Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.
An accident occurs on a busy road.A passer-by aware of KMES,calls Emergency Centre(EC).EC using GPS enabled Android app locates & informs the nearest available networked ambulances.As soon as an Ambulance driver accepts the message confirming it's availability,EC contacts him to convey details,such as exact spot,nearest Hospital with availability & shortest direction.EC will also send SMS to all volunteers who is paramedic trained & registered.If one of them is nearby & available,by the time Ambulance arrives at the spot,s/he will make the area secure & stabilize the victim. If none is available,as the driver and/or helper will be paramedic trained,they will be able to stabilize the victim and transport the victim to the nearest Hospital.
Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.
Phase I of the project in Kolkata,supported by Rockefeller Foundation, was started in 2013 as a pilot project with 2 hospitals.But due to interest from other hospitals & public,we increased the scope to include all major hospitals of Kolkata.It was launched on Feb 26th(http://goo.gl/YK37EJ) with 15 hospitals, showing availability of Intensive Care Unit(ICU/CCU) by type(NICU, CICU etc).The usage has been on average 20-30 users.A survey among users indicated that next requirement is quick transportation as patients have to wait long for a Hospital ambulance to arrive,without being aware that a private ambulance is sitting idly next door.In another survey,Hospitals felt that onsite paramedic care would have reduced mortality & morbidity rate by at-least 25%,specifically in road accidents.As such in Phase II,started on March 1st,we are concentrating on Ambulance & building a paramedic pool.
Spread Strategies: Moving forward, what are the main strategies for scaling impact?
At 3 Levels:
Overall Universal Health Care:In India,HealthCare system is deeply divided/biased based on social & economic condition of patient,which impacts severely at time of emergency.KMES disrupts this bias by providing same data & service to everyone during emergency,as it is a specific medical condition which has the legal & ethical backing.
At Emergency Provider level:Implicitly makes them more accountable by bringing them in the network, so that they act on the best interest of patient
At Citizen Level:Implicitly nudges citizens to be aware, empathy driven & be a Good Samaritan
Comments
Wonderful idea. Most powerful because it creates a highly replicable model. Indeed, Bangalore could be next with this competition being the perfect opportunity. One area that should be emphasised is how you can share the data you are gathering with other organisations in different cities. I think your data (if you are gathering it approriately) could help other orgs evolve their own programs. Love your collaborative attitude.
Such an informative topic! That is comprehended delivery of the resource for readers and most appreciable.
Sherlock Holmes Coat Wool Cape
Sachin, Thanks a lot for the encouraging comment and a great idea. As you have guessed, the biggest obstacle is
convincing the institutions/organizations to collaborate and share data.At the very onset of the project we identified
the following complexities in a medical emergency system implementation in Kolkata, where emergency care is provided by
multitude of service providers with varying capability. Here are few of the complexities from an Hospital ER/ICU
perspective:
1.Each Hospital has different workflow and it is very difficult to standardize Bed Management
2.The service providers are very heterogeneous when it comes to data & information mgmt
3.All Hospital information management systems are proprietary, closed & isolated. Several of them do not have any
internal IT staff to integrate the internal systems.
4.Though several standards exist for interoperability of clinical data (HL7, CCR etc), none exists for medical emergency
services.
5.No hospitals, Blood banks want to share their Patient data due to privacy and financial reason
6.In-fact, several of them do not want any automated interface between their internal system and KMES due to fear of
theft of patient list
7.And finally, several of the Hospitals manage the beds using paper tickets (known as bed-tickets) and do not have any
electronic system in place
Similar issues exists for Blood Banks and Ambulances also.
We tackled these issues by following few pragmatic approaches:
1.Multiple options to integrate, instead of dictating all to use a specific standard. KMES provides customizable
solutions for each Hospital/Blood Bank/Ambulances to integrate its own data source.
2.If agreed, real time integration with internal electronic systems
3.Easy, one-click update which do not have any electronic bed management system or not willing for automated integration.
4.Minimalistic intrusion to the existing internal system.
5.Only captures Supply chain information (CCU, BSU) without any patients record.
6.Efficient and optimum implementation framework uses Opensource technologies so that the wheel is not recreated.
Importance is given in implementation rather than on technology.
Aside the impact in saving public life, one of our negotiation point with the organization was, we will provide them
monthly, quarterly, yearly report of usage (which they don't have currently), based on which the organization itself can
evolve, make their workflow better etc. Your comment takes it to the next level , where the historical data of one org ,
which is running very efficiently can help the other org.
I have bring this comment to the notice of our Public Health research and communication team and we surely will keep it
in our conversation with the organizations in our continued discussions.
Let's chat more.
Thanks,
Rajib
good idea indeed !!
rescue road accident victim in golden hour is very much important and establishing trauma help is required.
I strongly recommend to implement this project by the government and bring all the Ambulances under one umbrella. Being a Motor Vehicles Inspector I faced some problems in providing Ambulance to the accident victims. There shall be one organization it should receive the calls and allocate the Ambulance, so that it will reach the victim as early as possible. To make this the government has to make some policy on this
Can this be scalable to 108 nationally ? In postaccident scenario, the approach looks practical .
Can this be scalable to 108 nationally ? In postaccident scenario, the approach looks practical . Economic sustainability aspect needs to come out clearer.
Dear Mr Venkichatalam,
Yes. I think this model can be scaled to 108. But we believe that India need a significant modification of the current 108 model. In most of the LMIC cities (including India's 108), the route usually taken to solve the medical emergency problem is to introduce a new Ambulance fleet without fulfilling the pre-requisites, such as paramedic workforce, real-time information from facilities etc. Setting up a city-wide Ambulance system is financially prohibitive (huge capital investment is required) and logistically difficult to implement (competes with existing services, local political issues). Plus, to maintain the quality, they either have to charge heavily or need to be funded by the government, failing which these services soon become unsustainable. The "Ambulance only model" cannot be the solution for a central medical emergency system for a diverse country like India, specifically where Health is a state subject and often implemented under the constrains of local political, economical and cultural issues. In the current 108 model , Government is becoming another ambulance provider, without really creating the infrastructure & resources required to satisfy the golden hour. We think government should provide the appropriate infrastructure and integration points. This leads to the second point of financial sustainability,
We recognized the fact that in a mega-metropolis like Kolkata, government or private, no-one can do this alone. It is financially not feasible and sustainable also. The KMES approach tries to solve this in a financial feasible manner, by NOT introducing any brand new emergency service (and an ambulance fleet). Instead, we are integrating the existing services for better utilization and enhancing / strengthening the services, as required with the proper toolset (Toolset is defined as Product, People or Processes – e.g: Providing Paramedic training, GPS enabling etc.) under the Kolkata Medical Emergency System (KMES) umbrella.
Thanks,
Rajib
It is a wonderful idea to try and replicate 911 in the Indian environment, the concept of immediate and effective paramedic assistance is invaluable.. Unfortunately dense traffic congestion might defeat the purpose of this wonderful endeavor, although In the US once you hear the ambulance sirens, it is mandatory to move aside and let it pass. In India, however,due to the densely packed traffic, there is no space to move. Ultimately the ambulance is forced to sit in traffic loosing precious minutes.Undoubtedly, your idea is a great first step, ultimately, to save our citizens we have to solve the problem of dense traffic issue simultaneously.Perhaps