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Where There Are No Emergency Medical Services—Prehospital Care for the Injured in Mumbai, India

Published online by Cambridge University Press:  28 June 2012

Nobhojit Roy ,
V. Murlidhar ,
Ritam Chowdhury ,
Sandeep B. Patil ,
Priyanka A. Supe ,
Poonam D. Vaishnav  and
Arvind Vatkar
Nobhojit Roy*
Affiliation:
Visiting Professor in Public Health, Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Deonar, Mumbai, India
V. Murlidhar
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India
Ritam Chowdhury
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India Ex-Interns, LTM Medical Collage, Sion, Mumbai, India
Sandeep B. Patil
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India Ex-Resident in Surgery, LTM Medical College and Hospital, Sion, Mumbai, India
Priyanka A. Supe
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India Ex-Interns, LTM Medical Collage, Sion, Mumbai, India
Poonam D. Vaishnav
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India Ex-Interns, LTM Medical Collage, Sion, Mumbai, India
Arvind Vatkar
Affiliation:
Ex A/Professor, Surgery, LTM Medical College and Hospital, Sion, Mumbai, India Ex-Interns, LTM Medical Collage, Sion, Mumbai, India
*
Jamshedji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Deonar, Mumbai, 400088 India E-mail: nobsroy@yahoo.com
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Abstract

Introduction:

In a populous city like Mumbai, which lacks an organized pre-hospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai.

Methods:

A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July–August 2005) at a Level-I, urban, trauma center.

Results:

The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0 .41) and those who came by taxi (OR = 0.54).

Conclusions:

Currently, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries and the insufficient evidence that prehospital field interventions by the EMS actually have improved outcomes, Mumbai must proceed with caution when implementing advanced EMS systems into its congested urban traffic. Similar cities, such as Mexico City and Jakarta, have had limited success with implementing EMS systems. Perhaps reinforcing the existing network of informal providers of taxi drivers and police and with training, funding quick transport with taxes on roads and automobile fuels and regulating the private ambulance providers, could be more cost-effective in a culture in which sharing and helping others is not just desirable, but is necessary for overall economic survival.

Keywords

ambulancedeveloping countriesemergency medical services (EMS)Indiainjurytrauma
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 2 , April 2010 , pp. 145 - 151
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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