Rushing to the Rescue

An emergency medical service started in Mumbai by American physicians of Indian origin aims to provide quick and timely treatment.

Sheikh Manzoor sells boiled eggs at Kurla railway station in suburban Mumbai. Manzoor, 42, originally from West Bengal, used to bring his daily stock of eggs to the station in the morning, right after his prayers. Now, he depends on his 17-year-old son to bring him to the station on the carrier of his bicycle, along with the eggs.

Manzoor remembers the day, December 26, 2007, when he lost both his legs after he fell under a running train while crossing the tracks. “I lost so much blood that my pulse was beating faintly. Policemen picked me up, put me in an ambulance and took me to a hospital. I don’t remember for how many days or weeks I remained there, but I remember that I lost all the money I had saved over the years. Also gone was my wife’s meager jewelry.”

Manzoor thanks God for saving his life, saying everybody is not as lucky as he was. He has a point: There are so many victims of rail and road accidents who are not as lucky as Manzoor to be quickly taken in an ambulance to a hospital.

According to a World Health Organization survey in 10 countries in Southeast Asia, an estimated 288,768 people died due to road traffic injuries in 2007. Of these, 73 percent occurred in India. Besides, an estimated 2 million people in India have a disability that results from a road traffic crash, according to the organization.

There is a significant difference between rail and road accidents: 20 percent of road accident victims die, compared to a 50 percent death rate among rail accident victims. Experts attribute the excessive fatalities to lack of enough mobile trauma centers and ambulance services.

In the past few years, voluntary organizations have started to address this problem. The Illinois-based American Association of Physicians of Indian Origin launched an emergency medical care service in June 2008, involving 26 Mumbai hospitals, 10 of them private. They are all linked by a common phone number, 1298. The service is largely the result of the efforts of Dr. Navin C. Shah, a urologist and former president of the American Association of Physicians of Indian Origin.

Asked whether the service is provided free of charge, the CEO of the emergency medical care service, Pramod Lele, says, “No. We are not in favor of free service. The poor can have a free service, but we charge common people, because people are not interested in something that comes for free.”

Dial 1298 ambulance service is part of the project. Fifty ambulances with up-to-date equipment are stationed in various areas of Mumbai. Some of these ambulances have been donated by the American Association of Physicians of Indian Origin’s emergency service. The ambulances have global positioning system trackers, and dispatchers are on duty in the control room round the clock. As soon as they receive a call for help, they relay it to the ambulance closest to the site, or to some other place desired by the caller. Depending on the problem and the severity of the case, the ambulance staff decides where to take the patient.

Sweta Mangal, CEO of Dial 1298 ambulance service, adds, “We take only half the fee from patients going to government hospitals compared to those going to private nursing homes and hospitals. For instance, for a large ambulance going to a government hospital we charge Rs. 750 and for a small ambulance Rs. 250.”

Dial 1298 was started in 2004 by five young Indian professionals educated in the United States. In its first months, 1298 established a 24-hour control room and developed an ambulance tracking system using Google Earth maps and global positioning systems on each ambulance to provide minute-by-minute location updates. The company invested in radio communications so that all its ambulances could be reached, even during disasters when mobile phone networks tend to fail. 

“For the project’s success it was not enough to just establish the infrastructure, but to let every income group know what is 1298 and what are the advantages of using an ambulance,” says Mangal, adding they ran an advertising campaign to drive home the point. One of the posters put up all over Mumbai said, “An ambulance starts treatment before you reach the hospital. A taxi doesn’t.”

Another advertising campaign addressed the difficult traffic situation that requires behavioral changes for the life-saving ambulance service to function smoothly, not only in Mumbai, but in other Indian cities. The slogan was, “Save a life. Make way for an ambulance.”

Dr. Kishore Sathe, a medical officer at Hinduja Hospital’s department of emergency medicine, says, “The traffic scenario in Mumbai has become so pathetic that every month we end up losing five to six patients on an average while they are on the way to a hospital. A majority of these are cardiac cases.”

The project is a byproduct of Dr. Shah’s three years of work with emergency medical services in the United States. In American cities and towns, one need only make a free call to the number 911 and the emergency medical service arrives within a few minutes to take the patient to the nearest trauma center, without bothering about the patient’s financial status, he explains. Sufficient staff is available at the hospital to immediately start treatment. Police inquiries and other formalities begin only after the patient is completely stabilized, Dr. Shah adds. After treatment, a bill for the ambulance service may be sent to the patient or the insurance company. But in many cases, the service is provided free by the local government.

It took several years to organize the ambulance service in Mumbai in collaboration with Hinduja Hospital. Part of the mission was a day-long ambulance service mock drill in 2008 in which fire brigade personnel, staff of the 1298 ambulance service, doctors from B.M.G. Hospital, King Edward Memorial Hospital and Hinduja Hospital, and paramedical students of the Mumbai-based Lifesupporters Institute for Health Sciences participated.

Led and supervised by experts from New York Presbyterian Hospital, Columbia University and the New York City Fire Department, the drill showed the participants how to take survivors of a terrorist attack to get medical care.

A major problem for emergency medical care service in Mumbai is a state law which stipulates that a doctor must be present in every ambulance. “In the neighboring states of Gujarat and Andhra Pradesh, it is legal to have paramedical staff in an ambulance instead of a doctor. Besides, we need public-private partnership to facilitate such work. We are not able to provide the kind of service to people that we intend to. Dr. Shah has been in talks with officials and we hope to get some positive outcome,” Lele says.

Maharashtra’s secretary of medical education, Bhushan Gargani, says the government is aware of the need and action is underway. “We are facing these problems because we do not have an Emergency Services Act, nor have we established a paramedical council so far. The state government has prepared a format for both. After passage of the appropriate legislation these problems will automatically be solved,” he says.

Ill-equipped vehicles are often used as ambulances in India. “But when we are talking of an ambulance we mean only the vehicle fully equipped with world-class equipment. A normal ambulance costs around Rs. 10 lakh and a cardiac ambulance costs about Rs. 30 lakh. We are talking of such vehicles only,” says Lele.

“We are merely fulfilling our social responsibility. All that we want is to intervene in the ‘golden hour’ and take the patient to a hospital in time. If we succeed in our project, this service would reduce accident-related mortality by 90 percent,” Lele says. He is referring to the hour after a trauma is suffered when the chances of saving the person’s life are much higher than if treatment is delayed beyond that period, due to shock, blood loss and infection.

Since Dr. Shah says he wants to run the emergency medical service and trauma center on world-class lines, a natural question arises: If the ambulance can’t get through traffic to reach the patient, maybe the patient should just be put into the nearest autorickshaw which can weave in and out of traffic and get to the hospital faster?

In many countries, including the United States, cars, buses and trucks move to the left or right lanes and stop to make sure there is a path for ambulances to get through when the siren is heard. In India, cars usually stay in their lanes driving or stopping in a jam and blocking the ambulance. This defeats much of the purpose of an ambulance.

“Like anybody else I have also observed the obstacle race that an ambulance has to undertake while navigating to reach its destination,” says Dr. Shah. “The basic function of the ambulance is not only transport of a patient to the appropriate hospital but also to provide emergency treatment on the spot and while in travel. In addition, during this time the receiving hospital is in contact with the ambulance for quick treatment at the arriving point. The participating hospitals in the (emergency medical service) have…dedicated staff to receive and treat the patient on a priority basis.”

Dial 1298’s Mangal adds that they have been emphasizing cooperation with the traffic police. “In more serious cases we call them, asking for help to quickly get the ambulance through traffic. They help by providing us with direction and clearing traffic. We have got their permission to use the other lane in case of a jam. That makes things easier.”

Anjum Naim is the former editor of Urdu SPAN.