The 108 service, modelled on the 911 service in the United States, is leading a wave of change in emergency medical services in Tamil Nadu. Text and pictures by Sukalp Sharma
In a small yet swanky call centre located in the heart of Chennai, 23-year-old A Rakesh and tens of others are busy answering relentless calls. But these calls have nothing to do with tele-marketing, and it?s not even a call centre you?d call if your credit card, phone or laptop wasn?t working. However, the service this call centre provides is second to none; in fact, it?s superior to most in a way. In Rakesh?s own words, ?The calls we take save lives.? This is the GVK Emergency Management and Research Institute (EMRI) emergency response centre and training facility in the Government Kasturiba Gandhi Hospital campus in Chennai. GVK EMRI runs the 108 ambulance services in Tamil Nadu on the Public Private Partnership (PPP) model, which has completely replaced the state ambulance services and is seen as a model project employing PPP in emergency health services.
This centre receives 17,755 calls a day and covers a population of 7.2 crore. More than 30% of these cases are pregnancy related. The call centre even has 14 doctors available for directing ambulance staff on the ground in cases of grave emergencies. Rakesh is just one of the many dispatch officers here whose primary job is to take calls of distressed people reporting medical emergencies, locate and contact the nearest ambulance using the global positioning system (GPS) and dispatch it for the scene. One call ends, and another one is flashing on his screen. ?On an average, we get about 150 calls per person in a daytime shift of nine hours. And within three minutes of taking the call, the emergency level is ascertained and the ambulance is dispatched,? says this computer science graduate who?s been working at GVK EMRI for over two years now.
The aim is to pick up every call within the first ring and take all the required information within 90 seconds, initiate and activate required processes and be ready for taking the next call. In an emergency, response time can at times be the difference between life and death. GVK EMRI also maintains an exhaustive call data that includes parameters like nature of medical emergency, its location, time of the day, etc. This data helps in reorienting the response systems according to the latest trends or patterns observed in the nature of emergencies and is also shared with the state government as it can be extremely useful in recognising the teething problems.
GVK EMRI now has a mandate to run this service in 13 Indian states, with Uttar Pradesh and Jammu & Kashmir being the latest additions to the list. In most of these states, the state governments bear 95% of the costs, while GVK puts in 5% and the managerial costs. In Tamil Nadu, there are 436 ambulances pressed into service, of which 398 have been funded by the World Bank as a part of its association with the highly acclaimed Tamil Nadu Health Systems Project (TNHSP). In a few weeks? time, the total number of 108 ambulances in the state would go up to 712 and a majority of the new fleet will be deployed in rural and tribal areas of the state.
While the project is partly funded by GVK, operating costs, including the cost of the remaining ambulances, is paid for by the Tamil Nadu government, which has spent R200 crore on this ambulance project. The operational cost for FY 2012 was close to R50 crore, and the maintenance and operational cost incurred per ambulance by the state government was around R94,000 per month. The state government has been assisted by the central government through the National Rural Health Mission (NRHM) for the recurring expenses of this project, and hence its rural and tribal focus. ?The NRHM share started at 60% of the costs, and over the course of time it has gone down to 20% now. From the next financial year, all costs shall be borne by the Tamil Nadu government,? says Dr K Gunasekaran, deputy director, TNHSP.
But beyond the cost equation and the project implementation statistics, there?s another set of rather important numbers?the human impact of this service. Since September 2008, the number of ?lives saved? by the 108 ambulance service stands at around 56,500. ?The parameter for lives saved is if the patient?s vitals were at or below the borderline mark at the time of pick up by the ambulance, and if the patient survives then for more than 48 hours. Currently, one ambulance caters to a population of 1.65 lakh. Ideally we would want the number to be one lakh, which should happen soon. We are, as of now, able to cover 99% of the population in Tamil Nadu and the 108 service is saving a life every half an hour,? says BN Sridhar, regional chief operating officer, GVK EMRI. Sridhar adds that the average response time for an ambulance to reach the pick-up spot is 16.53 minutes for urban areas and 24.20 mins for rural areas (overall average being 23.13 minutes).
Each ambulance is equipped with basic life support systems and equipment like stethoscopes, glucometers, blood pressure machines, nebulisers, oxygen cylinders and stretchers. The fleet, apart from the majority basic life support ambulances, also includes 57 advanced life support (ALS) ambulances with mobile ECG machines and ventilators on board, with the provision of sending live data from these systems to the nearest hospital if that hospital has shared its IP address. As of now, efforts are to at least get the cardiac institutes in the state to tie up and share network details. This shall facilitate real time transmission of patient data to any of the cardiac hospitals while dealing with cases of cardiac arrest and other heart-related emergencies.
All ambulances are manned by an emergency medical technician (EMT) and the driver who is called a ?pilot?, who is also trained to handle medical emergencies. ?The training period is 45-day long, which includes training at this centre, a few days of field training and in hospitals as well. We teach the EMT to keep the patient alive till they get admitted to the hospital using the equipment and other life saving drugs at hand. The EMTs are taught basic life support and advanced cardiac support skills, and also basic and advanced life support skills in obstetrics,? says Dr Adeline Dhivya Israel, head of the state-of-the-art training facility at GVK EMRI Chennai centre.
She adds that all the EMT trainees are required to be graduates in life sciences, and apart from medical training, they also undergo crowd management and stress management training. The training facility includes a simulation lab with a life-size ambulance model for training and the training programme has been jointly developed with the Stanford School of Medicine. More than 1,000 EMTs pass out of this training centre every year. Once in the field, the EMTs work in 12-hour shifts with salaries ranging between R8,000-11,000.
The GVK EMRI story has seen quite a turnaround over the past three years, at least from the reputation that rubbed off on it after the Satyam scam of 2009, for EMRI was B Ramalinga Raju?s brainchild which he started in 2005, and Andhra Pradesh was the first state where the service was launched. Later in 2009 itself, infrastructure major GVK Group took over EMRI and it was renamed GVK EMRI. But that seems a distant memory now with its nationwide operations including close to 17,000 employees, more than 3,100 ambulances, responses to more than 10 lakh emergencies per quarter, and more than 50,000 lives being saved every quarter. GVK has infused more than R125 crore into this arm of the group in past three years. The GVK Group maintains that GVK EMRI is a not-for-profit CSR project.
Sridhar states that the larger idea is to converge all emergency services (health, fire and police) into one common platform?108, based on the 911 emergency services in the United States. ?Fire and police services can also be accessed through 108 and we have an interface with these services as well in the states where we operate.?
?However, while 108 as the helpline number for health services is fairly well established, the same can?t be said for fire and police services. But eventually it will happen, as 108 is slowly on its way to become the universal emergency services number in India and having one number for any type of emergency makes much more sense than having four-five different numbers. It saves a lot of hassle and time for those calling in, which could be critical in case of an emergency,? he says.
In spite of the many accolades the service has received for its operations in Tamil Nadu, every day is a new challenge, and with every life saved there are more waiting for attention and help. It?s a relentless cycle that everyone from the call centre staff to the ambulance EMTs and pilots grapple with every single day, for lives depend on it, literally. ?It?s tiring and there is immense pressure as every second counts. But when you leave for home at the end of the shift, tired, you feel somewhere you?ve made some difference in someone?s life and of others around him. I guess that keeps me going,? says Rakesh.
