National Emergency Services-The Need of the Hour

Emergency ServicesThe other day I was at the Delhi airport early in the morning waiting for the security check to get over, when I realised there was some commotion ahead in the queue. As I moved on, I saw a man flat on his back, and a lady, apparently an air hostess trying to revive him by administering the CPR. There were a bunch of people including some security men looking on. The lady was doing her best, but it was quite apparent that she would not succeed. She appeared to be going through the motions rather than making a desperate attempt to save a life.There was no one else to help her, while many watched idly. I did not see any medical personnel or the emergency medical paraphernalia, that one would expect  on such an occasion. The man had been without a pulse for almost 20 minutes, before CPR had commenced.

How can a busy airport (brand new to boot) be without adequate medical emergency back-up? Almost a year ago when I was working for Artemis, we had proposed to the authorities to allow us to set up an emergency service at the airport. Artemis is reasonably close to the airport, has an Advanced Cardiac Life Support (ACLS) equipped ambulance service and the hospital is fully geared to manage medical emergencies round the clock. Nothing came of our proposal and the last we heard was that Indraprastha Apollo Hospitals has been awarded the contract to manage the medical room at the airport. Apollo Hospital is all of 40 kms or more from the airport and with the traffic that one usually encounters on the way, there is no way that an ambulance can reach the hospital in less than an hour. That fateful day, there was no one for at least 30 minutes from Apollo or anywhere else, to help the unfortunate man.

India attracts scores of patients from across the world, most of them benefit from the world class healthcare services now available in the country yet we do not have an emergency service that can be remotely called world class. This is a serious concern.

The government must take the lead in establishing a centralised medical emergency service through a statutory body, let us say, Medical Emergency Services Authority of India. It can work out the details of how this service will operate, the nodal hospitals, the communication infrastructure and the logistics of transporting patients to these network hospitals. It should set clear guidelines on managing emergencies (who, what, where, how),  establish internationally benchmarked service levels and establish a monitoring authority to measure efficiency and service levels

The Medical Emergency Services Authority should be allowed to set up emergency handling outlets in high traffic areas like airports, on national highways and busy malls etc. The Authority would be required to invest in the communications and transport infrastructure including paramedical personnel, while the participating/network hospitals will be responsible for patient’s care once the patient reaches the hospital.

While all this and more is possible, the key question is whether we should have private participation in something like this. I believe we should not. This is a service that should be rendered by the government to its citizens in distress. It should be paid for by the taxpayers. The government can charge a small sum from the taxpayers annually to keep the service afloat. The real challenge for the government would be to maintain high standards in the face of crippling bureaucratic controls that underlie all government initiatives. Corruption, sloth and inefficiency so characteristic of all government organisations must not be allowed to eat at the vitals of this service.

Easier said than done. Maybe the government can find another Nandan Nilekani or an E Sridharan and give him a free hand to set this up. I would like to believe if there is a will and a burning desire to accomplish something as important as setting up the National Emergency Services a way can certainly be found. It is afterall the need of the hour.

Pic courtesy http://www.flickr.com

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