In the first part of our series on ambulance services in the city, Citizen Matters focused on the challenges and memorable moments in the lives of ambulance crew serving the city and state.
Running an ambulance service is truly exciting work. It is a heart filling service that includes saving the lives of strangers in the quickest way possible, says Uma Maheswari, IAS, Project Director, Tamil Nadu Health Systems Project, Government of Tamil Nadu. 108 ambulance services are operated under the Public Private Partnership framework by GVK EMRI (Emergency Management and Research Institute), a not-for-profit organisation and the Tamil Nadu government.
In a candid interview with Citizen Matters, Uma Maheswari, who leads operations for Tamil Nadu, explains the day-to-day challenges faced by the team and various projects in the pipeline. She provides insights into the measures required to be followed by patients’ families and hospitals, so that more lives can be saved. Excerpts from the interview:
How many ambulances operate in Chennai? How is the demand?
A total of 930 ambulances run across Tamil Nadu, with 50 of them being operational in Greater Chennai. As the demand has been growing each day, the state government has been increasing the fleet consistently. On an average, the vehicles run around 47 lakh kilometres during a month, cutting across the entire state.
How many calls do you receive on an average during a day, especially in Chennai? Are there typically any particularly busy days of the week?
We receive more than 15,000 calls a day. We receive 40 per cent more cases on a Sunday than on a weekday. This has been the new trend in Chennai, unlike a few years ago, where Sundays used to be peaceful. This is closely connected to the change in lifestyle of Chennaites, who have been going out more during weekends.
What are the roles of an ambulance pilot and Emergency Medical Technician?
Three key aspects which we emphasise while training ambulance crew are assessment, immobilisation and resuscitation. The crew should be spontaneous enough to analyse the criticality of the patient and take requisite measures. In most of the injuries, the patients should be immobilised in order to prevent fatalities and stop permanent disabilities. For example, if a patient has a cervical collar fracture, mobilisation would lead to death. If a patient has no pulse and is not responsive, Cardiopulmonary Resuscitation (CPR), should be done to restore him back to life. The crew in the emergency services are given intensive classroom training, at hospitals and in the ambulance on various aspects including anatomy, physiology, common emergencies and treatment protocol.
Which is the primary equipment that should be present in any ambulance for life support?
Pulse oximeter to check pulse and saturation levels of the patient, blood pressure monitoring apparatus, glucometer, thermometer, suction apparatus, stethoscope, IV Fluids, splints, oxygen cylinder and emergency drugs are the basic checklists.
What are the ways by which citizens can reach the 108 ambulance service?
A quick phone call to the toll free number (108) would connect to the service. However, the best way is to call through the ‘Avasaram 108’ mobile application which sends the location of the patient to the Emergency Response Centre that disseminates the information to ambulance pilots. This GPS-enabled application reduces the response time, since the family members do not need to explain their location in those moments of trauma and panic.
Could you throw some light on the procedure that takes place at the back end, when a person calls for help?
Once a call is made to the service, our Emergency Response Centre team would get in touch with the nearest ambulance pilot and communicate the address and details of the caller. All the ambulances are GPS-enabled, which helps us track the journey.
What is the mantra that needs to be followed by the crew in an ambulance?
‘Do no harm’ — This is the mantra that should be followed by the crew in emergency medical services. If you are sure of emergency support, be quick. If you don’t, it is better to not do anything. For instance, a critical head injury patient should not be given water, as it may lead to aspiration and pose a threat to life.
What is expected from the hospitals and families?
In many hospitals, there are no separate parking lots for the ambulances, which thwarts rapid access. Every hospital should accept patients unconditionally and stabilise them first. Local institutions should be strengthened so that patients in critical condition are given time for revival.
Tell us about the 104 medical helpline. Is there enough awareness about it?
104 is a 24-hour health helpline service that sensitises the public about the dos and don’ts in case of any emergency. Patients can also resort to the 104 helpline if they have any complaints regarding government health facilities and 108 ambulance service. 104 acts as a directory for callers seeking information on nearest government health centres, blood bank, eye bank, speciality treatment centres etc. across the state. The helpline provides physiological and psychological advice and counselling through trained doctors, psychologists and paramedics. 104 can also be accessed for organ donation.
Awareness is consistently growing. The patronage from rural pockets has been especially encouraging. However in order to enhance awareness, a mass viability campaign is in progress presently. All government health facilities will have posters on 104 to ensure that it is on top-of-the-mind recall.
Technology wise, how good are we in running 108 ambulance services? Are we at par with the developed countries ?
We are certainly at par with the developed countries. On certain parameters, we are in fact ahead of certain global benchmarks. Fitting of GPS devices, live tracking of ambulances through GIS and ‘Avasaram 108’ for citizens to call 108 with precise GPS location are some of the technological advancements we’ve made in recent times.
Considering that the service has been at the receiving end of a backlash over inadequacy in the number of vehicles, are there any new projects in the pipeline?
Emergency Care Centres are intermediaries that help to revive and stabilise a critical person, until he is admitted in a hospital. Chennai has three such centres at Injambakkam, Tambaram and Red Hills and would soon be getting ten more centres in a phased manner. We shall also be steadily increasing the number of ambulances and replace older vehicles with new ones.
While appreciating the fact that numbers of ambulances is sought to be increased, it would be equally important to see that accidents are avoided to the maximum possible extent. In Chennai we have got very broad roads with good road margins and pedestrian passages. But thBut the pity is all the road margins and pedestrian platforms are being encroached by business people , hawkers, hoteliers and other home owners, thus disabling the pedestrian public form using these passages. Often times thes pedestrians are forced to walk on the main roads, because of the illegal occupation of these passages, and there number of instances, the pedestrians involved in accidents. So, by the encroachments , the Very purpose for which the pedestrian passages are intended for is defeated, making the pedestrians inevitably walk on the main road and getting themselves involved in accidents. So, if the pedestrian passages are cleared, it would be a major steps towards minimizing accidents.