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'Ambulances in India fail to arrive on time and are mostly ill-equipped'

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ET Health
23rd June, 2022 18:04 IST
Mumbai: Gurjit Singh, COO, Founding Member, StanPlus spoke to ETHealthWorld's Prabhat Prakash on the state of affairs of emergency medical services in India and how scaling, upgrading ambulance services can reach critical cases during the golden hour.

The private Indian healthcare fraternity does invest in upgrading to state-of-the-art facilities/services in healthcare delivery. How is it that the ambulance service system is still broken?

Indian healthcare has invested in improving healthcare delivery services but those services have always been largely towards tertiary care and recently in the diagnostics segment driven through private investment. We are now also witnessing significant investments in a single speciality, primary care, secondary care, and health supply chain logistics models. I do believe the time is right for staying true to the patient's first approach and thus by identifying the root cause of the problem, formalising platforms for emergency response. Large hospital ecosystems either have their emergency medical services (EMS) which are limited to their network and with limited technology, talent and focus on medical transport. This further has an impact of losing critical minutes simply for dispatching ambulances only because treating patients is their primary responsibility, not necessarily transporting them.

Generally, the EMS in the country faces two major challenges: first, getting to the patient on time, and second, providing critical services such as triaging, vital sharing, and an equipped ambulance to perform crucial functions such as advanced life support (ALS), basic life support (BLS), cardiopulmonary resuscitation (CPR) within the golden hour. Until and unless a skilled and equipped emergency response team is ready for dispatch within seconds of the patient's calls, the problem will not be solved. If hospitals partner for their EMS with companies like us, we can help deliver robust mobile critical care services to patients in the time of emergencies with our trained team specifically dedicated to this.

What are the challenges of the industry in having a robust mobile critical care service?

The healthcare sector in India is advancing and attaining world-class standards, but unfortunately, the emergency medical response system in India is lagging. The segment at an overall level projects a huge area of improvement as it is fragmented and unorganised with inefficient response systems. The lack of availability of quality ambulances along with skilled manpower and technology enablement at an overarching them.

While there are multiple challenges that are troubling the few grey ares which needs to be addressed are:

Importance of quality EMS: In the case of hospitals their primary responsibility is to deliver optimum healthcare and the well-being of the patients. Their diverted attention and focus to also provide ambulances is limiting the country’s emergency response potential. And in the corporate segment, large-scale event organisers need to play a significant role and give more importance to incorporating emergency response platforms like StanPlus to extend an on-ground comprehensive health concierge services with ER management.

Skilled manpower and training: In multiple cases, we witness ambulances to be a mere transportation facility, this is what I believe should be addressed on a large scale. Continuous skilling and upskilling of clinical talent should be taken on a periodic basis along with creating a robust clinical protocol for medical transport.

Availability of quality ambulances: Ambulances reaching the patient should be appropriately equipped for ALS and BLS to provide the first response.

Leveraging the technology to deliver ambulances on time: Developing and setting up AI algorithms to enable the first-minute last-mile delivery of ambulances to patients.

According to an All India Institute of Medical Science (AIIMS) report, 2020 98.5 per cent of ambulances carry dead bodies (as they are late in reaching the spot), 90 per cent of ambulances are without oxygen or necessary life-saving equipment, and 95 per cent do not have trained emergency medical technicians (EMTs). Most of these ambulances assigned by hospitals are unable to ensure that the EMS is equipped and that trained paramedics are present to understand and treat patients with clinical rapid care, as a result, the patient's condition deteriorates and worsens by the time they reach the hospitals.

I believe that even though much emphasis has been placed on treatment, EMS is the first response to emergencies, and if a trained and equipped response is provided within the golden hour, it has the potential to save millions of lives.

How can the emergency and injury care service system response team be built up to cater to those in need?

India is a software and solution outsourcing hotspot. We are the ones who provide prompt services, and yet ambulances in India fail to arrive on time and are mostly ill-equipped. When it comes to emergency and trauma care, time is of the essence. Hence the importance of the golden hour, globally we have seen specialised EMS providers have been able to reduce the casualty and the impact of trauma. Therefore we need trained clinical manpower and equipped ambulances to reach patients on time.

As technology is an integral part of healthcare delivery, how can it be integrated into the overall healthcare delivery experience seamlessly?

The country's EMS can only improve with robust technology and an advanced strategy to build a quick and efficient infrastructure. Whilst at StanPlus we aim to build 911 for India, technology, and skilled manpower will be the driving force behind it. The use of AI will enable and provide ambulances in 8-10 minutes and perform all functions ranging from responding to calls, triaging, and dispatching the ambulance.

The usage of connected devices will enable live data sharing with emergency rooms and potentially save time and patient lives.

What were the challenges faced at inception? What are the current challenges and how is StanPlus addressing them?

Scaling and replicating the model to different cities with skilled and trained manpower along with equipped technology would be a challenge at first, but with an advanced team and technology, I believe it is achievable. We have already accomplished a significant presence in cities like Hyderabad, Bengaluru, Kolkata, Raipur, Bhubaneswar, and Ahmedabad, and are planning to expand to 15 more cities in total by the end of the calendar year, including Delhi-NCR, Mumbai, Jaipur, Indore, Kochi, Coimbatore, and Lucknow amongst others.

What is the fleet size that your organisation is eyeing at the end of 2022? What will be the strategies to achieve the fleet size? What is the market size that your organisation is looking to consolidate by 2023?

We are expanding aggressively, in 2020 we responded to 87000 emergency calls, in 2021 we responded to over 1.2 lakh calls and in 2022 we are expecting to respond to around two lakh calls.

To facilitate these emergency calls, we currently have a fleet of 3000 ambulances that reach critical cases within 15 minutes to extend timely first-aid and are planning to double it by the end of 2022. Historically, our fleet had grown by 2x every year.

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