Roadmap to Resilience: Strengthening Emergency Care Systems

 

The Ministry of Road Transport & Highways, Government of India is observing the ‘National Road Safety Month’ from 15 January to 14 February 2024. In the light of this, let’s look at the Emergency Care Systems (ECS) through the lens of Road Safety.

 

The ECS is a lifeline that delivers timely healthcare services for acute illnesses and injuries across all age groups. The essential functions of an integrated ECS include human resources, equipment, and technology that extend from initial care at the scene, during transportation, and at healthcare facilities, as per the WHO Emergency Care System framework. 

The 72nd World Health Assembly deliberates upon the integrated ECS for universal health coverage, ensuring timely care for the acutely ill and injured including linkages with other relevant actors, and aligning with Sustainable Development Goal Target 3.6 to reduce global deaths and injuries from road accidents by 50% by 2030.

An organised and integrated emergency care system has the potential to prevent millions of deaths and disability cases. However, ECS is often challenged by issues including patient transfer delays, limited capacities of health facilities, inadequate referral linkages and a lack of standardised guidelines and ambulance readiness.

In India, NCDs, and injuries including road traffic crashes, represent a critical public health concern and a leading cause of death. The Government of India's Operational and Technical Guidelines on Emergency Care Services at District Hospitals (2023) recognise the need for restructuring, reorganization, training, and protocol integration within the healthcare system to address emergency care promptly.

To enhance ECS within the Indian public health systems, HSTP aims to:

• strengthen the emergency care services across healthcare facilities, primary to tertiary level, as per the Indian Public Health Standards 2022
• promote evidence-based decision-making and implementation of guidelines in emergency and trauma care, aligning with the state government’s priorities
• enhance pre-hospital care services using standardised protocols and procedures including ambulance readiness, and streamlined patient referrals in emergency care

One of the aspects of building a robust ECS for improving patient outcomes is to strengthen the ambulance services by establishing centralised databases, expanding the National Ambulance Code, ensuring well-trained ambulance personnel, conducting mandatory inspections, and guaranteeing affordability and standardisation of the cost of private ambulance service.

As part of HSTP's commitment to generate a body of work for strengthening health sector regulations, a report titled 'Regulation of Health Care Delivery in India - A Landscape Study' was published by Sunil Nandraj, Pallavi Gupta, and Dr Sonali Randhawa from Team HSTP in 2021. The report also delved into the regulatory aspects of Ambulances, covering licensing and registration, quantity, cost of care and mechanisms for patient protection.

Sonali and Sunil also developed a resource guide, titled ‘Ambulances In India: Lifesavers On Wheels’, with contributions from experts, which provides information on ambulance services, necessary medical consumables and personnel, including how to access and who to contact in case of grievances.

Taking the work in this space further, they co-authored an article on the Ambulance Services in India and their critical role in pre-hospital emergency medical care in transporting patients to health facilities within the ‘golden hour’. The article, ‘Ambulance Services in India – Are the sirens loud enough!’ has recently been recognised and included in the India Competition and Regulation Report (ICRR) 2023, a biennial publication of CUTS International and CUTS Institute for Regulation & Competition. The ICRR 2023 delves into the theme of “Regulatory Deficit in Access to Equitable Healthcare”.

Committed to our aim of making information available and accessible, HSTP’s website hosts an open-access repository where one can access legislation and regulations on ambulances in India as well. You can access the repository here.

Expanding our work in the area of Emergency Care Systems, this year the HSTP team is working with partner states, Chhattisgarh and Odisha, to strengthen system strategies, develop action plans and facilitate evidence-based decision-making.