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A long way to go

Tuesday, December 18, 2018

Despite all the advances in modern medicine, patients often die because they cannot get to hospital in time and ambulances are not equipped well enough, says Dr Santosh Datar

Few fields have developed quite to the degree that modern medicine has. From heart transplants, and cloning, to gene-editing, and robotic prosthetics, the industry has progressed to a remarkable degree, with many breakthroughs that would have been considered impossible even two decades ago.

Yet for all its achievements, hundreds of thousands of people die each year, not because the conditions they suffer cannot be medically treated, but rather because they are unable to get to the nearest hospital in time. In most circumstances, it’s not the lack of medical facilities that doom these patients, but rather, poor infrastructure and urban planning.

An estimated 115,000 Indians died in road accidents in 2017 alone while the same year saw over 15,000 deaths in railway accidents; additionally, cardiovascular diseases killed 2.1 million people in 2015. These statistics get even more tragic when you consider the vast majority of these individuals who could have been saved, had they received immediate medical attention.

Consider this scenario; a 55-year-old man starts experiencing sudden heaviness and pain in the centre of chest. He sweats profusely and feels breathless. His wife calls their family doctor and requests her to come immediately to patient’s home. The doctor, upon ascertaining the patient’s condition, advises the woman to take her husband to a hospital with an ICCU; in a cardiac ambulance. En route to the hospital, patient’s condition deteriorates and he suffers cardiac arrest. The paramedics immediately administer CPR, and the patient stabilises. On arrival at the hospital, CPR is continued and the patient’s life is saved.

The above hypothetical example shows us the importance of pre-hospital care.Though most hospitals in India are equipped and employ several trained medical staff; these resources are severely lacking in our nation’s ambulance services. In developed countries like the UK or Germany, the fatality rate of traffic accidents (per 100,000 inhabitants) is just 2.9 and 4.5 respectively, while in India it is 16.6. This is in addition to the fact that both the European nations have far more motor vehicles per capita than India, and higher speed limits. The true cause of this stark numerical disparity is the fact that British and German ambulances have better equipment and significantly faster response times.

In medical emergencies, we have a term called the ‘Golden Hour’. This essentially means that if the victim of a major accident or heart attack receives medical attention within that same hour, their odds of survival are excellent, but if not, their chances of recovery grow fainter with each passing minute. It is for this reason that the primary objective of the emergency services is to get patients to the nearest hospitals within the hour.

Unfortunately, given India’s penchant for traffic, poor roads, and vast distances between hospitals, this isn’t always possible. To counter this problem, there are two main classes of ambulances; ones which are equipped to treat patients en-route to the hospital; i.e. ALS, and those which are meant for less severe cases; i.e. BLS.

ALS (Advanced Life Support) ambulances are well equipped, with trained manpower along with the tools they need to save or stabilise patients. They house basic diagnostic instruments, emergency lifesaving medicines, I.V. fluids, oxygen cylinders, AMBU bags (to give artificial breaths manually), dressing material and stretchers, pulse oximeters, cardiac monitors (to monitor heart rhythm), defibrillators (to shock the heart when it stops beating), ventilators (to give artificial breaths), infusion pumps (to inject emergency medicines in a controlled manner), and a suction machine (to suck out secretions in mouth to clear air passage). They are, for all intents and purposes, mobile hospitals, capable of handling critical cases until they can be moved to more permanent facilities.

India has a long way to go when it comes to upgrading its fleet of ambulances to be able to properly tackle complicated emergency medical procedures en-route to the hospital. Until that day comes, we will continue to lose countless mothers, fathers, brothers, sisters, and children, to conditions/accidents which medical science is more than equipped to handle.

Dr Santosh Datar is Consultant Doctor and Medical Director, Ziqitza Healthcare Ltd.

Short Takes

Though most hospitals in India are equipped and employ several trained medical staff; these resources are severely lacking in our nation’s ambulance services.

India has a long way to go when it comes to upgrading its fleet of ambulances to be able to properly tackle complicated emergency medical procedures en-route to the hospital.

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