Emergency Management and Research Institute

1. Emergency Management and Research Institute A Nonprofit Organisation in PPP Taking a Giant Leap Established in April, 2005

2. Values Involving people (Leadership) Applying knowledge (Innovation) Making things happen (Execution)

3. Managing Non-Profit Organisation through Leadership, Strategies (for Marketing, Innovation and fund development), Defining and Measuring Performance, People Relationships and Self Development

4. A Beautiful Mind of Thinking, Doing and Communicating (TDC) • Thinking (Concepts, Models, Metaphors & Stories) • Doing (Metrics, Processes, Automation & Planning) • Communicating (Effective reviews, Presentations & Proposals) • Operating Principles • Simplicity • Problems as opportunities (No man ever injured his eyesight by looking on the bright side of things) • Ask a million questions • Leverage knowledge and technology • Virtuality • Continuous improvement (6 Sigma)

5. Enlarging Wellbeing of the World • A human being is born into this World fully equipped not only to take care of himself, but also to contribute to enlarging the wellbeing of the World as a whole • Many people never get any opportunity during their lifetime to unwrap the wonderful gift they are born with and they die unexplored and World remains deprived of their creativity and contribution • Some get the chance to explore their potential to some degree • Lastly but importantly, few get chance to explore their potential fully

6. Leadership • Initial funding provided by Raju Brothers ( US $ 23 M of property and US $ 12 of Cash ) • Thought Leadership provided by Governing Board • B. Ramalinga Raju, Founder and Chairman, Satyam • B. Rama Raju, Co-Founder and CEO, Satyam • Rajat Gupta, McKinsey • KV Kamath, MD&CEO, ICICI Bank • Tarun Das, Chief Mentor, CII • Prof. D.Raj Reddy, Carnegie Mellon University • Krishna Palepu, Harvard Business School • Dr. Jayaprakash Narayan, Lok Satta • Krishnam Raju, Chairman, Suchitra Group • Venkat Changavalli, CEO, EMRI

7. Inauguration of 108 services in Hyderabad - 15th Aug, 2005

8. Inauguration of 108 Services in Bhimavaram by President of India, Dr A P J Abdul Kalam 9th January, 2006

9. Inauguration of 108 Services to Rural Andhra Pradesh by Chief Minister of Andhra Pradesh, Dr Y S Rajasekhara Reddy – 26th January, 2007 and to be completed by May 2007

10. Andhra Pradesh Larger Presence in 50 Cities / Towns and 18 Districts completely (Medak, EG, Chottor, Krishna, Guntur, Adilabad, Ananthapur, Warangal, Karimnagar Rangareddy, Nalgonda, Srikakulam, Vijayanagaram, Visakhapatnam, West Godavari, Nellore, Prakasam and Khammam) excluding rural areas of 4 districts and 9 ITDAs covering 65 M population with 380 Ambulances

11. 10,500 Lives Saved Different emergencies compared to developed countries Injuries 34 % Cardiac 16 % Suicides 13 % Stroke 10 % Respiratory 5 % Diabetes 5 % Epilepsy 3 % Pregnancy 3 % Pediatric 2 % Abdominal 2 % Burns 2 % Animal Bites 1% Electrocution 1 % Drowning 1 %

12. Achievements • 5.5 M dialed 108 independent of geographical limits • Trustworthy (Positive, Competent and Honest) emergency response for 288,927 Emergency Victims • Ambulance is available in 15 Minutes to provide pre-Hospital Care free of cost • Access to Hospital (of choice) in 21 Minutes • Quick and hassle-free response for Police Emergencies (50% of emergencies) • Synergized private entity’s speed & efficiency with Government’s systems / resources to improve deliverables significantly

13. Communication Officer (CO) collects facts Dispatch Officer (DO) scopes emergency and assigns strategically located vehicle (Ambulance/Police/Fire) Emergency Medical Technician (EMT) to provide pre-hospital care while transporting patient / victim to appropriate hospital for stabilization Vehicle(s) to reach the site SRC Process innovation – Redefining process Sense Reach Care The communication channel connecting all the links including ERCP

14. One Number for all Emergencies Toll free (affordable) and Accessible on mobile and fixed lines

15. = 82 = 96 = 98 = 100 = 108 = 108

16. Physical Infrastructure

17. Major components Computer Telephony Integration Voice Loggers GIS / Maps GPS / AVLT COA / DOA Allied applications (PCR, Fleet Management, Hospital facilities) IVR Webcam Oracle Financials, CRM eLearning Technology

18. Ambulance Challenging conventional wisdom of delivery systems Pre-hospital Care

19. Advanced Life Saving Ambulance One Ambulance available for every 1.25 - 1.50 lac population

20. Human Resources Deskilling of work • Commitment • Ability • Resourcefulness • Empathy Dispatch Officers Communication Officers Pilots Emergency Medical Technicians (EMTs) Attitude is everything. Happiness is a journey not a destination (Live and enjoy now) Values are foundation for success

21. PartnershipTo reduce learning curve NENA Satyam AAPI Stanford AAEMI Richmond STC SHS • NENA: National Emergency Number Authority • AAPI: American Association of Physicians of Indian Origin • AAEMI: American Academy for Emergency Medicine in India • STC: R Adams Cowley Shock Trauma Centre • SHS: Singapore Health Services

22. Vijayanagaram Alliance Partners – Volunteers (10 per village) 108 VoICE(Volunteer In Case of Emergency) Awareness/Informer Vehicle / Pilot Doctor/Paramedic Physical Service Provider Knowledge, Skills, Experience, Social Status, Self Esteem will be enhanced leading to Self Actualization

23. Typical Emergencies Attended Consistently • Injuries • Lorry hit two wheeler (Hyderabad) – Rider lost right upper-limb – Heavy loss of blood - Controlled bleeding – Handed over the limb to hospital. • Truck hit another truck carrying iron rods (Suryapet) – One rod entered right chest of driver – Conscious, stable but stuck in the seat – Fire personnel removed victim – Not removed the rod and given IV fluids – Shifted to LB Nagar ambulance and Kamineni Hospital – Patient alive.

24. Typical Emergencies Attended Consistentlycontd. • Injuries contd. • Train accident (Hyderabad) – Victim lost both lower-limbs and in shock – IV fluids, Inj. TT / Voveran, dressing given – Amputation was done and discharged.

25. Typical Emergencies Attended Consistently contd. • Cardiac • 64 / male Coronary disease (Srikalahasti) - Severe chest pain, BP -170/100, Pulse rate -148/min - Treated with O2 therapy and Tab Sorbitrate / Aspirin and shifted to hospital – Saved • Diabetes • 60 / Female (Tenali) - History of DM (Diabetes mellitus) - Unconscious, BP not recordable, pulse pressure low, carotids, shallow breathing - Normal saline, IV high flow (rapid), assisted ventilation with AMBU 12 times per minute with Oxygen, Atropine IV - On reaching hospital BP 90/70, pulse 68 • Snake Bite • 26 Yr Male (Narsapur) bitten by snake - ooze and swelling – Semi conscious – Given IV, Hydrocortisone Injection, IM Diclofenac, Tourniquet, Supplemented with Oxygen – Admitted in CHC – Discharged after 24 hours

26. Typical Emergencies Attended Consistently contd. • Maternal Complications • 25/F (Sangareddy) - G2 TERM in labor - Head was visible - Advised fast shift on Left Lateral Position - Later the head was completely out - Cleaned the secretions of nose and mouth - Umbilical loop wound twice around the neck of the baby which would asphyxiate the foetus Two clamps on the loop and cut it and released the loop - Rest of the baby was delivered Initially was not crying - Suctioned and cleaned Kept on oxygen and baby started crying - Placenta delivered on reaching the hospital - Both mother and baby are safe • 25/F (Kodada) - Severe vaginal bleeding, BP 80/40, pulse 52 - History of 3 month amenorrhea (ectopic pregnancy or abortion )- IV on, High flow Oxygen and transported  patient with head low position - Both her BP and pulse improved

27. Injuries (Accidents, Drowning, Electrocution, etc) Maternal Health Child Health Cardio Vascular Diabetes Water-Borne Diseases (Diarrhoea) Crime (Domestic Violence, Sexual assaults, Suicide attempts) Occupational Health Unarticulated and Unexpected Emergencies Pre-Hospital Care Emergency Medical Dispatch / Direction First Responders (Education of Customers) EMTs Emergency Medicine Emergency Room Physicians General Practitioners Specialists Research & Trainingfor prevention and quality care Research Training In Collaboration with Singapore Health Services, Stanford, WISER, STC, Richmond of USA

28. Signing Agreement with Stanford USA on 9th May 2007

29. Road Ahead - AP • We will complete providing emergency response services (108 toll-free-number, transportation in 500 well equipped ambulances and pre-hospital care in ambulance) in Public Private Partnership (PPP), at international standards to every citizen in Andhra Pradesh free of charge by 31st May, 2007

30. Road Ahead - India • Every Citizen in India could be provided emergency response services in Public Private Partnership (PPP), at international standards in two years by 2009 with: • 108 toll-free-number accessible on mobile and fixed lines, • transportation in well equipped ambulances • pre-hospital care in ambulance by qualified EMTs enroute to reduce mortality, disability and hospital stay • Upgraded hospital facilities and capabilities • Supportive Legal Framework at Central and State levels (Model law circulated by Law Commission)

31. Making India Safer for the Common Man by 2009 The more we care the more we value and the more we respect human life, the more we will be changing the World with… • Humaneness • Humility and • Commitment to service

32. Thank you Anil_jampala@emri.in www.emri.in