City medical emergency services in limbo

City medical emergency services in limbo
The Hindu

In a city that has some of the best speciality medical care, emergency medical care is a glaring area of neglect. Why are our hospitals ill-equipped to deal with such cases?


Bangalore: On January 1, three-year-old Mallappa, son of a construction worker, suffered a serious injury when a van ran over him as he was playing near a pavement in Kanteeravanagar.

The blood vessel in his thigh was cut, and his distraught parents took their profusely bleeding son to four hospitals — K.C. General Hospital, the National Institute of Mental Health and Neurosciences, Vani Vilas Hospital and Indira Gandhi Institute of Child Health. Every hospital turned him away because they did not have a vascular specialist to attend to him.

He was finally treated at Victoria, six hours after the accident took place.

On Saturday last, Spandana Suresh of Annasandrapalya developed hypertension-linked breathing difficulty. Her husband, Suresh Babu, tried to revive her through artificial respiration but she seemed to be sinking.

"I first called Manipal Hospital for an ambulance. Not wanting to wait I also called the CTC-Sanjeevani ambulance on 1062. Although they could only reach my house in around 30 minutes, the immediate medical attention saved her life, said Mr. Suresh.

Both Mallappa and Spandana survived their ordeal. Not everyone, who has an accident or a medical emergency, is that fortunate. Several people die because they do not get emergency medical help in time.

Casualty

According to a study conducted by the Comprehensive Trauma Consortium (CTC), in Bangalore, 22 per cent of persons injured in accidents die before they get pre-hospital care; 10 per cent die while in transit to a medical centre, and 68 per cent die after they reach a hospital because they have not received trauma care in time. This picture reflects the abysmal state of emergency medical services, including ambulance services, in city hospitals.

Where ambulances are actually able to reach trauma victims, the traffic and bad roads make it almost impossible for them to reach hospitals in time.


What ails medical emergency services in this otherwise high-tech, globally competitive city?

Last year an average of three persons died and 17 were injured every day in traffic related accidents in the city. This constitutes only one segment of those who need emergency medical care.

For trauma victims, every second counts. Yet, there are only around 150 ambulances in the city, and most of them are ill-equipped.

There are around 45 organisations operating ambulance services apart from the 16 government hospitals. The costs of private ambulance services at Rs. 350 to Rs. 450 for a 10 km radius are yet another disincentive for their use.

Poor people usually use an autorickshaw to take the victim to hospital.

"The city does not have a proper ambulance network for trauma victims to reach the hospital within the golden hour. We rarely get calls for ambulances as they usually do not reach on time because of traffic snarls. Besides, most people do not know which ambulance service to call so depend on their own vehicles,"

Precious time

Mabel C. Vasnaik, Head of Emergency Medicine at the St. John's Medical College Hospital, said. Her hospital gets around 25 emergency cases a day.

She added that it was not practical to send an ambulance from one end of the city to the other in such situations. "Precious time is lost in transit" Dr. Mabel said.

According to N.K. Venkataramana, founder of the Comprehensive Trauma Consortium (CTC), Bangalore has the best system in place compared with other major Indian cities, although it is underutilised. The CTC is a non-profit organisation instituted to facilitate quick trauma care for accident and medical emergencies before patient reaches the nearest hospital.

"The CTC has network of 35 hospitals and we run an independent and fully-equipped ambulance service called Sanjeevani with 27 ambulances. Emergency calls on the number 1062 are directed to a central control room and when they get a call, ambulances with trained paramedics that are stationed at important points are sent to the accident spot," he said.

However, because of the lack of awareness among the public about this facility, only 20 per cent of CTC services are used, Dr. Venkataramana said.

V. Ashok Kumar, Medical Superintendent of Victoria Hospital, said: "Most ambulances are ill-equipped to give pre-hospital care and none of the drivers are trained to handle trauma patients," he said.

"The ambulance should ideally be equipped with a heart monitor, a defibrillator, an echocardiogram, oxygen supply, intra-venous fluids and blood substitutes (in case of loss of blood)," Dr. Venkataramana said. It must also have trained paramedics.

Bangalore hospitals have a long way to go in getting a prompt, efficient, affordable and well-networked trauma care system in place.

Stuck in the middle

While road widths in the city remain the same, the number of vehicles on the roads is nearing three million. The death toll from road accidents was 915 in 2006.

"We have instructed traffic policemen at signals to turn off signals and make way for ambulances," said Deputy Commissioner of Police (Traffic-East), M.A. Saleem. However, ambulances are often caught in traffic jams. "We are helpless in such situations," Mr. Saleem confessed.

He added that the traffic police do not object when ambulances flout one-ways and jump signals, but this could only cause more accidents.

He added that even when the siren is on, not many people give way. There have been several instances when the patient died while the ambulance is stuck in traffic, he added citing an example of a Central Government official in National Games Village in Koramangala, who passed away because the ambulance was caught in traffic and arrived too late.

The Golden Hour

According to the World Health Organisation, "Golden Hour" is defined as the first hour after injury, during which time it is important to administer first-aid and ensure the victim is out of danger. If first-aid is administered within the first hour after injury by trained paramedics or qualified doctors, the victim can experience better quality of life post-trauma.

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