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Medical Infrastructure in Medical Infrastructure in Medical Infrastructure in Medical Infrastructure in GujaratGujaratGujaratGujarat

Dr N B DholakiaAdditional Director, Medical Services

Department of Health and Family Welfare

Gandhinagar

14 March 2018

Emergency Medical ResponseEmergency Medical ResponseEmergency Medical ResponseEmergency Medical Response

Prehospital Phase Hospital Phase

Coworkers

Laymen

WardsICUEmergency

Department

Organization

Ambulances

108

Ambulances

Organization

Emergency No

108

Security

Police

Firebrigade

First Responders

Interhospital

Transfers

Rehabilitation

Lessons Learnt

Pr

e

p

ar

e

d

n

es

s

Inc

ide

nt

Aim: To prevent & reduce

Mortality and Morbidity with

intact survival

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Institutional Structure in GujaratInstitutional Structure in GujaratInstitutional Structure in GujaratInstitutional Structure in Gujarat

SubSubSubSub----Centers Centers Centers Centers ---- 9156915691569156

Mobile Health Units Mobile Health Units Mobile Health Units Mobile Health Units ----118118118118

Primary Health Centers Primary Health Centers Primary Health Centers Primary Health Centers ----1427142714271427

Community Health Centers Community Health Centers Community Health Centers Community Health Centers ---- 351351351351 SubSubSubSub----District Hospitals District Hospitals District Hospitals District Hospitals ---- 33333333

District Hospitals District Hospitals District Hospitals District Hospitals ---- 22222222

Medical College Hospitals Medical College Hospitals Medical College Hospitals Medical College Hospitals –––– 21 21 21 21 ( ( ( ( GovtGovtGovtGovt----6 , GMERS 6 , GMERS 6 , GMERS 6 , GMERS ----7 , Corp. 7 , Corp. 7 , Corp. 7 , Corp. ----3 , Pvt. 3 , Pvt. 3 , Pvt. 3 , Pvt. ----5 )5 )5 )5 )

Super Specialty Facility Super Specialty Facility Super Specialty Facility Super Specialty Facility ---- 03030303

First Aid, Stabilization,

Primary Treatment

+ Definitive Treatment

Institutional Structure in Gujarat

4H & FW Deptt.

Grant-in-aid

Hospitals 119

Private

Sector/NGOs/

Central Govt.

Institutions

Health & Family Welfare Department

Industry based hospitals:

ESIC Hospitals and Tie-up

Hospitals

ONGC Hospitals and Tie-up

Hospitals

IFFCO Facility- Kalol

Reliance Hospitals-

Adani Hospitals- Mundra, Bhuj

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Govt. Services

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Sr. No. Particular of Services Provision of Services ( Annually)

1 Total No.of Beds 35,843

2 OPD 3,57,04,407

3 IPD 44,15,079

4 Total IPD 1,84,448

5 Major Operations 2,10,319

6 Minor Operations 6,06,696

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• Public Health & Family Welfare• Medical Education & Medical Services• Vital Statistics ( VS)• State Institute of Health & Family Welfare ( SIHFW)• AYUSH• National Health Mission ( NHM)• Gujarat Medical Services Corporation Limited• Project Implementation Plan ( PIU)• Food & Drugs Control Administration ( FDCA)• Employees’ State Insurance Scheme ( ESIS)

January 8, 2013 Commissionerate of Health 15

Department Overview

Health & Family Welfare

•Epidemics-Waterborne diseases like cholera, typhoid/Airbornediseases like swine flu (H1N1)/MERS CoV/Ebola/Healthservices during Natural disasters/Man made disasters

• Preparing Primary Health Centres as First Respondersand First Aid Posts / Units

• Training of Ground Level workers – ASHA, Female andMale Health Workers, Medical Officers and throughthem training the people

January 8, 2013 Commissionerate of Health 16

Main Focus Area and Activities- Public Health

Health & Family Welfare

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Medical Services :• Secondary Health care Service• National Programme for Cancer, Diabetes, Cardio-vascular

Disease & Stroke• National Programme for Health care of the Elderly• Burns, Trauma Care, Dialysis. Mental Health• 108 Services / Rapid Response Team• Nursing Services• Disability Certificates

Medical Education• Medical/ Dental/ Physiotherapy UG/PG Education• Tertiary care through medical College affiliated Hospitals• Medical Research

January 8, 2013 Commissionerate of Health 17

Main Focus Areas

Health & Family Welfare

Vital Statistics :• Registration of Births, Deaths & Marriages

SIHFW• FHW/ANM School• Training to In-Service Health Staff• Self Finance Institute ( SFI ) for ANMs

GMSCL• Procurement of Drugs & medical equipmentPIU• Construction, Repair, renovation and maintenance of medical

infrastructure NHM• Umbrella for RCH/National Health Programmes/ASHA/ HR

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Main Focus Areas

Health & Family Welfare

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Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited (GMSCL)(GMSCL)(GMSCL)(GMSCL)

• Procurement of quality Drugs/ Drugs/ Drugs/ Drugs/ Promotion of GENERIC DrugsGENERIC DrugsGENERIC DrugsGENERIC Drugs

• Procurement of Medical Instruments Medical Instruments Medical Instruments Medical Instruments and MaintenanceMaintenanceMaintenanceMaintenance

• DiagnosticsDiagnosticsDiagnosticsDiagnostics centers and Services

• Store, preserve, distribute and manage warehouses and establish new Drug depots at different locations across the State to ensure smooth and timely timely timely timely supply of Drugs supply of Drugs supply of Drugs supply of Drugs & InstrumentsInstrumentsInstrumentsInstruments to Health Institutes.

• Rational use of DrugsRational use of DrugsRational use of DrugsRational use of Drugs

• To develop, devise and enable real time monitoring real time monitoring real time monitoring real time monitoring system of Drug Stock management up to PHC level

• Will be involved in procurement and stocking of antidotesWill be involved in procurement and stocking of antidotesWill be involved in procurement and stocking of antidotesWill be involved in procurement and stocking of antidotes

Food & Drug Control Administration ( FDCA)Food & Drug Control Administration ( FDCA)Food & Drug Control Administration ( FDCA)Food & Drug Control Administration ( FDCA)

� Implements Following Major Central Acts & Rules.�Drugs & cosmetics Act 1940

�Drugs & Cosmetics rules 1945.

�Food Safety and Standard Act 2006

�Food Safety and Standard Rules and Regulation 2011

�Drugs ( Price Control ) Order 2013.

�25 District Offices, 4 State Laboratories (for analysis of Food & DrugSamples)

�Coordinate with major antidote manufactures from Pharma Industriesin Gujarat and outside.

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Antidote Manufacturers in Gujarat

Activated Charcoal Ambrosia remedies pvt.Ltd., Vadodara

AtropineMorvel Laboratories Pvt. Ltd, Mehsana

Geevet Remedies, Mehsana

Cyanide Antidote Kit Troika, Ahmedabad

Edetate calcium disodium Shanpar Industries Pvt. Ltd

Pralidoxime Dishman Pharmaceuticals & Chemicals Limited

Troika, Ahmedabad

Sodium thiosulfate Shakti Chemicals, Halol

22Launch Dt: 29 Aug 2007

Launch of EMS in Launch of EMS in Launch of EMS in Launch of EMS in GujaratGujaratGujaratGujarat

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108 - Emergency Medical Services - Gujarat

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Innovation

Sustainable

Scalable

Capacity Building

(Leadership, Skill, Attitude, Quality

Assurance)Community Education

Awareness

Media Support

Strengths of Public &

Private Sector

Technology Integration

Communication

IT

Fleet

Medical

Processes for efficiency and

effectiveness in performance

delivery

Synergizing

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World class State-of-the-Art - 108 Infrastructure

Gujarat Emergency Response Centre, Ahmedabad

108 Emergency Service 108 Emergency Service 108 Emergency Service 108 Emergency Service

---- Ambulance SpecificationAmbulance SpecificationAmbulance SpecificationAmbulance Specification

Ambulance Basic

Specification

Force : Tempo

TravelerWinger ST

VOLUME 10.15 cubic meters 10.31cubic meter

LENGTH 3300mm 3200mm

HEIGHT 1830mm 1820mm

Force – Tempo Traveller

TATA Winger – ST

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High-tech and Equipped Ambulance :

108 Emergency Service

- Ambulance Interiors & Equipments

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� State of the art ambulances equipped to tackle

any type of emergency are furnished with basic

and advance life saving equipments and

medications.

� Providing appropriate care and transport within

“Golden“Golden“Golden“Golden Hour”Hour”Hour”Hour” of Emergency

� Customized to Indian needs – 108 ambulance

with view to rescue victims impacted due to

high energy collisions “Extrication“Extrication“Extrication“Extrication kit”kit”kit”kit” is an

essential component.

� Emergency Medical Technician (EMT) trained to

provide pre-hospital care and manage

emergency situations

� EMT gets support over phone from qualified

medical practitioner called ERCP (Emergency

Response Centre Physician) located at the ERC

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Key Components Key Components Key Components Key Components ---- CARECARECARECARE

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108: Innovative Process

Sense Reach CareFollow up

after 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

Medical Police Fire+ +=108 Emergency

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Robust EMS

Software

ERC

Location of Emergency

Caller

Nearest Appropriate

Hospital location

Information of patient arrival

throughVoice and Data

Robust

Application

e- PCR

Advance data

management

OLMD

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Ambulance Interception

for definitive treatment

ERCERO

Definitive

BLS

Patient on board

Having Cardiac Arrest enroute

Intimates nearest Definitive ALS Ambulance

Intercepts BLS

Ambulance

Patient on board

Advanced pre-

hospital care

enroute

• Trauma Care Ambulance

• Cardiac Care Ambulance

• Stroke Care Ambulance

• Neonatal Care Ambulance

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District wise Ambulances:

District No. of Ambulances District No. of Ambulances

Ahmedabad 66 Mahesana 16

Amreli 19 Mahisagar 12

Anand 17 Morbi 8

Aravalli 9 Narmada 12

Banas Kantha 23 Navsari 14

Bharuch 17 Panch Mahals 16

Bhavnagar 23 Patan 13

Botad 7 Porbandar 8

Chhota udepur 14 Rajkot 25

Dahod 27 Sabarkantha 13

Devbhumi-Dwarka 8 Surat 38

Gandhinagar 15 Surendranagar 16

Gir Somnath 11 Tapi 12

Jamnagar 15 The Dangs 7

Junagadh 13 Vadodara 28

Kheda 15 Valsad 20

Kutch 28 Grand Total 585

ALS Ambulances – 140 BLS Ambulances- 445

4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat for Hard to reach areasfor Hard to reach areasfor Hard to reach areasfor Hard to reach areas

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Hospital Type Count

Government Hospitals 2138

Government Supported Hospitals 414

Private Hospitals 10076

Trust Hospitals 441

Total 13,069

108 EMS Hospital Network

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Strengthening Govt. Mechanism and Civil Agency roles

Key Parameters Knowledge shared with Policy makers and

voluntary organisations

Emergency Status and

update of state and

districts

State Road safety councils

Respective District Collectorate

SMS notification to

Stakeholders

Regarding Multi-casualty incidents, large road

accidents, major disasters

Accident Spot

identification

Based on surveillance of road accidents and

regular analysis of multi-casualty and high speed

collisions

State Level information

channelization

and regular meets

• CM and HM Offices

• Commissioner of Health

• Commissioner of Transport

• Gujarat State Disaster management Authority

(GSDMA) integration

• Emergency Medical Services Authority (EMSA) –

Gujarat

District level

information sharing

• DDO, RDD, Commissioners (Police, Municipal)

• CDHO, CDMO and state health bodies

Interaction with

Domain experts from

Diverse fields and

NGOs:

• Indian Red Cross Society (IRCS)

• CEARCH (Center for Education, Awareness and

Research) on Chemicals and Health

• Indian Institute of management (IIM-A)

• UNICEF

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Mobile Health Unit – Arogya Sanjivni

Mock DrillIOCL Mock drill Baroda

GAIL Mock drill Kutch

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Awareness Activities

108 Display on Digital Screen during

Night Hours in Surat

Demo, Health Check Up &

Distribution of Chocolates in Schools

World Day Remembrance For

RTA Victims -20th Nov

Awareness Activity on Police Emergencies

Display Boards on Police Stations

Sadbhavana Mission of

Hon’ble Chief Minister

Boards on SP Ring Road- in every 1.5 Kms

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Safety Week

Surendranagar Jamnagar Rajkot

Kutch Rajkot

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Junagadh Gir somnath Porbandar

Dev bhumi Dwarka Bhavnagar Botad

Safety Week

MukhyamantriMukhyamantriMukhyamantriMukhyamantri AmritumAmritumAmritumAmritum (MA) (MA) (MA) (MA) YojanaYojanaYojanaYojana, RSBY, RSBY, RSBY, RSBY

• Launched to provide tertiary care treatment for catastrophic diseases to BPL andfamilies with annual income less than Rs 2 .5 lacs per annum 100% State fundedAssurance Scheme

• Cashless hospitalization

benefit of Rs.2,00,000/- per BPL family per annum on a family floater basis (5 membersper family).

• U-win card holders

RSBYCovers treatment cost upto Rs 30,000 per family per year- insurance based

To be subsumed with National Health Protection Scheme

Health & Family Welfare Department

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Disaster Preparedness• District and Hospital Disaster Preparedness Plans in place with resource

mapping including private hospitals, rapid responder medical teams, triage, IMA members, blood banks, overflow plans, transport plans under NABH / NQAS preparedness, control rooms, blood banks, NGOs

• First Responder Trainings

• Technical Support from NIOH, IIPH-G

• Mock drills held in hospitals

• Mental Health Services for Post Traumatic Stress Syndrome Management

• Trainings in in various aspects such as Hospital Disaster Preparedness, Dead Management, Ventilator Management with GIDM and others

• CPR trainings given to laypersons

• Centre of Excellence planned for Chemical Disasters Response at Medical College Hospital with help of Depts of Pharmacology and Medicine

Ammonia Leak

Accident

Wind Flow

Wind FlowSafe Direction

To Run

Safe Direction To Run

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Area Specific Approach- Ammonia Leak at IFFCO Kalol

Pre Accident Phase:

• People staying around IFFCO are educated regarding steps to be taken in case of leak

• Pictorial booklets distributed

• Computerized programmes ready with IFFCO to predict area affected depending on various variables

• Mock drills

Wish you all A Happy & Successful Disaster Preparedness