Emergency Care Preparedness Saves More Lives in Times of Tragedies

A riveting photograph of the bomb blasts that shook Mumbai recently was of bloodied victims being transported in a tempo to the nearest hospital – a telling comment on the state of emergency care in a city that has been facing major attacks every few years and, given its very large population, scores of minor emergencies daily.

Mumbai is no stranger to emergencies. There were the 1992-93 riots (900 casualties), the serial blasts of 1993 (250 dead), the bomb blasts in 2003 (54 dead), the floods of 2005 (447 dead), train blasts in 2006 (200 casualties), the November 26 terror attacks in 2008 (200 dead) and the three recent blasts that claimed 26 lives. And yet, even today, preparedness is the last thing the average citizen can hope to experience.

Sample this: Following the recent blasts, state Chief Minister Prithviraj Chauhan went on record to state that he wasn’t able to get in touch with his colleagues for 15 minutes because telephone lines were down! Then, according to eye-witness R.C. Shah, a trader at the Dadar blast site near Kabutharkhana, the police arrived 15 minutes late, ambulances were unavailable and the injured were ferried to hospitals in taxis and tempos.

Incensed by the picture of victims being transported in a tempo, Dr Sanjay Nagral, a senior surgeon who operates at the city’s premier Jaslok Hospital, penned an anguished article in a local daily. According to him, the world over, emergency care follows the concept of the ‘golden hour’ and transport is an essential aspect of this response. “This is not the first time we have voiced the need for specialised emergency care. Yet, it has not been a priority,” says Dr Nagral.

During an emergency, he elaborates, ‘Triage’, or the task of first isolating those affected – keeping aside the dead, the most severely injured and the less severely injured – is absolutely vital. Transporting victims in well-equipped ambulances that are staffed by trained paramedics is the next step. A proper mode of transport is important in case a patient may have suffered a spinal injury, Dr Nagral points out. But are these procedures followed here?

If a victim survives the breakdown of emergency procedures or the lack of proper ambulance services, what does the city have to offer in terms of trauma care? There are limited options. There’s the civic administration-run Sion Hospital in South-Central Mumbai. But this 25-year-old, 15-bed centre is not only overburdened – since it also caters to victims of road accidents on the Mumbai-Pune highway – but is also in desperate need of an overhaul.

Another trauma centre at the government-run JJ Hospital in South Mumbai is yet to materialise, despite a sanctioned approval at a cost of around Rs 40 crore. T.P. Lahane, Dean of JJ Hospital, is confident that the project will come through. “We have everything ready for the centre. It will be equipped with trained personnel – ward boys, nurses, technicians, doctors, investigation facilities, MRI or CT scans – everything will function like a self-sufficient division,” he says.

Dr Lahane avers that, despite the absence of a specialised trauma care centre, JJ Hospital was able to provide the 25 patients sent there during the recent blasts with immediate care within the golden hour. “We got the information of the blasts by 7.10 pm and by 7.30, around 200 medical personnel, including 35 doctors, were waiting in the lobby. The first patient arrived at 8.10 pm. From then, our Operation Theatre worked till 1.30 pm, until the next team took over,” he says.

He adds that it isn’t just the ‘golden hour’ but the 46 hours that follow, which are crucial. Increasing the capacity of the current 20-bed disaster ward to 100 beds and doubling the four operating theatres would definitely help improve patient care, he felt.

Of course, emergency doesn’t always strike in the form of extreme violence. Mumbai also has had to contend with natural disasters like floods, which have brought the city to its heels in the past few years. Today, there is a ‘108’ helpline that connects to the Disaster Management Department of the Municipal Corporation of Greater Mumbai (MCGM), the apex civic body that administers the city. This was set up after the 2006 floods and a major part of its work is to monitor the flood situation, says a senior official of the department, who did not wish to be named. “We have 35 automatic rain gauges that are updated every 15 minutes and they give us data on the rainfall across the city. Low-lying areas are particularly monitored,” he adds.

Moreover, the personnel in this unit have been trained to deal with all kinds of emergency situations including fire fighting, rescue, flood relief and wall collapses. The helpline gets at least 100 calls a day but even here a need for better ambulances and trained paramedics has been felt. “Many deaths are due to faulty transport to hospitals and we must have special ambulances. We also need better civic and traffic sense from the public. Often, ambulances don’t get right-of-way,” the civic official rues.

Of course, in the absence of trained personnel and tawdry service, it’s the caring and responsive Mumbai public that comes to the rescue. Take Sanjay Bengali, proprietor of a printing press, who lives on the second floor of a building opposite the Kabutarkhana area of Dadar in Central Mumbai, one of the recent blast sites. He recalls, “At first, I thought the noise was of a tube light bursting in the advertising hoarding on the bus-shelter. But when we saw the thick smoke rise up, we realised it was something worse.”

When the smoke began to clear, Bengali saw two bodies – a woman and a man – lying on the road. Calling out to his son to help, he rushed down. Initially, the two saw the woman moaning and bleeding, while the man seemed still. But then he too began to stir. Bengali and his son immediately stopped a passing taxi, picked up the man and put him into the cab. Meanwhile, some others helped the woman by requisitioning a passing police van to take her to the hospital.

Bengali and his wife, Nisha, believe that people must always come forward during an emergency. “We mustn’t panic and when the police come, we must help them in their work instead of crowding the site,” the duo says. However, when it is put to them that, according to emergency response guidelines, patients must not be picked up till an ambulance comes along, they are deeply offended: “When we see someone bleeding, what must we do? If we get the person to a hospital quickly, maybe his life can be saved. Besides, we took care to pick up this man carefully,” Bengali says.

JJ Hospital’s Dr Lahane agrees with the approach of the Bengalis. He says “The type of vehicle the patient comes in is not important, the speed with which they come is. I don’t think they will get a fracture or anything if they are not transported in the right vehicle. They are in any case, in deep shock and the protective response of their body makes them rigid. This is India, we have to respond in the best way we can.”

Given the overstretched public services, private initiatives in emergency care have emerged – though they are expensive. Ziqitza Health Care Ltd has a 30-ambulance service that is fully equipped with cardiac equipment, mobile intensive care units and GPS. The company has also tied-up with the state governments of Kerala, Bihar and Punjab.

But Dr Lahane is not in favour of private enterprises entering the field. “The answer lies in getting the government to spend the allotted money for public healthcare,” he stresses.

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