‘’Emergency department beds, should be five per cent of the total bed capacity of the hospitals’’

Achieving specialised emergency medical services in India is the need of the hour. However, this can be made possible only by creating infrastructure that suits an ideal emergency unit. Dr Paresh Navalkar, HOD-Pre Hospital Care, Ziqitza Health Care Limited (ZHL) explains to Raelene Kambli the need and pre-requisites for specialised infrastructure for emergency medical services in India

Infrastructure in hospitals has become a major safety concern for public health in India, especially with incidences such as the AMRI fire and the wall collapse in Kasturba Gandhi Hospital that resulted in the loss of many lives. What should be the infrastructure prerequisites for a hospital emergency unit in order to deal with in-house tragedies?

Dr Paresh Navalkar

Hospitals are mandated to have a ‘Hospital Emergency and Disaster Response Plan’ but unfortunately, even if one is prepared, it remains only on paper. But in actuality, training is needed to execute the plan and carrying out an ‘Emergency Management Exercise’ once a year is absolutely necessary to identify the gaps, review the plan and make necessary changes to it. The plan is dynamic and prepared for the existing infrastructure, manpower, patient needs and in alignment with the disaster plan of the local authorities. During exercises, structural and processes weaknesses come to fore and get focused attention. This, in turn, helps to take corrective measures in order to prevent impending disasters within the hospitals.

Describe an ideal emergency unit. What are the basic infrastructure requirements for the same?

Emergency department beds, going by the thumb rule, should be five per cent of the total bed capacity of the hospitals with a capacity to handle a surge in cases of mass casualty incidents or disasters. It should have a dedicated area for triage and decontamination. There should be demarcated beds for each triage priority with all the necessary equipment dedicatedly provided alongwith a fully equipped resuscitation area, nursing station, stores, doctors’ consulting room, documentation counter and waiting area for relatives.

What are the aspects that are needed to be considered while designing an emergency unit within emergency medical vans?

Emergency ambulances are of two types – basic and advanced. They should have sufficient space within them to permit emergency technicians (EMTs) to work on the patient. The design of the interior and placement of equipment should be at an arm’s length from the head of the patient, where the EMT sits. The equipment should be kept in standardised locations across the fleet for smooth functioning. The labelling of the drawers and containers is a must. Infection control systems and biomedical waste storage facility should be on board.

A basic ambulance should have oxygen delivery systems, suction device, spine boards, scoop stretchers, adjustable patient trolley with restrains, devices for monitoring patients’ baseline vitals, bandaging, splinting, resuscitation kit (adult and infant), AED, laryngeal tube, delivery kits, nubuliser, glucometer, medications- adrenaline, salbutamol respules and first aid kit.

An advanced ambulance, over and above the equipment should have a defibrillator, transport ventilator, advance airway management devices and medication for use under online medical guidance (as per the approved systems).

Tell us about your experience of setting up EMS units in various states within the country. What were the infrastructural challenges that you faced during the endeavour?

Each state has a different requirement depending on its needs. So in order to cater to those needs, we create client specific infrastructure and SOPs. The challenge is not in creating infrastructure but in getting the right manpower to work on the ambulance and their training since till date we do not have a trained EMTs pool.

Are there any kind of guidelines that you follow while establishing an EMS unit?

The best practises that are followed in the developed countries like the UK, the US are adopted. As we are supported by the London Ambulance Service and our partners are the US’s largest ambulance providers we have in-house access to the world’s best practises and processes. We adopt them, but after amending them to suit Indian conditions and available infrastructure.

How can we build better infrastructure for emergency medical services in India? What is the need of the hour?

To build EMS systems, the ambulance structure, design and certification of equipment should be standardised at the national level by taking inputs from EMS system operators. National EMS councils should be established to facilitate this process and to review it from time to time. Similarly, state EMS councils are a necessity to oversee, regulate and develop the EMS systems. National registry of EMTs has to be maintained.

The Emergency Medical Technician Course’s content for basic and advanced EMS programme which has been approved by the Society of Emergency Medicine should be adopted as the National Standard Curriculum. This will ensure high quality of training and uniform assessment of the paramedics.

Standardised training modules for drivers, with higher emphasis on safe driving, need to be adopted. They too have to be trained in first aid.

EMT-B and paramedics should be recognised as allied healthcare professionals to attract talent in this sector and develop jobs and growth prospects.

[email protected]