108 services in critical stage

The emergency ambulance services are far from the objective of covering 30 million emergencies across India and saving one million lives every year, a decade after launch

Published - June 04, 2015 10:18 am IST - HYDERABAD:

When launched in 2005, the basic objective of the 108 emergency ambulance services in the erstwhile Andhra Pradesh was to scale up operations across India covering 30 million emergencies and eventually saving one million lives every year. After almost a decade, given the frequent turmoil the 108 emergency services has seen in the last year in Telangana State, such goals appear tough to attain .

For the past few years, 108 emergency services have been saddled with strike threats from unhappy employees, uncertainty over funding following bifurcation, an ageing fleet of ambulances, shortcomings in infrastructure and last but not the least, public perception that quality of the ambulances is steadily on the decline.

So, what has gone wrong to the emergency services that held a lot of promise?

While there is not a single ‘silver bullet’ issue, experts point out that a combination of factors has hampered the services. They maintain that for any Public Private Partnership (PPP) like 108 services to function successfully, there needs to be a trust between the stakeholders. “Success of PPP model depends on trust between both parties or it won’t work. What I have personally experienced over the years is that one needs to have a passion to operate an innovative concept like 108 emergency services. As there is no profit in this service, the private partner should realise that the services are meant to save lives and not make money,” feels Advisor, Government of Uttar Pradesh (Health and Home), Venkat Changavalli.

Mr. Venkat, widely acknowledged as one of the architects of Emergency Management and Research Institute (EMRI), pointed out that transparency is needed in PPP models. “The challenge in PPP is maintaining transparency. One has to make sure EMRI continues to function independently and neither the State government nor private institute can meddle in its functioning” he says.

Many also agree that success of emergency medical services usually depend on the well being and respect given to the field-level healthcare workers - first responders in trauma cases.

“You have to show some respect to the emergency medical technicians and pilots who put their lives at risk for others. Almost all our members work for more than 12 hours per day and yet are treated shabbily by the management. We are not on rolls, do not have contracts, health insurance coverage etc. It’s as if our members do not exist,” complains president, Telangana State 108 Employees Union, Mahender Reddy.

In state of poor fitness

There are 316 emergency 108 ambulances across Telangana and most were procured between 2005 and 2008. They have run more than five lakh kilometres and have also reached their mandatory cut-off retirement age of five years.

Inside the ambulances, emergency medical equipment too needs replacement. The 108 ambulance service technicians point out that vital medical equipment to save victims of trauma, snake bites, medical pregnancies etc need replacements. “There are instances when BP monitors have shown reading even in dead bodies. Almost all ambulances do not have vital medical equipment like pulse oxymeter, blood pressure monitors and equipment to provide immediate relief to snake bite victims. Sometimes, even our stretchers do not work well,” reveals an EMT technician.

EMRI response

Chief Operating Officer (COO), GVK EMRI, Brahmananda Rao has maintained that all is not lost, as far as 108 services are concerned in Telangana. “There are close to 316 ambulances. By August, we are expecting to add 290 new ambulances to the fleet. We have 121 ambulances that have been operated for more than five years and have crossed five lakh kilometres. The government has already released the funds for acquiring the new ambulances,” the COO, EMRI said.

The TS government has already come with a tender to acquire new medical equipment that is needed to provide medical services to trauma cases. “Already the orders to procure close to 485 medical equipments for 108 emergency vehicles are underway. We are very hopeful that in another two months’ time, the ambulances will be fitted with the new medical equipment,” COO, EMRI said.

“EMRI continues to be resource constrained”

Chairman, Emergency Medicine, Kingsbrook Jewish Medical Centre, Brooklyn New York, Dr. Vijay Akkapeddi had played a vital role in procurement of the first few 108 emergency ambulances that were flown in from USA. The emergency medicine specialist shares some of his views on the 108 emergency services.

“I have always applauded the idea and concept of EMRI, but have also felt that it continues to be resource constrained. It is only funded by State governments and not by the Central government. The ambulance services are inadequate when you compare the number of ambulances for the population served. Public awareness is also needed, there is a lot of competition from ad hoc networks and there are not many MoUs between 108 and other hospitals. There is a dilemma on how the receiving hospitals treat patients who do not have the paying ability.

Traffic clearance for emergency vehicles should be priority. In New York City with similar traffic congestion, there are 500 ambulances serving a population of 8.5 million and these ambulances are in strategic locations instead of ambulance bases. Daily call volume is 4,000 per day, average transport time is just 20 minutes, distance is less than three kilometres and each ambulance averages 18 assignments in a day.

There is a definite need of a national debate on emergency care and funding and how to upgrade, integrate public and private hospitals care standards. There is a need to define the role of EMS, also review the care rendered in the emergency departments like well-trained staff. There is a definite need to address premature mortality and morbidity, which is often preventable with well co-ordinated approach.”

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ON A NOBLE MISSION

108 services at a glance

1. There are 316 emergency 108 ambulances in the ten districts of Telangana

2. Hyderabad and Ranga Reddy have 58 ambulances that are operational.

3. All these ambulances were purchased between the years 2005 and 2008.

4. A majority of the ambulances are past retirement, which is 5,00,000 km in 5 years.

5. The ageing fleet of 108 needs an urgent upgrade.

In need of attention

1. Present ambulances are suffering mechanical problems frequently.

2. There are niggling issues with collapsible stretchers and digital BP monitors.

3. Several ambulances have concerns with battery power backup for the internal systems.

4. Pulse oxymeter, medical equipment needed to handle poison victims seldom work.

Plans for a revamp

1. New ambulances will be added to the fleet shortly.

2. By August, the GVK EMRI is expecting to add 290 new ambulances to the fleet.

3. Additional personnel including pilots and EMT specialists are being trained.

4. Special training classes planned on behavioural change of emergency health care workers.

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