By Deepak Sharma
Even though Covid-19 has resurrected epidemiology and, indeed, broader health education and research to the top of policy makers’ priority list for now, the need to deal with medical emergencies will remain intact forever. Medical emergencies by their very nature – because the loss of a few precious seconds can mean the difference between life and death – require a rapid and infallible response system. And this response system can only be animated and executed by specialists duly trained in medicine and integrated emergency care. As such, there is a need to develop as well as disseminate specialized course materials that would prepare medical students and professionals in India to deal with emergencies holistically. In other words, structured emergency health courses inspired by advanced Western curricula and practices while taking into account India’s unique socio-cultural and demographic character can show the way forward for emergency care. in the country.
What are Emergency Health Courses?
While emergency is a common, all-encompassing term, an emergency health course seeks to address an assortment of life-threatening health situations, but in a somewhat unified and systematized way. The different life-threatening situations can range from patients involved in accidents and trauma, to those who are already in the emergency room inside or outside the hospital, to those who may have developed complications post -sudden operations with a rapid deterioration of their vital signs. However, despite the distinct and apparent differences between different emergencies, India needs to prepare a group of emergency care professionals who would be able to do a life-saving intervention by first triaging and stabilizing a patient before that a specialist in this particular condition cannot take over. .
The extraordinarily huge workload
According to a national level assessment report prepared by AIIMS and submitted to NITI Aayog, emergency and injury cases accounted for 9-13% of all patients presenting to a health facility annually, 19-24 % of government admissions. hospitals and 31-39% admissions to private hospitals. In fact, emergencies accounted for 11-30% of all OPD patients on any given day. For a country as populous as India, even modest estimates derived from these figures would suggest the colossal number of emergencies India faces. According to the same report, the availability of emergency operative care services (for trauma, non-traumatic, orthopedic, neurosurgical and obstetrical care) ranged between 47 and 60%, again underscoring the inadequacy of emergency services. in the country.
The impressive number of road accident victims
India carries the dubious distinction of having the highest number of deaths from road accidents and accidents. Last year, the country lost more than 1.5 million people in road accidents. Tragically enough, nearly 70% of road traffic deaths were among young people between the ages of 18 and 45, undermining the much-vaunted principle of the demographic dividend in economic terms. According to another estimate, almost 23% of all trauma cases in India have been attributed to transport incidents with 400 deaths occurring on Indian roads every day. The fact that almost 60% of road accidents occur in rural areas and 40% in urban areas again underlines the need to strengthen emergency care, particularly in the former given that they are already disadvantaged in terms of infrastructure and personnel compared to the last. In fact, the percentage of deaths due to road accidents has steadily increased. Hence, there is a massive need to train and prepare a large number of emergency care personnel in the country. And they would need this training based on the latest developed course materials and content in medicine and emergency care.
The prevailing ineffective emergency care management
In the face of the overwhelming burden, the existing emergency care proved to be totally ineffective. Emergency care is usually provided in what is called the emergency department, staffed by junior doctors who are not trained for it. According to the aforementioned AIIMS report, most public hospitals lack standard SOPs/manuals for emergency care, patient transfer and death management. Although triage and disaster management policies are largely found in private hospitals, only 50% of public hospitals have such policies. In practice, triage, essential to effective emergency care, is rarely implemented. Alarmingly, the patient disposition time for the sickest group (red zone) reaches 90 minutes in public medical schools compared to 15 minutes in private hospitals. Specifically, there are no specialist trauma surgeons and very few designated trauma centers in India. In fact, orthopedic surgeons are leading the trauma response in 50% of facilities and accountability is undefined in the rest. As a result, there is a delay in clinical decision making putting patients at risk.
The shortage of emergency medicine services and the lack of relevant courses
According to a popular education sector website that tracks comprehensive education in India, only 115 colleges offer postgraduate program in emergency medicine in both public and private sectors. This is well below what would be needed for a country with one of the highest death tolls from accidents and other health emergencies in the world. According to the AIIMS-NITI Aayog report published in 2020, only 28 medical colleges offered only 60 seats for EM, with DNB contributing around 120 seats. Last year, there were only 196 recognized government-sponsored training places available in emergency medicine. Certainly, there has been a 78% jump in the number of PG medical seats since 2014. This improvement must also be reflected in EM.
The need for pre-hospital care
Apart from well-designed courses and number of EM seats, India also urgently needs a well-oiled ecosystem of pre-hospital care comprising networked ambulances, paramedics trained in first aid and emergency protocols, emergency medical technicians (EMTs) and EM experts. Existing hotlines have yet to find credibility and traction and their responsiveness has always been questionable. In fact, according to research, almost 50% of trauma victims admitted to a leading hospital in an urban Indian city had not received any pre-hospital care. Imagine the situation in rural India.
Against more than 1.5 lakh deaths from accidents many of which could have been prevented, there are nearly 200 EM seats available today. These seats are believed to be present in about 115 colleges out of the total of 540 odd medical colleges today in the country. If even 350-400 of the remaining colleges only allow 2 EM seats each, the total number could reach 900+ seats, more than 4 times the existing number. Taking a different approach, if only 1% of the existing 81,400 MBBS students took a PG in EM program, there could be an additional 800 students initiated into the course each year who would become specialists in due course. And if these students had access to the best-developed and curated course content, inspired by the best in the world and subsequently integrated into the nation’s largest emergency care machinery, ED-related deaths could plummet. drastically. Needless to say, India cannot afford to let the so-called demographic dividend go to waste so easily.
By Deepak Sharma, Co-Founder and CEO, MedLern
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