A matter of life and death

A matter of life and death

A matter of life and death

Delhi government’s promised upgrade of its ambulance service needs to be done quickly. There are too few ambulances and many lack critical equipment. Worse, many people don’t even know that the service exists


As he drives the CATS ambulance from Ram Manohar Lohia Hospital to Connaught Place – a good location for a ambulance on standby – Rajendra Meena, 29, comments it is a “lean Monday.’

Minutes later, he is told over the wireless that an elderly man in a taxi near the Tibetan Market Janpath needs emergency medical treatment. From Palika Bazaar, the ambulance reaches the spot in five minutes. But the `Eeco taxi’ described by the control room can’t be spotted in the heavy traffic. Ten more minutes pass.

“The patient was feeling sick from the extreme hot condition. The co-passenger, who had called up the control room, decided to take him home,” says Rakesh Wadhwa, assistant ambulance officer, Centralised Accident and Trauma Services (CATS), after confirming with the traffic police.

Delhi government’s CATS ambulance system has one driver and one paramedic in every vehicle. They try to reach patients within minutes, but that is often not possible because of the traffic.

“The biggest challenge that we face at the ground level is that there is no emergency lane for ambulances. There is little awareness among citizens to make way for an ambulance. This delays the process of picking up patients,” says Wadhwa.

Doctors across hospitals agree, saying crucial time is lost due to “indiscipline” on the roads. This problem is not specific to government ambulances.

The Delhi government is now planning to carry out an awareness campaign.

“We are currently looking at the Emergency Medical Service Act which will cover these aspects once it comes into force in Delhi. In addition to raising public awareness, it has to be enforced that people stop their vehicles when they hear an ambulance siren,” says Vasantha Kumar N, additional secretary to Chief Minister and special project officer, CATS.

Currenly, CATS ambulances focus on ferrying accident victims and pregnant women. Under the project, a patient can be taken to any Delhi government, central government
or municipal corporation hospital.

“If a patient wants to be driven to a private hospital of his choice, he will be taken there. Otherwise, the driver takes a call on taking the patient to the nearest hospital,” says another CATS official.

Of the 156 vehicles, around 20 ambulances are equipped with an advanced life support system and 10 with basic life support system. The rest are just good enough to rush patients to hospitals.

However, at any given time, only 80-90 vehicles are operational, points out Narender Lakra, president of the CATS staff union. “This is due to staff shortage,” he says.
Admitting the CATS ambulance system remains underutilised, Vasantha Kumar says the scope of the service will be expanded once the planned 110 new ambulances are procured and the staff strength is increased.

“With a fleet of over 250, the ambulance system will be able to cater to entire Delhi smoothly. The focus will not only be accident victims or pregnant women but any kind patient needing transportation. We will also widely advertise the service so that the public directly call up the 102 helpline in case of a medical emergency,” says Kumar.

The numbers of drivers and paramedics are to go up to 800 each with the fresh recruits likely to be in place in the next two months. Of the new ambulances being procured, 10 will have advanced life support equipment. Vehicles with the advanced system are critical in saving lives. The capital has seen several cases in which critical patients died on the way to the hospital as no care could be provided in the ambulance.

Basic needs
Dr Siddharth Ramji, Director at Neonatology Department of Maulana Azad Medical College (MAMC) lists `basic strategies’ to improve transportation of patients to hospital.

“First, it takes the driver a while to locate the house or spot from where the call is placed. Moreover, to transfer sick patients, we require state of the art ambulances with ventilator support and nebulisers for newborns. This will mean it is less likely for patient to die en route and his condition can be constantly monitored,”
he says.

Both these criteria are missing from the existing fleet due to which critical patients often succumb before they can be brought to the hospital. In ambulances of private hospitals, a doctor is usually present along with a paramedic so that a patient can be revived while being transported to the hospital.

“Moreover, the paramedics are not trained enough at the moment. The training system needs to improve so that they are capable of providing adequate care to the patients. Lastly, the CATS ambulance should know which hospital to take the patient to and the family should not have to go hunting for beds, as has been seen in several cases,” says Dr Ramji.


Nerve centre
One of the major problems in the current system is that the CATS control room is not well equipped to handle a heavy traffic of calls. Around 12-15 staff members are deputed there, and they take between 400 and 600 calls daily. Now, the state government is overhauling the control room.

“The control room is the nerve centre. The stronger we make the control room, the easier will be operating the ambulances,” says Kumar.

The government is now coming up with a state-of-the-art control room in Laxmi Nagar in east Delhi. The services will be outsourced to tech company Wipro and there will be facilities to handle at least 5,000 calls daily.

“The control room will immediately map the location. Drivers will be provided with tablets for faster relay of information. There will also be information on the bed availability at the nearest hospital. We will also ensure pre-hospital notification so that the concerned hospital is aware of the patient being brought in,” says Kumar.

The major hospitals will be provided with screens where the patient details will be fed from the control room. The driver or paramedic will update the expected arrival time and if the patient needs immediate care.

“The new system will bring in accountability on part of the hospital. The databases will store important data which can be referred in case any patient is blindly referred,” adds
Kumar.

In the past, cases have been reported in which patients were turned away from one hospital to the other due to lack of beds, and they died before being admitted to any hospital. Currently, there is no coordination among government hospitals and doctors refer critical patients to other hospitals without ensuring if there are any beds available there at all.

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