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Dr G V Ramana Rao MD,DPH, PGDGM Executive Partner & Head Emergency Medicine Learning Centre and Research GVK EMR

Workshop on CHEMICAL EMERGENCY PLANNING, PREPAREDNESS AND RESPONSE-BEST PRACTICES AND INTERNATIONAL EXPERIENCES. (21 st Oct. 2010) Dept. of Factories, GoAP and National Safety Council Chemical Off-Site Emergencies-Ambulance Services ’. Dr G V Ramana Rao MD,DPH, PGDGM Executive Partner &

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Dr G V Ramana Rao MD,DPH, PGDGM Executive Partner & Head Emergency Medicine Learning Centre and Research GVK EMR

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  1. Workshop on CHEMICAL EMERGENCY PLANNING, PREPAREDNESS AND RESPONSE-BEST PRACTICES AND INTERNATIONAL EXPERIENCES. (21st Oct. 2010)Dept. of Factories, GoAP and National Safety CouncilChemical Off-Site Emergencies-Ambulance Services’ Dr G V Ramana Rao MD,DPH, PGDGM Executive Partner & Head Emergency Medicine Learning Centre and Research GVK EMRI

  2. Agenda • ‘108’ GVK EMRI emergency response services • Chemical emergencies and pre-hospital care

  3. Innovative Pro-Poor PPP (Public Private not for Profit Partnership)Service Delivery Model to provide free Emergency Response Servicesat one / Citizen / Month Serving 1 Emergency every 8 seconds and Saving 1 Life every 8 minutes

  4. GVK Emergency Management and Research Institute A Non-profit organization

  5. Why this Innovation ? • 75,000 emergencies occur per day • 80% are at the bottom of the pyramid • 80% deaths occur in hospitals in the first hour • 4 M deaths p.a. (Cardiac, Road Accidents, Maternal, Suicidal attempts, Neonatal / Infant / Pediatric, Diabetic related, etc) due to absence of 4As : • Access to a universal toll-free number • Availability of Life Saving Ambulance to reach quickly nearest and appropriate health facility • Affectionate Care by trained paramedics (Compassion, Ability, Resourcefulness & Energy) • Affordability by every citizen independent of income, religion and community • Hence, GVK EMRI was born in April 2005

  6. Technology Leadership Innovation R & T Vision of GVK EMRI • To respond to 30 million emergencies and save 1 million lives annually by 2011 • To deliver services at global standards through Leadership, Innovation, Technology and Research & Training • To become One Of Eight Wonders of the World

  7. What is Unique in this Innovation ? Integrated Emergency Response Services for Medical, Police and Fire emergencies with single universal toll-free number ‘108’ Free services (no cost to citizen) PPP framework Government provides funds for OPEX & CAPEX Private Partner brings leadership, innovation, execution and technological capabilities Conducting Research and building capability in Emergency Medicine and Management

  8. Kerala Launched on 15th Aug, ‘05 in Hyderabad and expanded to 10 other States Jammu & Kashmir Himachal Pradesh Arunachal Pradesh Punjab Uttarakhand Haryana Delhi Sikkim Rajasthan Uttar Pradesh Assam Nagaland Bihar Meghalaya Manipur Jharkhand West Bengal Mizoram Gujarat Madhya Pradesh Tripura Chattisgarh Orissa Maharashtra Andhra Pradesh Goa Karnataka Tamil Nadu

  9. Successfully Implemented by GVK EMRI in PPP Framework • Political will, Public Servants’ commitment and Public Support • 100% of Capital expenditure and Operational expenses by Government (Public) • GVK funds Leadership, Innovation (Infrastructure, Process), Collaborations, Research and Training, Knowledge transfer and Quality assurance • Mahindra Satyam provides free IT solutions as technology partner • GVK EMRI manages and leverages government resources for better outcomes to serve poor • Partnership involving Pain and Pleasure

  10. Building Blocks of GVK EMRI’s Innovation GIS / GPS to locate victim / ambulance and hospital Three digit toll-free No. Accessible from Land lines and Mobile phones Modern, spacious and open ERC Cost effective ambulances to provide quality care for Indian emergencies with facilities for rescuing and balancing patient care with public safety and patients relatives comfort Trained personnel for providing PHC

  11. Innovative Process Sense Care Reach Follow upafter 48 hrs • Developed detailed process understanding and well defined responsibilities through out the organization • Maintained all information related to emergency in Patient Care Records (PCRs) • Patient information is shared with the hospital on arrival • 48 hour follow up with the patients admitted to hospital

  12. Innovative use of Technology Public Switching Telephone Network (PSTN) COMPUTER SERVER ROOM Caller in distress Telephone DB SCCS, CCT & Voice Logger ERS DB GIS DB Dial 108 Nortel Switch Dispatch Officers (DO) Communication Officers (CO) Transfer E R C CO Supervisor DO Supervisor ERCP Conference EMT in Ambulance Ambulance FIELD Base Location Victim Shifted to Hospital Victim Location (Scene) CCT: Communication Control Toolkit; SCCS: Symposium Call Centre Server; ERCP: Emergency Response Center Physician; EMT: Emergency Medical Technician

  13. Innovative Pre-Hospital Care • Emergency Medical Technician (EMT) in the ambulance is trained not only to provide pre-hospital care but also to handle emergency situations • EMT gets support over phone from qualified medical practitioner called ERCP (Emergency Response Centre Physician) located at the ERC • ERCPs are in the ERC round the clock to provide support to EMT and to people at emergency scene until ambulance arrives

  14. Geomed Research Public Health Foundation of India Collaboration for transfer of Knowledge and Technology know-how, Best practices, Research & Training American Assoc of Physicians Of Indian Origin (AAPI) Shock Trauma Center, USA Singapore Health Services American Academy for Emergency Medicine in India Carnegie Mellon University, USA Stanford University, USA

  15. Govt. of Chhattisgarh Govt. of Karnataka Govt. of HP Impact .. Govt. of Tamilnadu Govt. of A.P. Govt. of Gujarat Govt. of Goa Govt. of Assam Govt. of Meghalaya Govt. of MP Govt. of Uttarakhand

  16. Impact

  17. Impact - Doing More with Less for More Bomb Blasts Ahmedabad

  18. A Gandhian Innovation July-Aug 2010

  19. Pre-hospital Care – ambulance services

  20. An injured patient needs (i) Treatment for life threatening injuries to maximize the likelihood of survival, (ii) Treatment for potentially disabling injuries to minimize disabilities and promote return to optimal functioning, and (iii) Reduction in pain and suffering (Mock et al. 2004).

  21. Chemical Industrial Emergencies • Evacuation of Casualties • Decontamination • Triage • Resuscitation • Treatment • Transport

  22. Ambulance

  23. Advanced Life Saving Ambulance

  24. 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

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

  26. Rescue and evacuation

  27. Four common triage categories (IDME) T3 Minimal T1 Immediate T2 Delayed T4 Expectant

  28. INJURED YES NO NO NO 10 - 29 WALKING T3 NOT INJURED DEAD SURVIVOR RECEPTION CENTRE OPEN AIRWAY BREATHING BREATHING YES YES RESPIRATORY RATE T1 less than 10 30 or more radial pulse absent or >120/min PULSE RATE T2 radial pulse <120/min

  29. Key Message 1 • Do Triage based on Airway, Breathing and Circulation when more than 3 patients are involved.

  30. Triage and onsite treatment techniques

  31. Andhra Pradesh: Mock Drill  at GVK EMRI, Secunderabad on 5th September ‘07

  32. Andhra Pradesh: Mock Drill  at Secunderabad Rly Station on 17th October ‘08

  33. Uttarakhand: Mock Drill  at Parade Grounds, Dehradun on 20th November’09

  34. 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)

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

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

  37. 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)

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

  39. Our legacy • Like so many other things that are Indian, Mahatma worked as volunteer in South African war in 1899 and served injured people.

  40. Thank you www.emri.in Ramanarao_gv@emri.in

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