BACKGROUND

It is terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that imply the importance of Emergency Medical Services (EMS) all over the world. It is a well-accepted fact that a patient who receives basic care from trained professionals and is transported to the nearest healthcare facility within 15-20 minutes of an emergency has the greatest chance of survival. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately.

We are living in a time when the emphasis on preventing damage is greater than ever, the provision of pre-hospital care will be the key to ensure that the lives are not lost due to avoidable circumstances. This acute need to have emergency services in Rajasthan motivated and encouraged 108 Ambulance Scheme to be announced in the State Budget 2008-09. Scheme was conceptualized to provide Emergency Response Services to people of Rajasthan. Government of Rajasthan, Ministry of Health and Family Welfare, under National Rural Health Mission initiated Emergency Response Services, popularly known as “108 Ambulance service project 108-Ambulance Services which is being run in PPP mode in the State.

PRESENT STATUS OF 108 AMBULANCE SERVICE PROJECT

108 Ambulance Project was launched in September 2008 with 5 Ambulances. The scheme was planned in a phased manner to cover the entire State. Presently a fleet of 741 ambulances are running across 34 Districts and 249 Blocks in the State. Fleet of 741 Ambulances also includes 14 ambulances provided by Disaster Management Authority. The procurement and deployment of the Ambulances is as below:

Fabrication and AC fitting work is pending in remaining 100 Ambulances after which they will also be deployed in the field.

SERVICE PROVIDERS:

OBJECTIVE OF THE PROGRAMME:

To provide comprehensive Emergency Response Services to the people of Rajasthan. Improve the access to Medical & Health care, police and fire service, particularly attending emergency situations relating to pregnant women, neonates, parents of neonates, infant and children in situations of serious ill health and all other emergencies in the general population: and thereby assist the state to achieve the critical Millennium Development goals in the health sector, i.e. reduction of infant mortality rate, and maternal mortality rate, and in general reduce the vulnerability of the people by providing access to Emergency Response Services.

To provide round the clock pre-hospital emergency transportation care (ambulance) services across the state.

Availability of ambulances for critical patients; reliable assured and affordable transport for pregnant women and new born/infants:

• All types of emergency cases are handled by 108-Services, including pregnancy cases, accidental, unconscious, paralysis, inflation, fever, heart attack, and all types of emergencies-

• Any person in need of emergency help can dial a toll free number 108 from any landline or mobile set, The ambulance reaches the site and rushes the victim to the nearest hospital with in 20 mins in Urban areas and 40 mins in Rural areas. During the trip, EMT provides the victim pre-hospital care. It’s a very popular and easily available service

   

  How it works?

   

• The 108 Services works on the unique paradigm of Sense – Reach – Care supported by an efficiently trained team and state-of-the-art equipment & software with GPS tracking systems

Sense

• Any person in need of emergency help can dial a toll free number 108 from any landline or mobile set. This call is attended within three rings by specially trained communications officers, who after understanding the nature of emergency; connect the caller to the dispatch division.

Reach

• The dispatch officer immediately identifies the ambulance nearest to the site and contacts the driver and guides him to the mishap site.

• Before the ambulance reaches the person in emergency, a virtual hand holding is also carried out, by putting the caller on a conference call with the Emergency Medical Technician (EMT) and/or the physician available 24/7 in the Emergency Response Centre.

Care

• The ambulance reaches the site and rushes the victim to the nearest hospital During the trip, EMT provides the victim pre-hospital care.

Establishing Control Room for timely response and provision of services:

A victim in emergency would call three digit phone number 108 which is accessible from all the locations where Emergency Response Services are operational. This line has toll free access in local area and also accessible on STD with priority routing through all telephone operators operating in Rajasthan and is Category service with unrestricted access from all landlines & mobile phones throughout Rajasthan.

These calls from all over the Rajasthan are routed to a centralized call centre situated in premises of State Institute of Health and Family Welfare at Jhalana Dungri in Jaipur.

The toll free number 108 has been allotted by Department of Telecom to Government of Rajasthan, Government of Rajasthan has provided access to the provider for this purpose up to the period of agreement for this purpose.

The provider would operate this call centre round the clock with necessary trained personnel and technology.

On receipt of call, the personnel receiving the call would collect initial critical information related to place, location, landmark and the type and seriousness of Emergency. Based on type of emergency he classifies the call into Medical, Police and Fire emergency. In case of Police and Fire emergency the call is transferred to the unit handling Police and Fire emergencies. In case of medical emergency after ascertaining the criticality an ambulance is dispatched based on need and availability.

On receipt of any call there is provision to capture following automatically using software –

Date, time of call
Patient Information (Name, contact details, Sex)

Automatically generate an ID

Information related to incident

Information related to location (District, town, landmark etc.)

The call centre has information related to all the hospitals in the area of operations along with the facilities available.

The call center receives considerable number of no response calls, nuisance calls, non-emergency request calls, request for inter facility transfers and other calls which are not of emergency nature and doesn’t need attention, further more these calls disrupt operations by blocking time of the available resources. Service Provider is permitted to device their own strategy to handle these situations, as per desired impact.

Technology:

The provider is operating the existing call centre at State Institute of Health and Family Welfare with necessary software procured by the provider. The software would provide for computer telephony integration with ability to log calls with geographical information system. All the ambulances are monitored with the help of Geographic Positioning System (GPS).

All the ambulances are to be provided with GPS and maintained by the provider.

Ambulances are having necessary equipment for life support as provided by Government of Rajasthan, the provider would man these ambulances with trained personnel. On receipt of instructions from call centre, ambulance confirms the location of the incident and starts immediately, after reaching the location, the ambulance personnel should be ensure scene safety before reaching the victim. After attending the patient, the Emergency Medical Technician would assess the need for ambulance transport. In case no Emergency exists, or inter facility request, would inform the call centre for further instructions, and proceed according to instructions of call centre.

In case only first aid or some basic support is required, it is provided on the spot and after informing the call centre ambulance would move back to base location as specified by call centre.

In case of mass casualties, and if there is need of additional ambulances, if any other resource is needed to attend to the emergency, including help from police and fire agencies, the same is communicated to the call centre.

In case of Emergency, Emergency Medical Technician (EMT) assesses the type of emergency and seriousness, and transport the patient to nearest appropriate medical facility, pre hospital care is provided en-route. If necessary the EMT interacts with the Emergency Response Centre Physician for guidance. Pre hospital care record is maintained which includes details of drugs and disposables consumed and which need to be replenished. The time or receipt of call, time of arrival at the incident location, time started towards hospital and time when reached the hospital would be captured either manually or automatically in log register or software.

Human Resource Management:

It is responsibility of the Service Provider to recruit adequate number of personnel either directly or through a contractor necessary staff required to execute the project. The staff would have necessary training.

1. The ambulance personnel deployed should have necessary prescribed qualifications
2. Emergency Medical Technicians (EMT) should be trained in General Nursing and Midwifery or B.Sc Nursing
3. Pilot – As per provisions in Government for driving of heavy vehicles.

The working process of Call Centre: Call & Dispatch Center Process:

In CDC, we do the following three things:

1. Receiving Calls
2. Identifying Emergency
3. Dispatching Ambulance

• A call is received by a Call Taker; he/she creates a call sheet by asking relevant questions. Ideally we divide the calls in two types:
  • Enquiry calls
  • Emergency calls

Enquiry calls are those where there is no emergency or any requirement of ambulance.

Emergency calls are those where Police or medical help is required. It is broadly categorized into: Medical, Police and Fire

The call sheet contains the following information:

• Caller Name
• Caller Number
• Patient name (if available)
• Patient number (if available)
• Location address where ambulance/police is required
• Alternate contact number
• Type of emergency (medical/police/fire)
• If Medical then complaint type (fever, heart-attack, assault, animal bite etc)
• Customized notes

  • This call sheet goes to Dispatcher after submitting. Dispatcher opens the call sheet, check the location address then look for nearest free ambulance and contacts the ambulance staff to go on that location and calls the caller (if required). Also, he/she sends message on phone and GPS, containing the address. The dispatcher takes the initial meter reading for records.

  • If police help is required, the same is informed to PDO (police dispatch officer), available 24x7 in CDC.

  • During serious emergency cases CDC also arrange conference call of EMT with Doctors for assistance.

  • Once the ambulance is back on the base location, staff calls on 108 to close the case. Dispatcher takes the on-scene and base location reading to close the case and give the auto generated case id to the ambulance staff.

All the conversation of CDC with ambulance staff & caller is automatically recorded for future references.

Call Details:

At present 649 Ambulances are functional in state and all types of case are handled like Medical, Police, Fire, Pregnancy by trained staffs, all EMT are trained for handling critical delivery cases, new born care. Ambulances are fully equipped with all equipments and other necessary arrangement to handle critical cases.

Necessary first aid services and other pre hospital care are provided during Emergency Transportation.

Emergency Response Center (ERC) is supported by Technology including latest telephonic switch with computer telephonic integration, integrated with Automatic Vehicle location and tracking system, GIS and GPS to locate the ambulance and hospital which is nearest to the victim.

Technology is used extensively in the project, ambulances are located using GPS. Advanced technology in IT and Telecommunications is used in the project.

Pre hospital is provided in the ambulances through trained Emergency Medical Technician (GNM) and all live saving and stabilization measures are initiated inside the ambulance, en-route to hospital.

Medical assistance is provided over phone to the attendant until the ambulance reaches the scene, further medical assistance is provided to the Emergency Medical Technician

Networking is done of major institutions and infrastructure set up in the state of Rajasthan like hospitals, Police Stations and fire brigades, information is available in the call center

Status of Deployment

Click here to download list of 741 Ambulances 

Status at A Glance:

Physical Progress Report Month upto Feb-2016

• Trips per vehicle per Month 46 (Feb-16)
• Average Kms covered per vehicle per Month 2647 Kms (Feb 16)

FUTURE PLANS:-

Running /Operation cost of Ambulances: As per Agreement with Service Provider Company, running cost of Ambulances would be borne by NRHM, also includes Medicines and Consumables based on present consumption pattern.

Operating cost for each Ambulance is Rs.1,12,500/ per ambulance/month as per Agreement with Service Provider company.

Details of Items/ activities including in running cast of Ambulances – Operation and maintenance of the services (including salary & allowances, recruitment & training , staff insurance, uniforms, conveyances & travelling & others) fuel, comprehensive maintenance charge of ambulances, comprehensive insurance, Ambulances mobile phones, asset insurance, telephone, Mobile, PRI line, internet etc., rent of building for Call center, electricity & water, housekeeping, AMC of hardwares, softwares, equipments etc., postage & courier, printing and stationary and all other miscellaneous, expanses inclusive of all taxes, duties, fees etc, and also included Expenditure on medical and non medical consumables used in ambulances.

Monitoring and Evaluation by External Agency:

It has been planned to timely monitor and evaluate the Ambulance Services, to serve the Mother and Child, un-served and under served areas. The monitoring will be conducted by an External Agency decided by NRHM.

Photographs of 108-Ambulance in Rajasthan