Sudipta was riding his bike at around 10:30 PM in Bhubaneswar when, all of a sudden, an ox ran across the road. Upon swerving his vehicle, he lost balance and fell off his vehicle which caused a fracture on his right hand and a bleeding wound on his head.
Emergencies are not a rarity in our country. Statistics show that an estimated 300,000 emergency cases, medical and non-medical, are recorded in the country every day, with 9.5 percent of the population being affected by an emergency annually. Of these, 80 per cent are medical emergencies. India has about severe 480,000 road accidents every year, and 33 percent of these are fatal, according to a 2016 report by the government’s Transport Research Wing.
In the US, only 2% of accident victims die. This difference in survival is mainly because of the lack of access to quality treatment in the first or “golden hour” of the accident. As a rule, 80 percent of deaths in medical emergencies occurs during the first hour.
In 2004, 10% (4,000 people) of all who died in India annually, lost their lives because of untreated or badly treated injuries according to a report by the National Human Rights Commission.
While most people assume that road accidents make for the most ambulance calls, it is, in fact, cardiac arrests that lead to more medical emergencies in India. According to the Accident-Statistical Year Book 2016, India has just a one per cent success rate in preventing deaths or permanent disability in the event of a cardiac arrest, another important category of emergency victims. In contrast, the success rate in the US was five to six per cent as far back as the early 1980s.
India’s EMS is largely ambulance driven. And that’s a big problem because ambulances are not cost-effective.
Running an ambulance-heavy EMS is expensive, and is not very effective in saving lives, in an emergency, in low-income countries like ours, as only several dozen ambulances serving a population of 10,000 will have the potential to save lives. After deployment, which happens after an ambulance is available, the wait stretches for 15-40 minutes for the dying victim in an urban area. In rural India, things are much worse.
The Indian Emergency Journal in its August 2005 issue states, “Twelve percent of institutions in the trauma care sector have no access to ambulances. Only fifty per cent of the available ambulance services possess the acute care facilities needed to keep an accident victim alive during transportation, and only four per cent of personnel staffing these services have certified formal training”.
Loads of people cite the high costs of First-Responder training as a barrier to initiate First-Responder programs in our country, but studies show a different reality.
Contrary to what people think, training lay responders and paramedics can be relatively cost-effective as compared to the cost of ambulatory services as a study conducted in Turkey found that ambulance vehicle costs were the leading component of capital costs in EMS (Altintas, Bilir, and Tuleylioglu 1999). The cost per ambulance trip was US$163, and the cost per patient transported was US$180.
These above numbers are saddening especially when simple life-saving techniques can be used to prevent lives in such emergencies. Multiple studies have shown that lives of 50% of the victims can be saved by helping them in the first hour, also called as the “golden” hour.
A First-Responder is a lay-person who receives basic first-aid care training and volunteers to respond to appropriate medical emergencies while an ambulance is en route. In several countries, people are actively recruited to provide first aid and initiate pre-hospital emergency care. A growing body of literature supports this low-cost, effective practice to save vulnerable lives. Having a network of medically trained volunteers in each city can make a world of a difference in a country like India, where countless lives are lost on the way to a hospital or while awaiting medical help.
One such organisation in India providing a one-stop healthcare platform for anybody who requires help in an emergency is G1 Health. First-Response is one of the crucial parts of this ecosystem, which provides first aid to patients of cardiac, ‘neuro’, obstetric, accident and trauma patients until professional or ambulatory help is available. The immediate aim of this program is to train over one lakh citizens in basic life-saving skills, starting with Hyderabad.
In the second part of the story mentioned in the beginning, Sudipta who was injured from the accident, immediately raised an emergency through the G1 app on his mobile to alert nearby First-Responders, and ambulances in order to get help. Ramakant, a First-Responder, who was nearby received a notification on his First-Responder App. Ramakant accepted the request and via GPS directions, arrived at the incident spot where Sudipta was, and then performed first-aid on Sudipta to stop the bleeding from the wounds. Since there were no ambulances nearby, Sudipta was taken to the nearest hospital in a fire station jeep.
This is one among many incidents which shows the power of an integrated emergency care ecosystem made possible by mobile-enabled technology. In another story, a police officer in Hyderabad trained on First-Response stepped forward to help an accident victim in need of help and provided first-aid by stopping the bleeding and cleaning the wounds.
The vision of the First-Responder program is to make India emergency ready by creating a network of First-Responders capable of providing basic life support in case of common emergencies like cardiac arrest, stroke, delivery-related emergencies, and road accident trauma cases before an ambulance arrives.
There is no doubt that a community First-Responder driven EMS will see many lives getting saved through prompt action by lay First-Responders. It’s about time that all players in the Indian healthcare space step up to give our people this chance at saving precious lives.
This article is an extract of the white paper ‘Scattered Saviours: Why First-Responders are the Future of the Indian Emergency Care Management System?’ which can be downloaded for free here.