Report No. 201
Pre-hospital Care: Equipped Ambulances and transport
The British Medical Journal noted in one of its reviews on 'trauma' issues that society seems to accept a lower standard of safety for road users than for other modes of transport. In India, the problem is more acute due to shortage of trained surgeons to handle accident trauma, poor diagnostic infrastructure in government hospitals and because of grossly insufficient ambulance services in rural and semi-urban areas. Trained personnel staffing professional ambulance services will make a world of difference. The British Journal states that for accident victims, the golden hour is a continuous process beginning with the care that is given in the ambulance en route to hospital; this protection is vital for survival rates.
Dr. P.V. Jayashankaran and Dr. P.C. Raja Ravi Verma, in an article in the 'Hindu' magazine section (dated Oct. 16, 2005) have, after giving statistics about accidents globally, and in India and Tamil Nadu state are as follows:
"the chances of survival are bleak as we truly lack an awareness of the most important service, the pre-hospital care'. 'any tragic accident can be construed to be a success or failure within the first 10 minutes of medical attention as this is the time when the most important decisions are to be taken. It is here that the concept of the Golden Hour comes into play. The concept can be better understood if one were to learn the primary (Trimodal) causes of death in major accidents. In fact, the London blasts highlighted the case of an explosion in a double-decker bus that went off near a conference hall hosting a meeting of medical practitioners. The prompt medical care made available by the various specialists is a case in point.'
About the pre-hospital facilities available in UK, the authors say that in the United Kingdom the support systems are quite effective. The National Health Services has well-equipped ambulances with top class personnel (para-medicals) to manage accident victims throughout the country under a single umbrella. These ambulances rush to the spot and effectively avert any tragedy within the early minutes by way of proper assessment of the injuries and they quickly transport the victims to the nearest hospitals. By the time the victim reaches the hospital, he or she is almost saved and in becomes easy for starting definitive treatment.
In India, according to the above authors, the situation is different. Whenever an accident occurs, the focus on saving the life of the victims gets diluted due to the fear of subsequent legal procedures and due to paucity of people with an awareness of the importance of pre-hospital care. What is required is a well maintained, state-of-the-art ambulance with oxygen, intravenous infusions, life-saving drugs, splints, defibrillators and ventilators. Well trained para-medical staff must be available at all times in the ambulance.
The government has formed a number of Emergency Accident Relief Centres (ARCD) through which the ambulances are sent to the scene of accident but there is dearth of qualified para-medical personnel who can assess or assist a victim. 32 Centralised Accident Trauma Services (CATS) ambulances, says a Delhi Report (Express Newsline, Aug. 25, 2005) were imported from Japan in the year 2000 at a cost of Rs.17.50 lakhs each and of them, only 18 are functional. Compared to the early Omni-vans and Gypsies that were used as ambulances, the CATS Ambulances are more spacious and have medical facilities fitted inside the ambulances.
The advanced equipment in big vans, says a paramedical, were previously not available in the Omni Vans or Gypsies. In case there is a serious road accident, if the ambulance is not well equipped and if paramedical personnel are not available in the ambulance, the transport facility does not qualify for being recognized as a pre-hospital care facility.
His Excellency the President of India Shri A.P.J. Abdul Kalam in his inaugurated address at the Annual General Meeting of the Indian Red Cross Society and St. John Ambulance, New Delhi on October 17, 2004 strongly pleaded for an integrated and institutionalized approach for emergency response. He suggested a scheme, in which whenever an accident occurs, a message could be sent to the nearest ambulance team and immediate medical help is arranged for.
He also recommended for formulating a legal mechanism for providing such emergency support in critical situations. He disapproved the tendency among people to avoid coming to the succour of accident victims, fearing medico-legal issues. He said that hospitals demanding the presence of the police and the completion of formalities before they could start treating the patients are undesirable (see an article Challenges of Emergency Management in India by Anil K. Sampada, published in Indian Emergency Journal, vol.1).
As of now in India, there is no proper legal framework to (1) encourage citizens to report and come out to give help to the accident victims without fear of harassment, (ii) to mandate all doctors and hospitals to attend accident victims and provide all medical facilities for stabilizing patients in emergency, (iii) establish trained paramedics for pre hospital care during transport (iv) to aid and implement trauma care system regardless of jurisdictional boundaries.
In the light of the number of accidents in the country, the indifference of those who witness an accident in offering prompt assistance on account of the likelihood of facing to comply with legal formalities, lack of ambulances with well equipped medical facilities or para-medical staff, it is clear that the situation needs to be remedied by corrective action. We are proposing draft legislation as a step in this direction. It is first necessary to certain laws relating to emergency medical care in other jurisdictions. It is first necessary to certain laws relating to emergency medical care in other jurisdiction.
