Context: Recently, NITI Aayog released comprehensive report on current status on Country level- secondary and tertiary level emergency and injury care in India.
Objectives

• To assess the prevailing status of emergency and trauma care at government and private hospital settings of India.
• To bring out the existing gaps and provide a framework for further improvement and the needed policy directions.

Data Set

• 100 tertiary and secondary level hospitals in 29 States and 2 Union Territories from 5 regions of India was conducted.

Salient Findings of the study
Ambulance Services

• Even though 91% of hospitals had in-house ambulances, trained paramedics needed to assist ambulance services were present only in 34%.

Physical Infrastructure

• The number of beds available at Emergency Departments accounted for only 3-5% of total hospital beds.

Human Resource

• Most of the hospitals lacked presence of general doctors, specialists and nursing staff dedicated for Emergency Departments.

Essential Medicines

• Only 9% of all hospitals, fulfilled the criteria to have the complete list of all recommended emergency medicines 24*7 in the emergency departments.

Patient disposition time

• The patient disposition time for the sickest group (Red zone) was high at Government Medical Colleges (90 Minutes) vis-à-vis Private Hospital (15 minutes).

The reasons for this delay amongst others were due to

• High patient load
• Lack of in-house specialists in the emergency department.
• Need for multiple cross referrals, with an overarching lack of a dedicated department for emergency services.
• There was lack facilities such as presence of Police/ private security guards, to mitigate violence episodes between relatives of the care-seekers and health care providers.
• Financing: None of the Hospitals had funds dedicated for emergency care services.

Key Recommendations

• Develop a robust integrated emergency care service system which can comprehensively address all medical and surgical emergencies inclusive of trauma-related care.
• Develop standardize protocols and SOPs for emergency care to have a common optimal nation-wide policy.
• Strengthen the prevailing pre-hospital services such that a world-class ambulance services are made available 24*7.
• Create adequate space for emergency care systems at the prevailing health facilities.
• Systems to ensure efficient handling of medical care during disasters need to be ensured at all hospitals.
• Upgrade all the prevailing emergency care services to meet the standardized norms, with efforts made to accredit all the existing emergency departments.
• Create standalone Central/ State level efficient funding mechanisms to ensure continuous upgradation of emergency related issues at all hospitals.
• Develop mechanisms to ensure free treatment for emergency care services for all citizens covering the minimal required period for early stabilization.

By: Shubham Tiwari