Dial 108 For Rescue

The Emergency Response Service initiated by the Emergency Management and Research Institute in Andhra Pradesh will revolutionise the delivery of emergency medical services, reports Nayantara Som

EMRI’s specially-equipped ambulance

Imagine this: it is your 25th wedding anniversary—a special moment not just for you and your spouse but also for all your near and dear ones. Everything around you is joyful. Suddenly pandemonium breaks out. One of your relatives has just had an accident. His mutilated body is brought in. Amid chaos and panic, there is a heated argument about whom to call and which is the nearest hospital you should take him to.

To add to the misery, the telephone directory is not to be found and each hospital has its own set of emergency numbers. Time is running out and in the dead of the night a trillion questions cross your mind. This is definitely a medico-legal case. In such an emergency, will the doctors even accept such a case? You surrender yourself to the hopelessness of the situation because now there is nothing you can do.

Many of us have faced such edgy moments in life. All that is past now.

The 108 Emergency Response Service (ERS), which was launched by the Hyderabad-based Emergency Management and Research Institute (EMRI) in 2005 is here to efface all our apprehensions and worries.

The Project

The project, covering medical, fire and police emergencies, was launched on August 15 2005 in Hyderabad. The first call was initiated by Dr YS Rajasekhar Reddy, Chief Minister of Andhra Pradesh (AP). The President of India Dr Abdul Kalam inaugurated the service in Bhimavaram and Amalapuram on January 9, 2006.

Today, it is available in 50 locations in all the 23 districts of AP.

Need For Such Service

The need for such a service arises because the country lacks a systematic ERS, prevalent in the developed countries of the world. It is appalling that in 2006, despite progressing in other areas of medicine, India still lacks basic emergency services.

Murali Mohan, Partner in Marketing and Corporate Communications, EMRI elaborates, “In India, two lakh people face medical emergencies in a day. Maternal mortality is 1,36,000 per year; 86,000 people are killed in accidents annually and 4,35,000 more are seriously injured. More than 80 per cent of deaths in hospitals take place in the first hour of admission.”

The EMRI has thus proved to be a boon. It was born in the context of the ineffective co-ordination among multiple emergency response systems in the country coupled with an inadequate legal framework. To top it all, there was an absence of a single emergency number, trauma care facilities and basic life support ambulances. All these bottlenecks led the genesis of the EMRI.

Brains Behind The Project

The project is the brainchild of B Ramalinga Raju, Founder and Chairman of Satyam Computers and his brother B Rama Raju. Venkat Changavalli, CEO of this project explains, “The Raju brothers felt that there was no ERS in the country, no single number to dial and an inadequate transport system. Each hospital has its own set of emergency numbers which is difficult to remember.”

There was an urgent need to combine technology with saving lives within a single number. The EMRI is thus India’s 911 and in the words of Dr Prasad Rajhans, President of the Society for Emergency Medicine India (SEMI) and consultant to this project, “If call centres in India can be the back-office for the world, why can’t we have a call centre for our own country that can attend to emergency calls?”

The Raju brothers invited Venkat Changavalli, who was then the CEO of a German MNC to take charge of the EMRI project.

Setting Up The Facility

Guided by their vision to save more lives and synchronise technology with a comprehensive emergency service, the Raju brothers had invested around Rs 34 crore from their own funds in building up this service. Also, they donated 35 acres of land costing nearly Rs 70 crore for the call centre in Hyderabad.

Before the onset of the service, myriad aspects had to be taken into consideration.Specially-equipped ambulance vans and two-wheelers had to be designed. Satyam Computers designed the technology now used by the call centre.

Then they had to zero in on the number to be dialled. “We wanted a three digit, easy-to-remember number. 911 was the first option, however, it was already in use in the US. The number 112 was already in use in Europe and the police uses 100. So, we considered various options before settling in on 108,” Changavalli adds.

"The biggest advantage is that it is accessible from any landline or mobile in AP " - Venkat Changavalli CEO EMRI

Technically, 108 is a superior number: the network is faster while operating on this number. Apart from the fact that it is a toll-free number, the biggest advantage, according to Changavalli, is that it is accessible from any landline or mobile in AP.

The Modus Operandi

The ERS operates in three stages- Sense, Reach, Care. These three phases demand the meticulous synthesis of technology, people and process.

Sense

At the click of a button, a person sitting at the call centre in Hyderabad can direct the nearest ambulance to any remote corner of the state. He senses the type of emergency and the location. Dr Rajhans explains, “The Global Positioning System (GPS) and Global Information System (GIS) help in tracking the vehicle and sending it to its destination. A map showing the road routes of the entire city appears on the computer screen. Accordingly, the communications officer then collects the facts.”

The dispatch officer in the call centre then defines the problem and according to the nature of the problem, decides on the required help (fire engine/police van/ambulance).

Doctors in the call centre give pre-arrival medical instructions before the ambulance arrives.

Medical Emergencies are mainly Road Traffic Accidents (RTA) cases, cardiac, respiratory, hypertension, cancer, convulsions and obstetric. The call centre receives around 12,000 calls a day out of which 400 calls are classified as emergency calls.

Reach

The nearest possible ambulance— each costing around Rs 21 lakh— is sent to the site of the accident. At this crucial moment, there is co-ordination with the police and the fire departments. These Emergency Response vehicles are equipped with AVL devices and are designed with public and patient safety in mind. Changavalli adds, “These emergency vehicles are even modelled so as to provide maximum comfort to the patient’s relatives who are anxious and tense.”

The ambulances are equipped with patient friendly equipment like detachable stretchers, wheelchairs, life-saving drugs, ventilators, IV fluids and seat belts. Mohan says, “Thirty Advanced Life Saving (ALS) Ambulances 40 Basic Life Saving (BLS) and 30 First Responders (Two-Wheelers), ALS equipped with Bird Avian Transport Ventilator and Phillips Heart Start M Rx Defibrillator are used.” The EMRI also provides two-wheeler facilities whereby trained technicians are sent to the patient’s house to give pre-hospital treatment and instructions. There are 70 such ambulances and 302 two-wheelers in operation.

Care

Emergency medical technicians or other personnel provide pre-hospital care en route to the hospital. For medical emergencies, the patient will be transported to an appropriate facility. Trained technicians in constant co-ordination with the doctors at the call centres monitor the patient’s health and try to stabilise him before admitting him to the hospital.

Working In Tandem

This is the first ERS in the country, launched in collaboration with the Government. The Government has recognised EMRI as the nodal agency for providing ERS in AP. The Government also provides support by ensuring that the police and fire departments attend emergencies as necessary. Apart from this, it ensures that in an emergency case, especially if it is a medico-legalcase, Government hospitals accept the patients.

The performance of the 108 services in each district is reviewed by the District Executive Committee headed by the Collector. At the state level, the Advisory Committee headed by the Chief Secretary reviews the performance.

Considering the lackadaisical attitude and scepticism of the Indian Government, were there any apprehensions before venturing into a pact with the Government? Changavalli gives a positive reply: “Any project to be successful has to work in nexus with the Government. You cannot work in isolation from the Government.”

The EMRI works in nexus with almost all the private hospitals in the state. “We have entered into a Memorandum of Understanding (MoU) with 654 private hospitals in the state to provide medical help and stabilise the patient,” points out Changavalli.

What are their criteria before entering an agreement with a hospital? Mohan explains, “We sign an MoU with the hospital only after we are satisfied with the trauma care facilities provided by the hospital. Once we enter into an MoU with the hospital, they are supposed to treat the victim admitted by a 108 ambulance for the first 24 hours free of cost.”

The laudable fact of this venture is that the EMRI does not charge a single penny for its services. It selflessly carries on with its duties and responsibilities right from shifting the patient, safe transit and stabilising the patient and bringing his health under control before admitting him to a private hospital.

Diversifying To Other States

"Vilas Rao Deshmukh intends to bring this project to Maharashtra " - Dr Prasad Rajhans President SEMI

“The Chief Minister of Maharashtra, Vilas Rao Deshmukh, who visited the EMRI centre, was thoroughly impressed by this project and he now intends to bring this project to Maharashtra,” informs Dr Rajhans, who was instrumental in starting EMS in Pune earlier and now has taken over the charge of bringing the service to the rest of Maharashtra.

There were isolated attempts earlier to address the emergency services in the country. However, none of the projects were as ambitious as the EMRI project.

However, for the moment, AP is the main focus. Changavalli says, “We appreciate similar services started by a MNC or the State Government in other parts of the country. As of now we would like to operate only in AP. However, we will take the lead in helping other state Governments starting similar services in their state with the help of an NGO or a multinational company.”

The Road Ahead

Though the EMRI operation is restricted to AP, it is definitely an inspiration for all other attempts in harnessing ERS in the country. While it’s been just a year since the EMRI began its operations in AP, the organisation nurtures ambitious plans.

An official points out that one year down the line, EMRI will receive one million calls a day, and save one million lives a year by the year 2010.

This can make a world of a difference to people on the micro level and the country on a macro level.

Synergy between Sense, Reach & Care

nayantarasom@expresshealthcaremgmt.com