Download - PPT presentation by Dr. G V Ramana Rao
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Workshop on CHEMICAL EMERGENCY PLANNING, PREPAREDNESS AND RESPONSE-BEST
PRACTICES AND INTERNATIONAL EXPERIENCES. (21st 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 & Head Emergency Medicine Learning Centre and Research
GVK EMRI
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Agenda
• ‘108’ GVK EMRI emergency response services
• Chemical emergencies and pre-hospital care
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Innovative Pro-Poor PPP (Public Private not for Profit Partnership)
Service Delivery Model to provide free Emergency Response Services
at one / Citizen / Month
Serving 1 Emergency every 8 seconds and Saving 1 Life every 8 minutes
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GVK Emergency Management and Research Institute
A Non-profit organization
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Why this Innovation ?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
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• 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
Vision of GVK EMRIVision of GVK EMRI
Leadership R & TInnovation Technology
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What is Unique in this What is Unique in this Innovation ?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
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Launched on 15th Aug, ‘05 in Hyderabad and expanded to 10 other States
Andhra Pradesh
Gujarat
Sikkim
Karnataka
Orissa
Haryana
Punjab
Himachal Pradesh
Uttar Pradesh
Chattis
garh
JharkhandWest Bengal
Bihar
Arunachal Pradesh
Meghalaya
Tripura
Manipur
Nagaland
Mizoram
Uttarakhand
Madhya Pradesh
Tamil Nadu
Kerala
Jammu & Kashmir
Maharashtra
RajasthanAssam
Goa
Delhi
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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
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Building Blocks of GVK Building Blocks of GVK EMRI’s InnovationEMRI’s Innovation
Three digit toll-free No. Accessible from Land lines and Mobile phones
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
Modern, spacious and open ERCGIS / GPS to locate victim / ambulance and hospital
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Innovative ProcessInnovative Process
Sense Reach Care 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
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Conference
CCT: Communication Control Toolkit; SCCS: Symposium Call Centre Server; ERCP: Emergency Response Center Physician; EMT: Emergency Medical Technician
SCCS, CCT & Voice Logger
Telephone DB ERS DB
Nortel Switch
Public Switching Telephone
Network (PSTN)
Dial 108Caller in distress GIS DB
ERCPDO Supervisor
CO Supervisor
Transfer
Dispatch Officers (DO) Communication Officers (CO)
EMT in Ambulance
Victim Shifted to Hospital
COM
PUTE
R SE
RVER
RO
OM
E R
CFI
ELD
Base Location Victim Location (Scene)
Ambulance
Innovative use of TechnologyInnovative use of Technology
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Innovative Pre-Hospital Innovative Pre-Hospital CareCare
• 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
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Singapore HealthServices
American Assoc of Physicians
Of Indian Origin (AAPI)
Shock Trauma Center,
USA
Stanford University,USA
American Academy for
Emergency Medicine in India
Carnegie Mellon University,
USAGeomed Research
Public HealthFoundation of India
Collaboration for transfer of Knowledge and Technology know-how, Best practices, Research & Training
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Impact ..Impact ..
Size • One Center for 40 M population against one for every 0.05 M population in USA
• 372 M population covered in 9 States (increased reach of health care in rural , hilly and tribal areas)
• Trained 35,650 people (11,500 - EMTs, 10,000 – Pilots, 3,100 - Doctors, 2,100 - Nurses, 6,800 - First Responders and AHA/ ITLS Certification for - 2,150)
• 12,170 + emergencies handled per day (9.3 Million cumulative)
• 2,600 Ambulances - 4.5 trips a day• 15,900 + GVK EMRI Associates
Speed • Went live in less than 4 months from signing MoU • 91% calls taken in first ring • < 15 minutes (urban) and < 25 minutes (rural)
Ambulances reached
Govt. ofA.P.
Govt. ofGujarat
Govt. ofMP
Govt. ofUttarakhand
Govt. of Tamilnadu
Govt. ofGoa
Govt. ofAssam
Govt. ofKarnataka
Govt. ofMeghalaya
Govt. ofChhattisgarh
Govt. ofHP
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ImpactImpactType of Emergencies and Lives saved
• Pregnancy related - 29%, Vehicular Trauma – 18%, Acute Abdomen – 13% Cardiac – 4%, Respiratory – 4%, Suicidal – 2%, Animal Bites 1%
• 300+ lives were saved per day (247,021 + till now) and 11,870 victims per day received timely, high-quality pre-hospital care
Costs • Cost per ambulance trip Rs. 600 to Rs. 700 against $ 600 to $700 in USA
Qualitative Outcomes
• Angel of Mercy – 108 Ambulance• Successful PPP• Well documented systems, impressive EMT training,
high order management competence• A historic landmark in health care delivery system • Built more trust in the health system as a whole • Increased institutional deliveries and reduced maternal
mortalities by 20 – 25% • A model for replication across the Country in any state
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Impact - Doing More with Less for MoreImpact - Doing More with Less for More
Bomb Blasts Ahmedabad
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A Gandhian A Gandhian InnovationInnovation
July-Aug 2010
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PRE-HOSPITAL CARE – AMBULANCE SERVICES
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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).
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Chemical Industrial Emergencies
• Evacuation of Casualties • Decontamination• Triage• Resuscitation• Treatment• Transport
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Ambulance
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Advanced Life Saving Ambulance
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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
AUTOLOADERWHEEL CHAIR
SCOOP
SPIINE BOARD
AIR LIFTING
AMBULANCE EQUIPMENT
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MEDICAL EQUIPMENTSUCTION APPARATUS AUTOMATED EXTERNAL DEFIBRILLATOR
VENTILATOR VACUUM SPLINTS
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Rescue and evacuation
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Four common triage categories (IDME)
T4Expectant
T3Minimal
T2Delayed
T1Immediate
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T3
DEAD
BREATHING BREATHING
WALKING
OPEN
AIRWAY
YES
YESYES
NO
NO
RESPIRATORY
RATET1
PULSE
RATET2
NO
less than 1030 or more
10 - 29
radial pulse <120/min
or >120/min
INJURED
NOT
INJURED
SURVIVOR RECEPTION CENTRE
radial pulse absent
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Key Message 1
• Do Triage based on Airway, Breathing and Circulation when more than 3 patients are involved.
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Triage and onsite treatment techniques
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Andhra Pradesh: Mock Drill at GVK EMRI, Secunderabad on 5th September ‘07
32
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Andhra Pradesh: Mock Drill at Secunderabad Rly Station on 17th October ‘08
33
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Uttarakhand: Mock Drill at Parade Grounds, Dehradun on 20th November’09
34
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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)
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Evacuation of Casualties – NDMA- MP-MPE-
Major Recommendations – Ambulances Reference NDMA EMRIResponse time
-Maintain minimum ( Golden hour)
Urban 14mts; Rural – 21mts<10mts – 2/3 of RTA & cardiac.
Medical Equipment
For resuscitation, Essential drugs,
Stretchers
2-way communication
Spine board/ CPR skills;106 drugs under medical directions; Collapsible / Scoop /Pediatric / Chair stretchers; Cell phones.
Support Staff
Well versed with equipment usageQuality checks
Yes (training)
Yes (OE wkly visits; Qrtly. Checks by quality teams)
SOPs Maintenance of vehicles Yes including preventive maintenance, repair/accident processes etc.(Fleet managers)
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Evacuation of Casualties – NDMA- CIDM-
Medical Emergency Plans Reference CIDM EMRIDistrict Off-site Plan
Mock drills Yes
Dedicated institutes for CDM
To be identified / established Can be seriously considered for training and research.
Community awareness
Develop mechanism –kits. VoiCE program
SOPs To be laid out – Decontamination; risk and resource inventory, proper casualty chemical treatment kits,
can cascade and provide
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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)
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Essential elements for IAN• Strategy partnerships • Strategic support – technology, training and research• Size and scale • SOP• Skills set• Surface ambulances • Site experiences• Simulation• SLA
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Our legacy• Like so many other things that are Indian, Mahatma worked as volunteer in
South African war in 1899 and served injured people.