With increasing urbanization in Low and Middle income countries in the absence of a Government-owned 911-style system, the medical emergency services are provided by multiple, isolated providers (government, semi-government, private for-profit, NGOs) with varying capability, resulting in an inefficient & fragmented emergency management system which frequently result in serious delay in treatment. Often the patient needs to wait for ambulance and/or is transported without proper paramedic support in public transport, and after reaching hospital, shuttles from one hospital to another due to unavailability of the required critical care unit (e.g.: NICU, CICU) as not all hospitals have all facilities. Finally, when a specific emergency product is required (e.g.: Blood), nobody knows where to obtain it, as most of the hospitals are always short on the product. As such, the patient often doesn’t receive the life-saving treatment during the golden-hour of emergency, resulting in several loss of lives.
The above issues are multiplied exponentially during any disaster, large or small (e.g: a fire in a public area, train accident, terrorist attack) that affects people’s health. Currently, there is no central, real-time system for medical emergency in our pilot city, Kolkata, India, making coordination between disaster recovery agencies and public health services nearly impossible.
Due to the absence of regular, proactive health check-up among general public, including individuals who can afford, early intervention & management of chronic diseases are severely lacking, the impact of which is quite significant among the geriatric group. This often results in sudden critical health emergencies, where the same process of ‘delayed presentation’ as explained above, repeats itself but with a higher probability of mortality, morbidity and disability
In most of the LMIC cities (including India), the route usually taken to solve the medical emergency problem is to introduce a new Ambulance fleet without fulfilling the pre-requisites, such as paramedic workforce, real-time information from facilities etc. Setting up a city-wide Ambulance system is financially prohibitive (huge capital investment is required) and logistically difficult to implement (competes with existing services, local political issues). Plus, to maintain the quality, they either have to charge heavily or need to be funded by the government, failing which these services soon become unsustainable.
The "Ambulance only model" cannot be the solution for a central medical emergency system for a diverse country like India. While the 108 model (Public-Private partnership, where Government pays and private organization operates) is a gold mine of corruption/scam (thus public exchequer flowing out freely) and government in-effectiveness making it completely useless, the new Private ALS ambulances model has proved to be very costly to operate and difficult to sustain due to local competitions and political tug-of-war. Outside the "Ambulance only model", the other effort need to be mentioned is introduction of Urgent Care centres, which also being a new, parallel, isolated service has all the issues explained above (e.g.: Competition with existing Hospitals, Sustaining and Scaling the operation is financially costly and logistically difficult and reaching the urgent care under proper care not available due to shortage of skilled paramedics etc).
We recognized the fact that in a mega-metropolis like Kolkata, government or private, no-one can do this alone. It is financially not feasible and sustainable also. So, while other emergency service providers have launched different types of services (such as ALS Ambulance, neighborhood critical care unit), we are not introducing any brand new emergency service. Instead, we are integrating the existing services for better utilization and enhancing / strengthening the services, as required with the proper toolset (Toolset is defined as Product, People or Processes – e.g: Providing Paramedic training, GPS enabling etc.)
While the project is inspired from North America's 911 system, the situation is way different: While in US emergency healthcare is standardized & government financed, emergency healthcare in India is varied, ranging from free, but inefficient govt. healthcare to responsive but costly private services. As such, the operational & business model of our project is drastically different than 911.
We propose to integrate and enhance the isolated emergency providers in urban area, both public & private, to create a standardized, centralized, integrated, interoperable, real-time Medical Emergency System that seamlessly connects the “Sense”, “Reach” & “Care”, the three cardinal pillars of medical emergency care. The system will be easily accessible via internet, SMS and phone and operated by a state-of-the art emergency control room.
We will be implementing this project first in Kolkata, India, the most congested metropolitan city in India with an overburdened Healthcare system. Currently, we are developing the Kolkata Medical Emergency System(KMES) Phase I to manage availability of Emergency Healthcare Facilities & Products. In partnerships with Kolkata’s primary hospitals & blood banks, KMES is gathering and broadcasting the fundamentals of urgent care, the availability of Critical Care Unit(CCU) & blood products, to all, irrespective of social & economic status. Healthcare providers, emergency responders, disaster management agency all will get the same information. Next, in Phase II, we will integrate, enhance, strengthen & organize the existing ambulance services in Kolkata, which is primarily a small fleet of independently operated private ambulances along with few government/police ambulances. First, the ambulances will be equipped with GPS tracking software to capture real-time location & availability information. Next, paramedic training will be provided to the networked ambulance staff as they currently lacks it. We will also create a pool of paramedics from which ambulances, hospitals, police & fire can recruit. Finally, a state-of-the-art multi-lingual emergency response centre will provide 911 type coordination by dispatching the nearest networked ambulance & paramedic, who after stabilizing the patient will transport him/her to the nearest facility. Further, when an elderly patient staying alone suddenly falls sick, he/she can use a mobile phone and/or a wearable device (prototype being designed) to send an alert to the medical emergency centre for emergency retrieval.
As explained above, KMES relies on a very simple assumption – Instead of competition let’s collaborate. And not only collaborate among institutions but bring general public in the mix – when proper toolsets (such as information) is provided to the general public they can do wonders. The idea is instead of introducing new emergency service, we will like to enhance & strengthen ALL the existing medical emergency services, integrate them under a common emergency response centre and empower citizens with information for crowd-sourced quick response to cater critical patients within golden hour of emergency in an innovative yet practical and feasible business model.