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- Model for Integrated Services for Evacuation of Casualties CIDM 12 th Feb.2009

- Model for Integrated Services for Evacuation of Casualties CIDM 12 th Feb.2009. Dr. G V Ramana Rao MD, DPH, PGDGM,ACLS, ITLS Executive Partner , EMRI, Hyderabad. Structure of presentation. Responding individual emergencies – EMRI Way MCI and DM – EMRI efforts

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- Model for Integrated Services for Evacuation of Casualties CIDM 12 th Feb.2009

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  1. - Model for Integrated Services for Evacuation of Casualties CIDM12th Feb.2009 Dr. G V Ramana RaoMD, DPH, PGDGM,ACLS, ITLS Executive Partner, EMRI, Hyderabad

  2. Structure of presentation • Responding individual emergencies – EMRI Way • MCI and DM – EMRI efforts • Evacuation of Casualties – NDMA – MPMCE & CIDM • Model EoC

  3. Changing the World The experience of EMRI as India’s First and Only Professional Integrated Emergency Response Provider

  4. Emergency Scenario in India Until 2004 • 300,000 emergencies occur per day (108 M p.a.) • 80% are at the bottom of the pyramid • 80% deaths occur in hospitals in the first hour • 4 M deaths p.a. • Absence of 4 As • Access • Availability • Affectionate Care • Affordability

  5. Vision • To provide Free emergency response services for Medical, Police and Fire emergencies across India by 2010 in PPP (Public Private Partnership) framework • To respond to 30 million emergencies and save 1 million lives annually by 2010 • To deliver services at global standards through Leadership, Innovation, Research & Training and Technology • To be recognized as best-in-class • With the following architecture of 9 elements

  6. 1. NPO • EMRI a Non-profit organisation (commenced in 2005)

  7. 2. PPP(Public Private Partnership) Govt. of Karnataka Govt. of Punjab Govt. of Tamilnadu Govt. of A.P. Govt. of Gujarat Govt. of Rajasthan Govt. of Goa Govt. of Assam Govt. of Meghalaya Govt. of MP Govt. of Uttarakhand • EMRI architecture and performance led to the following PPP (Public Private Partnership) framework • Up to 95% of expenses by Government (Public) • EMRI to contribute a minimum of 5% of expenses towards costs of Leadership, Technology (Process, Medical & Research) and provide free IT solutions • Management by EMRI to sustain long term performance at International quality and speed

  8. 3. Leadership • Is not Charisma, Public Relations, Showmanship • Is performance consistent behaviour and trustworthiness • Is Thinking, Doing and Communicating • Is setting Direction, Aligning and Motivating • Is creating an environment of continuous learning • Learning doesn’t end with school or college • You must learn throughout you life - never cease to be a student

  9. 3.1 Partnerships Rishmond Ambulance Authority, USA Satyam Computer Services Geomed Research Public Health Foundation of India American Assoc of Physicians Of Indian Origin (AAPI) Shock Trauma Center, USA National Emergency Number Assocoation 911 NENA, USA Singapore Health Services American Academy for Emergency Medicine in India Carnegie Mellon University, USA City of Austin USA Stanford University, USA 9

  10. 4. 1-0-8 • Single toll free number ‘1-0-8’ accessible on land and mobile phones • Significance of 1-0-8 in • 11 X 22 X 33 • Sacred number in Hinduism in many ways (Pillars, Nama Japa, Krishna dances with 108 Gopies, Natraja dances in 108 poses) • Distance of the sun from the earth divided by the diameter of the sun • In Japan, at the end of the year a bell is chimed 108 times to finish the old year and welcome the new one. Each ring represents one of 108 earthly temptations a person must overcome to achieve Nirvana • Number of minutes cosmonaut Yuri Gagerin orbited earth during the first manned space flight • The number of stitches on a base ball

  11. 5. ERC • 24X7 Unique Emergency Response Center staffed with trained Communication, Medical and Police personnel

  12. Computer Telephony Integration Voice Loggers GIS / Maps GPS / AVLT Mobile Communication Application software for Sense, Reach and Care ePCR (Electronic Patient Case Record) Form 6. Technology Sense Care Reach prevention

  13. 7. Ambulance • Ambulance design based on best of class - Indianized

  14. AMBULANCE EQUIPMENT SPIINE BOARD WHEEL CHAIR AUTOLOADER SCOOP AIR LIFTING S T R E T C H E R S E X T R I C A T I O N T O O L S

  15. MEDICAL EQUIPMENT SUCTION APPARATUS AUTOMATED EXTERNAL DEFIBRILLATOR VACUUM SPLINTS VENTILATOR

  16. 8. Research • Medical Research • Effectiveness of interventions in specific emergency conditions • Integration with hospital care • Innovations in interventions, capacities and capabilities MR • Systems Research - Best-practices in EMS / prevention of emergency • Processes • PCR • Prevention • Education and Training SR • Operations research (Analytics) • Predict future state of healthcare, disease incidence • Better utilization of resources • Reconfiguring processes OR

  17. 9. Training • Pre-hospital Care / Emergency Medicine Training in collaboration with Stanford

  18. Today at EMRI Kerala • 12,300 + EMRI Associates • 6,800 + Private Hospitals / Nursing homes (31% in AP and 15% in Guj - patients admitted in pvt hospitals) • 2,000 Police / Fire Stations • 368 M population covered in 9 States • 91% calls taken in first ring • 8,950 emergencies handled (3.3 Million annualized) • 1,582 Ambulances - 6 trips a day • < 10 minutes (2/3rd of RTA and Cardiac) ambulances reached • < 15 minutes (73% of urban) and < 25 minutes (68% of rural) Ambulances reached • 100% virtual handholding (in ambulance) by EMTs and physicians • 130+ lives were saved (51,000+ till now) and 8,820 victims received timely, high-quality pre-hospital care Jammu & Kashmir Himachal Pradesh Arunachal Pradesh Punjab Uttarakhand Haryana Delhi Sikkim Rajasthan Uttar Pradesh Assam Nagaland Bihar Meghalaya a Manipur Jharkhand West Bengal Mizoram Gujarat Madhya Pradesh Tripura Chattisgarh Orissa Maharashtra Andhra Pradesh Goa Karnataka Tamil Nadu

  19. Medical Emergencies - AP

  20. Medical Emergencies - Gujarat

  21. Follow-up after 48 hours - AP

  22. Extraordinary Performance from Ordinary People 3 Hour Neonate (Baby Girl) Buried Cyclist– Fell on road divider rod Firing - Between Army Commanders and Naxalites Robbery – Thief requested wife to dial 108 after 10 minutes to take the injured husband to hospital

  23. Pre-Hospital Care Process-EMRI • Pre- Arrival Instructions (PAI) • Pre-Hospital EMT Care – Standing Orders • On-Line Medical Direction by ERCP • PCR Documentation

  24. EMRI MCI and DM

  25. EMERGENCY MANAGEMENT INFRASTRUCTURE CAN ALSO BE LEVERAGED IN DISASTER MANAGEMENT SITUATIONS May 18 blasts, Hyderabad “EMRI took off a lot of the burden from our shoulders by arriving on time and taking up the responsibility of getting the injured persons to hospitals.” - Government of Andhra Pradesh • Bomb blasts at Mecca Masjid area in Hyderabad injuring 40 and killing 12 • EMRI deploys ambulances immediately after the first call • Victims transported by EMRI to local private and government hospitals with treatment on the way “I reached the hospital on the 108 ambulance… the person on the ambulance removed a splinter from my arm” - Victim

  26. – Bihar floods / Ahmedabad blasts Disaster and Post-Disaster experiences

  27. Learning in simulated environment

  28. Interaction with Dr. APJ Kalam

  29. Thank you www.emri.in

  30. MCI- Important Roles – On site and Transportation • Ambulance Incidence Officer (AIO) • Triage Officer(TO) • Treatment Area Supervisor (TAS) • Treatment Area Officer (TAO) • Logistic Officer (LO) • Equipment Officer (EO) • Ambulance Parking Officer (APO) • Ambulance Loading Officer (ALO) • Safety Officer (SO) • Public Information Officer (PIO)

  31. MCI workshop

  32. Essential elements for IAN • Strategy partnerships • Strategic support – technology, training and research • Size and scale • SOP • Skills set • Surface ambulances • Site experiences • Simulation • SLA

  33. Evacuation of Casualties – NDMA- MP-MPE- Major Recommendations – Ambulances

  34. Evacuation of Casualties – NDMA- CIDM- Medical Emergency Plans

  35. Integrated EoC Services -EMRI and NDMA • Computer – Cellphone Integration (CTI) • Ambulance network • Community Awareness (VoiCE) • Preparedness &Mock Drills (Medical/Police/Fire/ Railways) • First Responders (> 3000 trained and handbook) • Emergency Medical Technicians and Paramedics (PGPEC) • Standard Operating Protocols (SO,MD,CCPs,MCI) • Hospital Network (>6000 MoUs) • Documentation (Pre-hospital Care Record PCR)

  36. Evacuation of Casualties • Decontamination • Triage • Resuscitation • Treatment • Transport

  37. Conclusion • EMRI can significantly contribute in EoC in an in MCE and CIDM with relevant and specialized support from NDMA and thereby model Integrated Services for Evacuation of Casualties.

  38. Thank you www.emri.in

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