Sanjivani-108 Emergency Ambulance services- Madhya Pradesh

It is terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that imply the importance of Emergency Medical Services (EMS) all over the world. It is a well-accepted fact that a patient who receives basic care from trained professionals and is transported to the nearest healthcare facility within 15-20 minutes of an emergency has the greatest chance of survival. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately.
We are living in a time when the emphasis on preventing damage is greater than ever, the provision of pre-hospital care will be the key to ensure that the lives are not lost due to avoidable circumstances. This acute need to have emergency services in Madhya Pradesh motivated and encouraged 108 Ambulance Scheme to be announced in the State Budget 2008-09. Scheme was conceptualized to provide Emergency Response Services to people of Madhya Pradesh. Government of Madhya Pradesh, Ministry of Health and Family Welfare, under National Rural Health Mission initiated Emergency Response Services, popularly known as “108 Ambulance service project 108-Ambulance Services which is being run in PPP mode in the State.

108 Ambulance service Project- Madhya Pradesh:
This Scheme is an emergency Medical Ambulance Service (EMAS) which is running across the State of M.P. and is also popularly known as "108 Ambulance Service". This Emergency Medical Ambulance Services, with a fleet of 554 Basic Life Support (BLS) Ambulances and 50 Advance Life Support (ALS) Ambulances deployed strategically across the State of Madhya Pradesh supported with a fully functional centralized call center situated near TB Hospital, Idgah Hills, Bhopal which is receiving more than 25000 calls per day and handling approx. 2500 emergencies on daily basis. GPS with Biometric System has been installed in. ambulances. Presently this project has approx. 3000 employees of the service provider including approx. 1400 Pilots (Drivers) and Emergency Management Technician (EMT) each. The project is being managed under Public Private Partnership mode and financials are on reimbursement basis. All capital expenditure (Capex) is borne by NHM, Government of Madhya Pradesh. Capital expenditure (CAPEX) includes ambulance, its refurbishment & equipment cost, establishment cost of call centre, hardware and software required to run the services. Operational expenditure (OPEX) is reimbursed quarterly on actuals subject to an agreed ceiling amount.

Objectives of Schemes:
• To provide round the clock pre-hospital emergency transportation care (ambulance) services across the state.
• Improve the access to Medical & Health care, police and fire service, particularly attending emergency situations relating to pregnant women, neonates, parents of neonates, infant and children in situations of serious ill health and all other emergencies in the general population: and thereby assist the state to achieve the critical Millennium Development goals in the health sector, i.e. reduction of infant mortality rate, and maternal mortality rate, and in general reduce the vulnerability of the people by providing access to Emergency Response Services.
Availability of ambulances for critical patients; reliable assured and affordable transport for pregnant women and new born/infants:
• All types of emergency cases are handled by 108-Services, including pregnancy cases, accidental, unconscious, paralysis, inflation, fever, heart attack, and all types of emergencies.
• Any person in need of emergency help can dial a toll free number 108 from any landline or mobile set, The ambulance reaches the site and rushes the victim to the nearest hospital with in 15-20 mins in Urban areas and 30 mins in Rural areas. During the trip, EMT provides the victim pre-hospital care. It’s a very popular and easily available service.

How it works?
• The 108 Services works on the unique paradigm of Sense – Reach – Care supported by an efficiently trained team and state-of-the-art equipment & software with GPS tracking systems.
• Any person in need of emergency help can dial a toll free number 108 from any landline or mobile set. This call is attended within three rings by specially trained communications officers, who after understanding the nature of emergency; connect the caller to the dispatch division. Reach
• The dispatch officer immediately identifies the ambulance nearest to the site and contacts the driver and guides him to the mishap site.
• Before the ambulance reaches the person in emergency, a virtual hand holding is also carried out, by putting the caller on a conference call with the Emergency Medical Technician (EMT) and/or the physician available 24/7 in the Emergency Response Centre. Care
• The ambulance reaches the site and rushes the victim to the nearest hospital During the trip, EMT provides the victim pre-hospital care.

Establishing Control Room for timely response and provision of services:
A victim in emergency would call three digit phone number 108 which is accessible from all the locations where Emergency Response Services are operational. This line has toll free access in local area and also accessible on STD with priority routing through all telephone operators operating in Madhya Pradesh and is Category service with unrestricted access from all landlines & mobile phones throughout Madhya Pradesh. These calls from all over the Madhya Pradesh are routed to a centralized call centre situated in premises of TB association Building at Idgah Hills Bhopal. The toll free number 108 has been allotted by Department of Telecom to Government of Madhya Pradesh, has provided access to the provider for this purpose up to the period of agreement for this purpose. The provider would operate this call centre round the clock with necessary trained personnel and technology. On receipt of call, the personnel receiving the call would collect initial critical information related to place, location, landmark and the type and seriousness of Emergency. Based on type of emergency he classifies the call into Medical, Police and Fire emergency. In case of Police and Fire emergency the call is transferred to the unit handling Police and Fire emergencies. In case of medical emergency after ascertaining the criticality an ambulance is dispatched based on need and availability. The call center receives considerable number of no response calls, nuisance calls, non-emergency request calls, request for inter facility transfers and other calls which are not of emergency nature and doesn’t need attention, further more these calls disrupt operations by blocking time of the available resources. Service Provider is permitted to device their own strategy to handle these situations, as per desired impact.

All the ambulances are to be provided with GPS and maintained by the provider. Ambulances are having necessary equipment for life support as provided by Government of Madhya Pradesh, the provider would man these ambulances with trained personnel. On receipt of instructions from call centre, ambulance confirms the location of the incident and starts immediately, after reaching the location, the ambulance personnel should be ensure scene safety before reaching the victim. After attending the patient, the Emergency Medical Technician would assess the need for ambulance transport. In case no Emergency exists, or inter facility request, would inform the call centre for further instructions, and proceed according to instructions of call centre. In case only first aid or some basic support is required, it is provided on the spot and after informing the call centre ambulance would move back to base location as specified by call centre. In case of mass casualties, and if there is need of additional ambulances, if any other resource is needed to attend to the emergency, including help from police and fire agencies, the same is communicated to the call centre. In case of Emergency, Emergency Medical Technician (EMT) assesses the type of emergency and seriousness, and transport the patient to nearest appropriate medical facility, pre hospital care is provided en-route. If necessary the EMT interacts with the Emergency Response Centre Physician for guidance. Pre hospital care record is maintained which includes details of drugs and disposables consumed and which need to be replenished. The time or receipt of call, time of arrival at the incident location, time started towards hospital and time when reached the hospital would be captured either manually or automatically in log register or software.