He was involved in a road accident, then rushed to hospital in an ambulance but ended up being shunted from hospital to hospital for seven hours, from Kollam to Thiruvananthapuram. No one took him in. The death of migrant worker Murugan, in Kerala last week, who was turned away from four hospitals on the grounds of not having the facilities to treat him, has highlighted the abysmal level of emergency care in the country.
Trauma care project
An ambitious five-year Rs. 128 crore project was mooted in Kerala last October to improve emergency care facilities, where it is planned to bring down the emergency response time to between 15 to 20 minutes. Once functional, it will operate through a centralised helpline. Here, control room operators, using live updates on the number of ventilators and beds available at the nearest hospital and information on the kind of injuries sustained by a patient, can direct an ambulance driver to the nearest Level 1 or Level 2 hospital, according to Dr. Mohammad Asheel, the nodal officer for the Comprehensive Trauma Care Project. “We believe we can bring down accident response time to 15 to 20 minutes using this model,” he says. The project entails upgrading 35 hospitals in the State, along with the operation of 315 ‘Basic Life Support’ ambulances and 35 ‘Advanced Life Support’ ambulances for inter-facility transfer.
Work is nearing completion at four centres across the State which includes Trivandrum Medical College (Level 1), which is being upgraded at a cost of Rs. 6.5 crore. “Three more hospitals in Ernakulam, Neyyattinkara and Alappuzha will be upgraded and functional in six months,” says Dr. Asheel.
However, without support from private hospitals which have an extensive network of facilities across the State and often the first places to treat road accident victims, the system looks set to fail. Referring to the Kollam incident, Dr. Asheel says a Government Order states that the inability of an accident victim to pay cannot be a reason to refuse him treatment.
“We hope that once the Clinical Establishments Act comes into action, there will be greater regulation over private hospitals and information on [the] number[s] of equipment and facilities provided to patients is made available to the government easily,” he adds. After furore over Murugan’s death in the State, the Kerala Clinical Establishments (Registration and Regulation) Bill, 2017, which had been pending for years, was presented in the Kerala Assembly last week.
In neighbouring Karnataka, after complaints of ambulance services being misused to facilitate the private sector, the Karnataka Health and Family Welfare Department ended its association with GVK-EMRI (Emergency Management and Research Institute) to provide emergency care through its ambulance services. According to the Health Department, misuse of funds, and an increasing number of referrals to private hospitals were some of the reasons for terminating the contract. Meanwhile, the Health Department’s promised centralised ventilator helpline across the State has still to be functional even after two years.
Any health-care system requires regular checks and maintenance without which medical help can be hard to get even in places with large amounts of footfall. Last Tuesday, a man in his fifties who suffered an acute heart attack at Kempegowda bus station, Bengaluru’s central bus terminal, had to wait for an hour and fifteen minutes for an ambulance to arrive. A bystander, Rajesh N., who noticed his discomfiture, tried to get him medical help but was told by the Bangalore Metropolitan Transport Corporation that the only ambulance available had broke down while ferrying another patient to a hospital. “While there was a medical room, it did not have the required medicines. A doctor had to intervene and send an employee to get medicines to treat the man,” says Mr. Rajesh. The man was lucky to survive, but it is disheartening that a central commute point in a metropolitan city such as Bengaluru, where lakhs of passengers travel every day, has just the bare minimum as far as emergency care facilities are concerned.
Unfortunately, even the best of schemes fail when systems are not maintained and ethics are ignored, which was what happened to the unfortunate migrant worker in Kerala.
With inputs from C. Maya in Thiruvananthapuram