AIIMS, Delhi, found that the emergency medical care system in the country was far from adequate. The report also stated that while 91 per cent of hospitals in secondary and tertiary level centres in the country have ambulances, less than 35 percent of these have trained medical staff and paramedics to provide emergency medical care to the patients.

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According to the NCRB (National Crime Records Bureau), more than 3.74 lakh people lost their lives due to accidents in 2020. A staggering 35 per cent, i.e. 1.31 lakh victims, were involved in road accidents. While the Ministry of Road Transport and Highways (MoRTH) and the Ministry of Health and Family Affairs are undertaking conjoined efforts to reduce the fatalities caused due to lack of emergency medical response, the results are yet to be visible. It is possible to reduce the accidental death rate. However, several factors are responsible for the high casualty rate during accidents.

Here’s what to consider.

Unawareness of first aid measures

First aid is crucial for any accident victim, for it can help them recover from the shock of the mishap and keep themselves stable till help reaches them. However, a majority of Indians are unaware of the basic first aid measures. A study conducted by the MoRTH found that the condition of accident victims often deteriorated as they could not get primary care at the time of the accident. In case of accidents, it is pertinent to help the patient remain stable till the ambulance arrives at the spot. If the victim has suffered injuries leading to cuts, immediate efforts to reduce the bleeding are necessary. If unconscious, the victim should be given CPR and other essential care as quickly as possible.

Medical transport and triaging

We do not have a comprehensive emergency medical service network in India. Unlike the United States of America and several other countries, there is no unified emergency helpline number. Helpline numbers like 102 and 108 are functional in some areas, however, the ambulances operating through these helplines are often inadequate. They neither have the requisite medical equipment nor do they have Emergency Medical Technicians (EMTs) and paramedics to support the patient during the transit to the nearest healthcare facility. The Ministry of Road Transport and Highways and the Ministry of Health and Family Affairs launched the National Ambulance Code in 2016 to bring uniformity to the standards of emergency medical care. However, a considerable number of ambulances are far from the prescribed standards. The code envisaged all ambulances to upgrade to the specified norms by 2018. Irrespective of that, scores of ambulance service operators blatantly flout rules to remain in service. Moreover, the drivers and personnel on these ambulances are usually incompetent at triaging.

They do not have the ability to gauge the situation and decide on the nearest hospital where the patient can receive immediate help. However, triaging is significant during medical emergencies. Choosing the hospital where the patient can receive adequate medical care while considering his vitals and stability can play a crucial role in his revival. It can help the patient reach a suitable healthcare facility during the golden hour.

Ambulance service operated by Prabhdeep Singh’s Red Ambulance platform. (Express photo)

Medical aid during the golden hour

The healthcare fraternity has been vocal about the need for emergency medical care during the golden hour. While there are minor disagreements regarding the time frame that can be called the golden hour — the first 60 minutes following an accident or trauma. If the patient receives emergency medical support during this time, the chances of revival and survival increase. However, providing this help becomes further problematic as crucial time is lost even after the patient’s arrival at the hospital. Most ambulances do not have the ways and means to flag the hospitals about incoming patients, and the absence of central monitoring of emergency helplines adds to the woes.

India needs to develop a comprehensive emergency care network, and the masses need to be trained in first aid and primary medical care to help the patients survive. The healthcare facilities and hospitals should outsource EMS to specialised agencies and focus on the core work of providing in-house medical care as the ambulance services run by the specialised agencies are quick, efficient and effective.

The author is Founder and CEO StanPlus

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