“MED ONE”
Articulate a national policy of point-to-point carrier service for patients on self-sustainable model which includes ground transportation- road and rail, air transportation, and coordination with the patients and receiving hospital.
(An initiative of CAPSR INDIA to support 102/108 NHM/NHRM 24X7 National Ambulance Service (NAS) Becoming Partner for Air Ambulance Service Provider)
BACKGROUND
- One of the achievement of National Health Mission (NHM) is the patient transport ambulances operating under Dial 108/102 ambulance services.
- At the time of launch of National Rural Health Mission (NRHM), a sub- mission of NHM in 2005, such ambulances networks were non-existent.
- Now 35 States/UTs have the facility where people can Dial 108 or 102 telephone number for calling an ambulance.
- Dial 108 is predominantly an emergency response system, primarily designed to attend to patients of critical care, trauma and accident victims etc.
- Dial 102 services essentially consist of basic patient transport aimed to cater the needs of pregnant women and children though other categories are also taking benefit and are not excluded. Janani Shishu Suraksha Karyakaram (JSSK) entitlements e.g. free transfer from home to facility, inter facility transfer in case of referral and drop back for mother and children are the key focus of 102 service.
- For Dial 102 Service and Dial 108 Service, operational cost is supported under NHM.
- Implementation of National Ambulance Service (NAS) guidelines has been made mandatory for all the ambulances whose Operational Cost is supported under NHM.
- 10993 ambulances are being supported under 108 emergency transport systems including new.(Source : NHM MIS)
- 9955 ambulances are operating as 102 patient transport including new ambulances.(Source : NHM MIS
- 5126 empaneled vehicles are also being used in some States to provide transport to pregnant women and children e.g. Janani express in MP, Odisha, Mamta Vihaan in Jharkhand, Nish hay Yan Prakalpa in West Bengal and Khushiyo ki Sawari in Uttarakhand.(Source : NHM MIS)
- Air ambulance service is considered to be a commercial air service, which needs to be regulated to ensure safe aircraft operations. Rule 134A of the Aircraft Rules, 1937 specifies that no person shall operate any non-scheduled air transport service from, to, in, or across India except with the permission of the central government. This Civil Aviation Requirement contains minimum requirements for air ambulance operations.
INTRODUCTION
National Ambulance Plan for India
India is the second most densely populated country in the world, with a density of 464 people per km²? For a population so large, problems like congestion and traffic jams are common hassles during medical emergencies. According to information released by MoRTH, there were approximately 1.3 lakh fatalities and 3.4 lakh people injured in road accidents in 2020. Establishing a comprehensive National Ambulance Plan for India is crucial to improve emergency medical services and reduce casualties due to the unavailability of ambulances. Learning from successful international models, we can tailor a plan that addresses the unique needs and challenges faced by India.
To expand medical outreach and access to trauma care services to a wider population base across the country a National Policy for Ambulance Services may be launched by the central govt. bringing all the existing stake holders like different ambulance operators, hospitals etc. on the single IT enabled program controlling through a single number and single code process by setting up call centers at various levels. A person seeking medical transfer, may call on a single three digit number and can be transferred to the right solution provider without wasting the first precious hours.
Successful International Models:
- United Kingdom (NHS Ambulance Services): The UK’s National Health Service (NHS) has a well-organized ambulance service that ensures quick and efficient emergency response.
- United States (EMS Systems): The U.S. Emergency Medical Services (EMS) system, coordinated at both state and local levels, has significantly improved patient outcomes.
- Germany (Integrierte Leitstelle): Germany’s integrated emergency control centers coordinate various emergency services, including ambulances, for prompt response.
Reasons for the National Ambulance Plan in India:
High Population Density: India’s dense population demands a robust ambulance network to cater to emergencies promptly.
Geographical Diversity: The diverse geography requires a flexible and adaptive ambulance system to reach remote and urban areas.
Traffic Challenges: Congested roads in metropolitan cities necessitate well-planned ambulance routes and coordination.
Casualty Statistics: According to available data, a significant number of casualties occur annually in India due to delayed or unavailable ambulance services. Exact numbers need to be compiled through collaboration with health agencies and emergency services.
Categorization of Ambulances:
a. Transportation Type:
i. Basic Life Support (BLS): For non-critical patients requiring basic medical care during transportation.
ii. Advanced Life Support (ALS): Equipped for critical patients needing advanced medical interventions during transit.
b. Patient Type:
i. Adults: Ambulances designed to cater to the needs of adult patients.
ii. Pediatric: Specialized units equipped to handle medical emergencies in children.
Government Grant Required: Estimating the required funds is contingent on a thorough needs assessment, but a substantial initial investment is necessary. A ballpark figure
might be in the range of [Specify Amount] to [Specify Amount] INR.
7. Public-Private Participation Model:
a. Cost Efficiency: The private sector can bring efficiency and cost-effectiveness to ambulance services, leveraging existing infrastructure and expertise.
b. Innovation: Private entities often bring innovative solutions and technology, enhancing the quality of services.
c. Quick Implementation: Public-private partnerships can expedite the implementation of the National Ambulance Plan.
8.Justification for Public-Private Participation:
a. Resource Optimization: Utilizing private resources allows the government to focus on policy-making and regulatory oversight.
b. Risk Sharing: Risks associated with service delivery and maintenance can be shared, ensuring a more sustainable and resilient system.
c. Quality Improvement: Private sector involvement often leads to improved service quality and responsiveness.
Ambulance services play a crucial role in emergency medical care and transport. Bed-to-bed service, which includes ground transportation- road and rail, air transportation, and coordination with the receiving hospital. This ensures a smooth and hassle-free transfer process for the patient and their family. They are the first point of contact in case of a medical emergency and can make a difference between life and death. In India, the need for ambulance services is particularly significant due to the high population density, traffic congestion, and a lack of basic healthcare facilities in many areas.
Over the years, there has been significant progress in the development of ambulance services in India. The government has taken several initiatives to improve the availability and accessibility of ambulance services across the country.
Public-Private Participation Model:
a. Cost Efficiency: The private sector can bring efficiency and cost-effectiveness to ambulance services, leveraging existing infrastructure and expertise.
b. Innovation: Private entities often bring innovative solutions and technology, enhancing the quality of services.
c. Quick Implementation: Public-private partnerships can expedite the implementation of the National Ambulance Plan.
Justification for Public-Private Participation:
a. Resource Optimization: Utilizing private resources allows the government to focus on policy-making and regulatory oversight.
b. Risk Sharing: Risks associated with service delivery and maintenance can be shared, ensuring a more sustainable and resilient system.
c. Quality Improvement: Private sector involvement often leads to improved service quality and responsiveness.
When it comes to emergency medical care, time is of the essence. The availability and response time of the ambulance service are critical factors to consider. Here, three stages support system may be developed. The first call should land to the primary call center and they should be forwarded to the applicable ambulance mode on a nominal cost. The applicable mode call center should evaluate the condition of the patient and collect following document/information from the patient side.
- A valid medical certificate from a registered medical practitioner.
- A medical clearance certificate from the hospital where the patient is admitted.
- A valid passport or other valid identity documents of the patient.
- A valid visa, if required.
- If applicable, a copy of the patient’s medical insurance policy.
- A copy of the air ambulance service provider’s insurance policy.
- A copy of the patient’s medical history and relevant medical records
- Note : In case of abandoned patient, his basic case history from the nearest Medical center doctor/pharmacist/RMPs should be accepted.
- A signed and dated authorization letter from the patient and the patient’s family permitting the air ambulance service to be carried out.
- Any additional documents that the air ambulance service provider or relevant government authorities may require.
The second level of call center will evaluate the condition, find the right sources to approach for the movement. They will contact the right sources and share patients’ data for their final consent. Once they have final list of support resources, they will forward the same to the victim. Now the patient or their help
can reach to the right source and negotiate the actual movement without wasting golden hours. There are several agencies in the country working in different areas in a scattered manner as an unorganized sector in the ambulance segment. Bringing all such ambulance service providers, may be government or private, of different mode should be brought on a single platform and should be made available through a single window system. Detailed process may be decided through a dedicated research. If such facility is developed on the national level on a self- sustainable model, it can be the most suitable option for the people in their critical situation. In conclusion, the establishment of a National Ambulance Plan for India is imperative to save lives and improve the overall healthcare system. A collaborative effort between the government and private sector can bring efficiency, innovation, and quick implementation to ensure timely and effective emergency medical services nationwide.
CAPSR CAMPAIGN to Develop Single Source Call Center to Provide Air Ambulance Service in the National Interest
Air Ambulance Services are basically used for the evacuation of accident victims, transfer of critical patients from one place to another place and shifting of organs. Air Ambulances in India are equipped with basic medical equipment such as oxygen cylinders, stretchers, first aid kits, and cardiac monitors. The best Air Ambulance Service emergency ambulance service should have a 24/7 availability and a fast response time. According to information provided by Ministry of Civil Aviation (moca) in March 2022, 49 air ambulances (aeroplanes and helicopters) were operated by 19 non-scheduled operators in India. The state-wise split of these air ambulances was Delhi (39), Gujarat (1), Kerala (2), Maharashtra (5), Odisha (1) and West Bengal (1).
Air carrier and air taxi flights who are responding to medical emergencies are the AIR AMBULANCE service providers. The nature of these medical emergency flights usually concerns the transportation of urgently needed lifesaving medical materials or vital organs, but can include inflight medical emergencies. It is imperative that the company/pilot determine, by the nature/urgency of the specific medical cargo. If priority is needed, ATC assistance is required for priority airport handling services.
Airlifting patients during a medical emergency is quicker, safer, and needs a lot more efficient staff to handle to achieve the goal. Medical Intensive Care Units (MICU) are made within the cabin of the aircraft because of the priority afforded to the patients’ condition in air.
Air ambulance flights in the ATC system needs extreme discretion when using the term “MEDEVAC.” It is only intended for those missions of an urgent medical flight. Term “MED ONE” should be made the code to be utilized only for that portion of the flight requiring such expeditious handling. When requested by the pilot, necessary notification to expedite ground handling of patients, etc., is provided by ATC; however, when possible, this information should be passed in advance through other mode of communication as well. Landing and parking charges for helicopters &aircraft should be waived off by the airport operators in this case.
Despite significant progress, ambulance services in India still face several challenges. Some of the common challenges include a lack of trained medical staff, inadequate infrastructure to support such operation, insufficient funding, and a shortage of ambulances in some areas. There is no Standard Operating Procedure (SOP) to initiate and operate such flights and cost of such flights are also not regulated.
CAPSR INDIA intends to develop a software platform where all the Indian registered aircraft intend to give service as Air Ambulance should be registered. CAPSR INDIA shall become a coordination center through its software enabled control room and act as a facilitator between the patient and the MED ONE operators.
The central govt. should allot them the MED ONE Code to operate. They can only fly as air ambulance and they have to share the live location of their aircraft with the software control center so that they should decide whom to approach for a particular requirement. Government should also fix the charges operating under this program. This software enabled control center shall be used under National Ambulance Program as secondary call center or it can be connected to governments all medical emergency services to get wide coverage of this program. A separate three digit call number may be allotted
independently to this service and can be advertised through media within the country for its wide publicity. A detailed work report will be published if government gives permission to move ahead in this direction. DGCA may incorporate this program
under the provision of its law by amending CIVIL AVIATION REQUIREMENTS SECTION 3 – Air Transport SERIES ‘C’, PART XII and make INDIA safer.