PRE HOSPITAL CARE,

EMERGENCY MEDICAL SERVICE

Binod Adhikari (Health Journalist & Media Enthusiast)

56 million people die each year in the world .68% people die because of non communicable disease. Out of all non communicable disease, cardiac cause comes in the front About 9.1 million people die because of trauma .The ultimate reason of death mostly in trauma and cardiac underlying cause would be cardiac arrest.

American heart association (AHA) guidelines suggested that every minute missed to apply defibrillation after cardiac arrest, the survival rate will be decreased by 7% -10%. The survival rate of cardiac arrest is below 10 % if it occurs out of hospital and about 20 % if it occurs in the hospital.

Proper CPR and Defibrillation is the main treatment modality of cardiac arrest to bring the patient back .However it can be occurred anytime time anywhere in the corner.

Pre hospital care, Emergency medical service has its value to reach on scene on time and manage the case promptly although bystanders’ role is to start CPR immediately if they are trained .In some advance society even the defibrillators are available in the different stations like train station ,police station ,airport etc.

Nepal where the concept of pre hospital care is almost nil.

1. Road to the remote area is still limited

2. Presence of road but no health facility available

3. Health facility is available but no ambulance service is present

4. Ambulance service is available but no concept of paramedics in it is practiced

5. Even if in case paramedics are available, no life saving equipments and drugs are available.

6. Vast majority of ambulance in Nepal is squeezed with just a limited oxygen cylinder with the capacity of 9 lit.

Kathmandu the capital of Nepal consists of many advanced hospitals even do not have well equipped ambulance and the system of paramedics’ service is not at all available.

According to the study performed by Patan Hospital in Nepal very limited numbers of 10 % patients are coming to the door of Emergency department by Ambulance, 54% of the patients are using Taxi.

200 bedded ´Grande International hospital’ having a motive of “Care to Cure” was established in February 2010.Having in mind to serve the patients from the very remote areas of Nepal, it consists of 3 helipads .Roof top helipad in the 14th floor of GIH started its Helicopter emergency medical service since Oct 29th 2013 .Secondary helipad is just 200m from the department of emergency medicine and the helipad for the bigger size helicopters is just in the front door of the hospital.

Due to the given facility, from the any corner of Nepal if patient needs to be transferred to Kathmandu, the rapid response team (Specialized emergency physicians and nurses) will be ready by 10 min and will fly with all the life saving equipments and drugs including the portable ventilator and AED .So far several hundred medical evacuation has already been performed by GIH .

About 4 million inhabitants are in Kathmandu. Teaching hospitals as well as many advanced set ups are available here .Many referral centers are also located in Kathmandu.

Pre hospital care department is present only at Grande International hospital in Nepal which serve Emergency medical service in its best possible way .Consists of three ambulances, one is highly equipped with the portable ventilator of Dragor Oxylog 1000, Zoll AED Plus, Suction device,Laryngscope, Nebulizer, Hard board, CPR board, Syringe pumps, Pelvic binders, Air splints, cervical collar,O2 facility of 100 lit and all the life saving drugs are inside it .Paramedics are all the time available in the ambulance .Paramedics are with the qualification of CMA and obtained PTC training,Inhouse BLS and ACLS training given . Ambulance attendant who are drivers are trained at least how to lift the patients and to carry them. GIH EMS logo as well as paramedics dress are coded.

Tracker device is installed inside the ambulance which will give all the information about the movement of the ambulance .Location of an ambulance as well as its speed can be monitored from the PHC office.

Depending on the case, Emergency medicine specialist is on board and will accompany the patients while transferring the complicated ones. The service is available 24 hours.

All the six stages of ‘star of life’ are being tried to follow.1) Early detection 2) Early reporting 3) Early response 4) On scene care 5) Care in transit 6) Transfer to definitive care.

As it is known to the fact that Patient outcomes are determined by:

Bystander care

Dispatch

Response

Pre-hospital care

Transportation

Emergency room Care

Definitive care and Rehabilitation

Bystander care in Nepal is very poor .Even in the metropolitan city Kathmandu, no one performs CPR if they found the patient collapsed and in need of CPR. AED is not familiar to the locals. From the school level education it should be taught in Nepal and different campaigns should be organized immediately.

’Nepal ambulance service’ has been functioning having three digit number of 102 and they have their dispatcher and few ambulances are standby in Kathmandu and the nearby city Chitwan.it is serving in the community.

Hospital based EMS service is one and only in GIH having its own dispatcher and the number is 01-5159077.Soon after getting the call, the limited information will be obtained and the message will be given to the IT section of the hospital, there after pressing the specific number will activate the Ambulance service and in need helicopter emergency medical service .Team on mission informs about the condition of the patient and immediately after finding the information, ER department will be ready to attain the patient. Meantime respective specialists will be informed and they will be on standby to intervene the patients.

The department is fully functioning carrying the goal of treating the patient on scene as well en route and bringing back to the hospital as well as it does inter hospital transfer. Since it has started its function, many ventilated cases are successfully transferred where hundreds of complicated cases got the service. The very first month, number of calls to the PHC department were 66, next month the department got 98 calls and the third month crossed 100 shows that if the information goes to the local level, the number of beneficiaries will grow up and the department of Pre hospital care –EMERGENCY MEDICAL SERVICE GIH has taken ground breaking innovation in Nepal and the department will be pleased to serve the nation in its level.