Today’s global EMS
has advanced so much that it contributes widely to the overall function of
health care systems. The World Health Organization regards EMS systems as an
integral part of any effective and functional health care system. It is the
first point of contact for the majority of people to health care services
during emergencies and life-threatening injuries and act as a gate-keeping step
for accessing secondary and tertiary services. Emergency medical providers
around the world have developed an extended role to deal with medical and
trauma emergencies utilizing advanced clinical technology.
Since 1970s, the mode of emergency health care delivery in
pre-hospital environment evolved around two main models of EMS with distinct
features. These are the Anglo-American and the Franco-German model. These
categorical distinctions were obvious during the 1970s until the end of the
20th century. Today, most EMS systems around the world have varied compositions
from each model.
The delivery of emergency medical services in pre-hospital
settings can be categorized broadly into Franco-German or Anglo-American models
according to the philosophy of pre-hospital care delivery. Another method of
EMS classification is according to the level of care provided into Basic Life
Support and Advanced Life Support according to the level of care provided.
The Franco-German model of EMS delivery is based on the
“stay and stabilize” philosophy. The motive of this model is to bring the
hospital to patients. It is usually run
by physicians and they have extensive scope of practice with very advanced
technology. The model utilizes more of other methods of transportations
alongside land ambulance such as helicopters and coastal ambulances. This model
is usually a sub-set of the wider health care system. This philosophy is widely
implemented in Europe in which emergency medicine is relatively a young field.
Therefore in Europe, pre-hospital emergency care is almost always provided by
emergency physicians. The attending
emergency doctors in the field have the authority to make complex clinical
judgment and treat patients in their homes or at the scene. This results in
many EMS users being treated at the site of incident and less being transported
to hospitals. The very few transported patients are usually directly admitted
to hospital wards by the attending field emergency medicine physician bypassing
the emergency department. Countries such as Germany, France, Greece, Malta and
Austria have well-developed Franco-German EMS systems.
In contrast to the Franco-German model, the Anglo-American
model is based around “scoop and run” philosophy. The aim of this model is to
rapidly bring patients to the hospital with less pre-hospital interventions. It
is usually allied with public safety services such as police or fire
departments rather than public health services and hospitals. Trained
paramedics and Emergency Medical Technicians (EMTs) run the system with a
clinical oversight. It relies heavily on land ambulance and less so on
aero-medical evacuation or coastal ambulance. In countries following this
model, emergency medicine is well-developed and generally recognized as a
separate medical specialty. Almost all patients in the Anglo-American model are
transported by EMS personnel to developed Emergency Departments rather than
hospital wards. Countries which use this model of EMS delivery include the
United States, Canada, New Zealand, Sultanate of Oman and Australia.
In stark disparity, many developing nations struggle to
provide basic emergency medical care to their citizens. Adequate infrastructure is often lacking, and
even in areas with significant financial and medical resources, emergency
medical personnel training is limited. Furthermore, EM is often not recognized
as a medical specialty overseas, making it unfeasible for interested care
providers to obtain the skills required to deliver effective care.
An extrapolation from a report provided by the World Health
Organisation(WHO) on emergency medical cases indicates that by 2020 road crashes
will be a major killer in India, accounting for 546,000 deaths. Although India
has only one per cent of the world’s motor vehicles, it still accounts for six
per cent of the total global Road Traffic Accidental (RTA) deaths. Moreover,
registered deaths due to other medical emergencies such as stroke, cardiac
arrests, natural calamities and terrorist attacks are also mounting. Dr Kole in
one of the white papers has mentioned that in India 98.5 per cent ambulances
are used for transporting dead bodies, 90 per cent of ambulances are devoid of
oxygen equipment, 95 per cent ambulances have untrained personnel, most ED
doctors having no formal training in EM, there is misuse of government
ambulances and 30 per cent mortality has been reported in recent times due to
delay in care.
Also, in many developing countries the pre-hospital
activities are not coordinated with hospital activities. Typically the patients
are brought by private or by public transport (police ambulances, rescue
services ambulances, mainly civil defense, etc.) without any information and
without coordination among the various agencies. Often this leads to
inappropriate transfer of patients to hospitals having not the technical
capability (nor the capacity in the case of mass casualty situations) to treat
these patients so that secondary transfer of patients is necessary. Most often
all patients are brought to single hospital while the other nearby health care
facility is not utilized or sometimes patients are brought to the nearest
hospital to the emergency site which in most cases is unable to manage the
patient properly due to lack of facilities and expertise to manage such a case.
Often the receiving hospital cannot mobilize in due time its internal resources
due to the lack of timely information regarding the arrival of patients in the
case of mass casualty situations.
Thus, in such a scenario, specialized Ambulance services
with trained personnels & evolved technology is a boon for an economy like
us, headed towards becoming a global superpower, which help in securing,
enhancing & enriching every life in need. A phenomenon crucial for maintaining
the balance between progress & humanity.
What else can be done to improve the Emergency Medical
Services in India?
·
To develop faculty out of other
specialties
·
To train the faculty in countries where
emergency medicine is being practiced
·
To have exchange programmes
·
To plan for EMS training, Paramedic training EM
nursing
·
To formulate disaster plan
·
To form governing body and academic council
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