Kolkata Medical Emergency System & Services (KMES)

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Kolkata Medical Emergency System & Services (KMES): An efficient, responsive, integrated & sustainable model of Medical Emergency

Kolkata (Next city is Bangalore), IndiaKolkata, India
Year Founded:
2013
Organization type: 
hybrid
Project Stage:
Start-Up
Budget: 
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Aims to strengthen,standardize & integrate isolated emergency services with varying capability under a centralized medical emergency system to help co-ordinate the emergency retrieval as well as empower citizens for crowd-sourced quick response to cater to road accident victims within golden hour.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if we can had a crowd-sourced Medical Emergency System, like 911, in India for road accidents?
About Project

Problem: What problem is this project trying to address?

With increasing urbanization in absence of Govt-owned 911 system,medical emergency is provided by multiple,isolated providers with varying capability,resulting in an inefficient emergency management system.During road accidents victim receives no paramedic care & transported in public transport to a hospital. It may not be the nearest, and may not have proper emergency facilities & products(blood) available,causing serious delay & loss of life.

Solution: What is the proposed solution? Please be specific!

Instead of introducing new service, integrate & enhance the existing isolated emergency providers,to create a centralized, inter-operable, standardized Real-time Medical Emergency System that seamlessly connects “Sense”,“Reach”,“Care”,the 3 pillars of medical emergency.The system accessible via internet & mobile will empower citizens for crowd-sourced quick response while a state-of-the-art emergency control room,sustained using an freemium business model,will provide paramedic supported emergency retrieval to all road accident victims free of cost within golden hour.The 3 resources of emergency to be integrated-1.Hospital Emergency/ICU,2. Ambulances & Paramedics,3.Blood Banks & Donors followed by citizen awareness.(More:kmes.in/about.html)
Impact: How does it Work

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
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

While the crowd-sourced response is self-sustained,the emergency coordination is sustained by a Freemium model:Provide value-added services(VAS) to users who need it & can afford it and use the revenue for free basic services,such as retrieval of road accident victims.The VAS's are-1.Home based medical care & warranteed ambulance in emergency for users with wearable monitor(Elderly patients)2.Web/Mobile booking & Paid Ad for subscribed Health Org

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

In most cities, the usual route to solve medical emergency is to introduce new Ambulance fleet (public or private)without fulfilling the pre-requisites (e.g:paramedic workforce,real-time information from facilities etc). Setting up a city-wide Ambulance system is financially prohibitive & logistically difficult(competes with existing services,local political issues). Also to operate & maintain quality,they either have to charge thus excluding road accident victims or need to be funded/operated by the govt.An "Ambulance only model" cannot be the solution for a central medical emergency system.
Team

Founding Story

In 2010, my(Rajib) school friend, Dr Tanmay Mahapatra,who is a Critical Care Physician in Kolkata(my birth place),visited us in our house in Florida for a trip to the Florida Keys.On our way,just in front of us,two cars collided & a passenger from the back seat was thrown out of the car. Being a physician,Tanmay rushed to the scene & was concerned about the victim's survival. But he was amazed to see that within 5 minutes an 911 ambulance arrived with all proper equipment and well trained paramedic,who quickly brought the situation under control, stabilized the patient & transported her.When I explained 911 system to Tanmay, his instant reaction was to have a system similar to this in our hometown Kolkata & KMES was born!!

Team

Our org is setup as a lean group with 2 arms:1)HealthCare Research team led by Dr. Tanmay Mahapatra - responsible for identifying HealthCare issues in India and 2)Technology & Operations team led by Rajib Sengupta - responsible for ideation & implementing solutions to bridge the gap. KMES project is a classic example of this workflow. Outside this core team, we have a strong Advisory team of Emergency Physicians & Opensource Technology experts.
About You
About You
First Name

Rajib

Last Name

Sengupta

About Your Project
Organization Name
How long has your organization been operating?

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Project
Organization Country

, Kolkata

Country where this project is creating social impact

, Kolkata (Next city is Bangalore)

What awards or honors has the project received?
Funding: How is your project financial supported?

Friends and family, Individuals, Foundations, NGOs, Customers.

Supplemental
Partnerships

Developing relationships with local govt & providers rests at the center of KMES approach.Several Hospitals,Ambulances,Blood Banks are already part of KMES. While Govt. support has been obtained, a policy by Govt advising KMES adoption,will make it more impactful."Doctors For You" is our partner in Paramedic Training. For Technology we are partnering with Opensource communities(e.g:DHIS2,OpenMRS,Sahana, OpenDataKit) to stop recreating the wheel.

How does your idea encourage citizens to participate in making roads safer?

We rely on a simple assumption:Instead of competition let’s collaborate where collaboration should not be limited to institutions, but should also empower & involve citizens.We empower citizens with easily accessible realtime information,a responsive emergency centre, community emergency training,dos & don'ts in road accident & implicitly nudge them towards Good Samaritan Practices which we hope, by public pressure will be a law(goo.gl/JHuZEJ)

Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?

The primary barrier is “Adoption by Hospitals, Ambulances & Blood Banks” which we are tackling using bottoms up approach followed by top-down approach.First, we are explaining the benefits of KMES to each organization and stressing on the optimal utilization of their scare resources. Now we are obtaining endorsement from the Government.We have obtained support from Mayor Of Kolkata and planning to meet the Chief Minister of West Bengal.

Additional Information
Is your project targeted at solving any of the following challenges?

Active citizenship: Projects that work to promote active engagement with road safety from individual citizens, pedestrians, communities, and social networks, or that use education as a tool to raise awareness and promote engagement, Technology: Projects that leverage technology to promote road safety, Infrastructure: Projects that address road or administrative infrastructure, emergency care, or financial systems.

Would you like your project to be considered for the Bangalore People’s Choice Prize?

Yes

If yes, how is your project applicable to the Bangalore context?

The project due to its unique & innovative,yet practical & feasible concept is seen as a bottom-up solution for medical emergency which can be replicated across cities in India where emergency service is provided by varied emergency service providers with varying capability in absence of govt sponsored medical emergency system(e.g:911 in USA).Realizing the immense potential of the idea during medical emergency not only in Kolkata,but in any cities of developing countries,the project has been awarded three prestigious awards-1)Rockefeller Foundation Centennial Innovation Challenge award in 2012(http://goo.gl/dp5vYN) 2) 2nd Prize in Emergency HealthCare innovation in the Country’s leading Emergency Service Award program conducted by AIIMS New Delhi in 2013, and 3) Recently, Grand Challenge Canada Stars in Global Health(http://goo.gl/3LWy9g).Bangalore has very similar emergency healthcare scenario where emergency services are provided by multiple isolated providers each with varying capability. While in the Hospital infrastructure side, the situation may be a little better compared to Kolkata, but the medical emergency care that starts at the site & stops at the door of the Hospital is pretty much similar.Such as, no pool of paramedics,no readily accessible information of nearest hospitals with emergency facilities/ICU availability, no blood bank availability info etc and no awareness among citizens on dos and don'ts during road accidents.We have to accept the fact that, Road accidents will remain and with increase in traffic it may only go-up, whether it's Kolkata or Bangalore.As such a centralized medical emergency system in each city is a must for providing the maximum chance for survival of a road accident victim. Due to the complex nature of Indian Healthcare(State vs Central,Pvt vs public),having a governmental centralized medical emergency system is a distant dream while a private org cannot build and sustain on it's own. As such, we need to use the power of collaboration & crowd-sourcing to build a 911 for Indian cities whether it is Kolkata or Bangalore.

Comments

Sachin Malhan's picture

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.

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

AVOID ACCIDENT's picture

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

RA Venkichatalam's picture

Can this be scalable to 108 nationally ? In postaccident scenario, the approach looks practical .

RA Venkichatalam's picture

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