Rural Emergency Medical Service (EMS) in J&K

We can save thousands of precious lives!

In what is now being seen as a shocking, misplaced sense of implementing the law more in letter and less in spirit, a Special Mobile Magistrate (Traffic) in Sopore stopped an ambulance carrying a critical patient from Handwara to Srinagar for using the “wrong” siren. The “inordinate” delay is being seen as a major factor in the patient’s death and the Honorable Chief Minister has personally initiated an inquiry and decided to write to the High Court.

While this incident is upsetting and yet again underscores the perceived lack of sensitivity and empathy in law enforcement agencies, it is important that we look at systemic flaws and deficiencies in our healthcare system – especially in the dispensation of critical-care in rural, far-flung areas.

We lose hundreds if not thousands of lives every year to the inaccessibility of millions of people to quick, emergent healthcare. This happens especially in cases where patients need urgent, life-saving interventions within the first hour of the medical emergency; for instance - accidents, brain and spine traumas, birthing complications, cardiac distress or injuries resulting in severe blood loss.

There are no two ways about the need for a couple more state-of-the-art super specialty medical institutes like SKIMS – one each in North and South Kashmir or improvements in the existing tiers of our public healthcare infrastructure. We need well-equipped and adequately staffed District and Sub-District Hospitals in our towns and Government Dispensaries in our villages. However, it will take decades for the existing system to reach a position where every critical patient in our State has timely access to super-specialty critical and emergent care.

I have written frequently about the need for better healthcare in our rural areas and I have also written about the need for a complete, adequate and grid-integrated ambulance service with presence all around the State – through existing public healthcare units.

The unfortunate incident of the stalled ambulance at Sopore got me thinking about a hybrid solution that would combine not just the transport and out-of-hospital emergency-care part of the problem but also help in saving thousands of lives by ensuring that critical, life saving care can be provided on spot in rural areas by trained paramedics, following which patients can be properly transported to places of definitive care.

In cases of bus accidents, natural health emergencies in far-flung areas, natural disasters or violence related injuries – we face two challenges. First – Providing on spot, out-of-the-hospital acute medical care. Second – Ensuring proper, well coordinated and life-support integrated transport of critical patients to definitive/intensive care. Had there been a system in place, both these objectives could have been attained and the old man from the stalled ambulance could have been saved. We have thousands of such cases every year where critical patients don’t get immediate medical care and where they cannot be transported in a timely and proper manner to super specialty hospitals and medical institutes in the city. Very often, severe traumatic injuries (especially brain and spine injuries) need near-perfect attention in how the patient is lifted, carried and transferred to the hospital. A failure to do so results in permanent disabilities and could also result in death. 

Then, there comes the question of rescue and relief operations – a car that has plunged into a gorge or a river, a bus that has toppled into a ravine with dozens of school children, a house or a commercial building on fire, flash floods, earthquakes, land-slides, avalanches, etc. All such cases require specialized rescue personnel with specialized training, equipment and logistical support. Here too, a delay in rescue and first-aid or an improper, chaotic mode of transportation can result in an avoidable loss of lives – especially if these accidents or situations were to take place in rural areas or towns that are at distances of greater than an hour’s travel time from intensive care and specialty hospitals like SKIMS and SMHS. 

We need an entirely new policy to deal with this issue. There is no doubt in my mind that we lose thousands of lives every single year due to this deficiency in our system. Most of these deaths are avoidable. We need an integrated, well-funded, well-equipped and professionally managed Emergency Medical Services (EMS) Department in J&K with First-aid, Emergency, Rescue & Relief, Flood Rescue, Accident Response and Vehicle Extrication Squads. Each district in the State could have a District EMS Headquarter from where EMS operations for the entire district could be coordinated and life-support ambulances with trained paramedics could be stationed at the Tehsil Level per the population of the area.

The J&K Traffic Police has tried to put in place a coordinated system where the Police would be informed of ambulance movements. However this system in isolation is bound to fail in the bigger objective of saving precious lives. An EMS Department, with its own fleet of ambulances, call-center and liaison functions (with police, hospitals, government departments) is the answer. The EMS Department would also provide constructive employment to thousands of unemployed youth and place J&K at the top of the list in public healthcare in the country. Till the time every citizen of our State has a specialty/intensive care hospital within an hour’s distance of his village/town – this is the most suitable, practical solution.

(Junaid Azim Mattu belongs to the J&K National Conference. Views expressed are personal. Feedback at junaid.msu@gmail.com)