30 Minute Interview

'The Service would Reduce Accident-related Mortality by 90 per cent'

In India, an average 24 trauma accidents take place per 10,000 vehicles every day as against only two such accidents in the US. In Mumbai, the ratio is 40 trauma accidents per 10,000 vehicles. While the fatality rate in road accidents are up to 20 per cent, for train accidents the casualty rate is at least 50 per cent. Thus having an EMS facility in Mumbai is sine qua non. And that is where the American Association of Physicians of Indian Origin (AAPI), which has about 42,000 doctors of Indian origin as its members, has played a key role. AAPI has been instrumental in getting together private and public hospitals in Mumbai to initiate EMS facility in Mumbai, the first phase of which is going to kickstart from June, this year with 25 ambulances. In his recent visit to Mumbai, Dr Navin C Shah, Co-Founder and Past President of AAPI and also Past President American College of Int'l Physicians, spoke to Rita Dutta about the significance of the service.

Dr Navin C Shah Co-Founder and Past President of AAPI

Please brief us about how the EMS and Trauma Centre in Mumbai came about? What area is the facility is planning to cover?

The project is based on our US experience of running EMS for 30 years. In the US, by calling the toll-free 911, in matter of minutes, EMS is made available without any discrimination or concern about patients financial status. The hospital is ready to receive the patient with all the necessary staff present right in the hospital premises so as to provide prompt and proper medical care. The police enquiry occurs after the patient is fully stabilised.

The Mumbai project will have one dedicated telephone number for the patient connected to the command center through which fully equipped and manned ambulances will be dispatched to reach the patient in matter of minutes. The '1298 Dial For Ambulance' service, an Ambulance Access for All (AAA) venture set up in 2005, will now be extended to the entire city. A dedicated fleet of 70 ambulances, each costing Rs 20 lakh, will be put into service to provide medical care within minutes. The AAA already has a fleet of 10 such ambulances. The first phase would start from June, this year with a fleet of 25 ambulances.

In addition, there are a dozen of ambulances, which are with the hospitals, will also join the service. The ambulance would have all the facilities available in an operation theatre. One doctors, one assistant, oxygen, other required machines would be placed inside it. On the way, the attending doctor would start consulting an expert physician of any nearby hospital and take the patient to the hospital best equipped to deal with the problems. The service would reduce mortality rate due to road accidents by 90 per cent. This project will cover the whole of Mumbai-metro area.

What would be the various levels of participating hospitals?

There are four levels of hospitals. Level one will have presence of general surgeon, anesthesiologist, emergency room physician, OR staff, respiratory therapist on the premises round the clock. It should have availability of thoracic, cardiac, neurosurgery and all other surgical sub-specialties. This would have availability of CT scan, MRI, lab facilities, OR and ICU facilities, specially equipped area in emergency room dedicated for trauma patients, trauma education and research facilities.

Level two is same as Level one but without neuro and cardio surgery, along with trauma education and research facilities. Level three would have surgeon and sub specialists on call - available in 30 minutes at the hospital. Level four would have resuscitation and stabilisation facilities for seriously injured patients.

Who are the major participants?

Four medical school hospitals, ten major private hospitals and 10 Government and municipal hospitals along with ambulance services. We are expecting participation of over 100 hospitals and nursing homes.

What has been AAPI's role in this?

AAPI is one of the participant in the training of the local medicos. Recently, I met the Maharashtra Chief Minister Vilasrao Deshmukh, Health Secretary A Khan, Joint Municipal Commissioner GS Damle and chief executives of 10 top hospitals. For the project, I have obtained full support of training of four Mumbai surgeons in the US (air fare and local hospitality paid) trauma centers.- American College of Surgeons, International College of Surgeons and Shock Trauma Center of UMD at Baltimore.

Will the ambulances be graded, the way Gujarat has done it as patient transfer vehicles, basic and advanced ambulances?

We are yet to decide that.

What is the command structure of the system?

Connected to call center for dispatching the ambulance and for communications with all concerned.

Will this be seen as a social service or a profitable venture?

This is both private and public undertaking for all affected. The payment will be as per patients' economical capabilities. In all cases, services will be rendered first.

Why do you think there was delay in starting an EMS facility in Mumbai, when Hyderabad, Pune, Ahmedabad and Bangalore have started it long time back?

Mumbai model connects hospitals as per their facilities's levels and makes the appropriate available to patient to obtain the best in that time frame.

Who would monitor the facilities and how?

The Board and the Executive Committee, which is already created for Mumbai project. The board would consist of heads of all participating hospitals with representatives from ambulance service, state government, fire brigade, police, municipality, and US. Dr Gustav Daver, Medical Director of PD Hinduja Hospital will be the chairman and Lokmanya Tilak Hospital Dean Dr YE Yeolekar will be the secretary of the board.

The Executive Committee would consist of chairman, secretary, treasurer, executive secretary and US representative. The function of the administrative body is continual quality improvement, CME, mortality and morbidity conference, peer review, technical staff and physician training, site and equipment inspection, organ procurement, trauma registry and liaison with US bodies.

EMS facilities in few cities are using GIS, GPS and wi-fi. What kind of advanced technology be used in the Mumbai facility? Who would fund such an initiative?

No, additional technology would be added. The existing facilities available at various hospitals - as per their designated levels-would be used. All participating hospitals will provide the needed services. There is a talk that BMC would give Rs 2 crore. Details for additional funds are still being worked out.

rita.dutta@expressindia.com