Medical Infrastructure in Gujarat Dr N B Dholakia Additional Director, Medical Services Department of Health and Family Welfare Gandhinagar 14 March 2018 Emergency Medical Response Aim: To prevent & reduce Mortality and Morbidity with intact survival Pr e p ar e d n es s Coworkers Laymen Inc ide nt Organization Emergency No 108 Security Police Firebrigade First Responders Organization Ambulances 108 Ambulances Prehospital Phase Emergency Department Interhospital Transfers ICU Hospital Phase Wards Rehabilitation Lessons Learnt 1
Institutional Structure in Gujarat First Aid, Stabilization, Primary Treatment Sub-Centers - 9156 + Definitive Treatment Super Specialty Facility - 03 Mobile Health Units - 118 Medical College Hospitals 21 ( Govt-6, GMERS -7, Corp. -3, Pvt. -5 ) Primary Health Centers - 1427 District Hospitals - 22 Community Health Centers - 351 Sub-District Hospitals - 33 Institutional Structure in Gujarat Private Sector/NGOs/ Central Govt. Institutions Grant-in-aid Hospitals 119 Industry based hospitals: ESIC Hospitals and Tie-up Hospitals ONGC Hospitals and Tie-up Hospitals IFFCO Facility- Kalol Reliance Hospitals- Adani Hospitals- Mundra, Bhuj H & FW Deptt. Health & Family Welfare Department 4 2
Govt. Services Sr. No. Particularof Services Provisionof Services ( Annually) 1 Total No.of Beds 35,843 2 OPD 3,57,04,407 3 IPD 44,15,079 4 Total IPD 1,84,448 5 Major Operations 2,10,319 6 Minor Operations 6,06,696 5 3
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Department Overview Public Health& Family Welfare Medical Education& Medical Services Vital Statistics( VS) State Institute of Health& Family Welfare( SIHFW) AYUSH National Health Mission( NHM) Gujarat Medical Services Corporation Limited Project Implementation Plan( PIU) Food& Drugs Control Administration( FDCA) Employees State Insurance Scheme( ESIS) January 8, 2013 Commissionerate of Health 15 Health & Family Welfare Main Focus Area and Activities-Public Health Epidemics-Waterborne diseases like cholera, typhoid/airborne diseases like swine flu(h1n1)/mers CoV/Ebola/Health services during Natural disasters/man made disasters Preparing Primary Health Centres as First Responders andfirstaidposts/units Training of Ground Level workers ASHA, Female and Male Health Workers, Medical Officers and through them training the people January 8, 2013 Commissionerate of Health 16 Health & Family Welfare 8
Main Focus Areas Medical Services : Secondary Health care Service National Programme for Cancer, Diabetes, Cardio-vascular Disease& Stroke National Programme for Health care of the Elderly Burns, Trauma Care, Dialysis. Mental Health 108Services/RapidResponseTeam Nursing Services Disability Certificates Medical Education Medical/ Dental/ Physiotherapy UG/PG Education Tertiary care through medical College affiliated Hospitals Medical Research January 8, 2013 Commissionerate of Health 17 Health & Family Welfare Main Focus Areas Vital Statistics : Registration of Births, Deaths& Marriages SIHFW FHW/ANM School Training to In-Service Health Staff SelfFinanceInstitute (SFI)forANMs GMSCL Procurement of Drugs& medical equipment PIU Construction, Repair, renovation and maintenance of medical infrastructure NHM Umbrella for RCH/National Health Programmes/ASHA/ HR January 8, 2013 Commissionerate of Health 18 Health & Family Welfare 9
Gujarat Medical Service Corporation Limited (GMSCL) Procurement of quality Drugs/ Promotion of GENERIC Drugs Procurement of Medical Instruments and Maintenance Diagnostics centers and Services Store, preserve, distribute and manage warehouses and establish new Drug depots at different locations across the State to ensure smooth and timely supply of Drugs & Instruments to Health Institutes. Rational use of Drugs To develop, devise and enable real time monitoring system of Drug Stock management up to PHC level Will be involved in procurement and stocking of antidotes Food & Drug Control Administration ( FDCA) Implements Following Major Central Acts& Rules. Drugs& cosmetics Act 1940 Drugs& Cosmetics rules 1945. Food Safety and Standard Act 2006 Food Safety and Standard Rules and Regulation 2011 Drugs(PriceControl)Order2013. 25 District Offices, 4 State Laboratories (for analysis of Food & Drug Samples) Coordinate with major antidote manufactures from Pharma Industries in Gujarat and outside. 10
Antidote Activated Charcoal Atropine Cyanide Antidote Kit Manufacturers in Gujarat Ambrosia remedies pvt.ltd., Vadodara Morvel Laboratories Pvt. Ltd, Mehsana Geevet Remedies, Mehsana Troika, Ahmedabad Edetate calcium disodium Shanpar Industries Pvt. Ltd Pralidoxime Sodium thiosulfate Dishman Pharmaceuticals & Chemicals Limited Troika, Ahmedabad Shakti Chemicals, Halol Launch of EMS in Gujarat Gujarat 22 Launch Dt: 29 Aug 2007 11
108 -Emergency Medical Services -Gujarat Synergizing Processesfor efficiency and effectiveness in performance delivery Innovation Sustainable Scalable Technology Integration Communication IT Fleet Medical Strengths of Public & Private Sector Community Education Awareness Media Support Capacity Building (Leadership, Skill, Attitude, Quality Assurance) 24 12
World class State-of-the-Art - 108 Infrastructure Gujarat Emergency Response Centre, Ahmedabad 108 Emergency Service - Ambulance Specification Ambulance Basic Specification VOLUME Force : Tempo Traveler Winger ST 10.15 cubic meters 10.31cubic meter LENGTH 3300mm 3200mm HEIGHT 1830mm 1820mm Force Tempo Traveller TATA Winger ST 13
19-03-2018 High-tech and Equipped Ambulance : 27 108 Emergency Service - Ambulance Interiors & Equipments 14
Key Components - CARE State of the art ambulances equipped to tackle any type of emergency are furnished with basic and advance life saving equipments and medications. Providing appropriate care and transport within Golden Hour of Emergency Customized to Indian needs 108 ambulance with view to rescue victims impacted due to high energy collisions Extrication kit is an essential component. Emergency Medical Technician(EMT) trained to provide pre-hospital care and manage emergency situations EMT gets support over phone from qualified medical practitioner called ERCP (Emergency Response Centre Physician) located at the ERC 29 108: Innovative Process Sense Reach Care Follow up after 48 hrs Developed detailed process understanding and well defined responsibilities through out the organization Maintained all information related to emergency in Patient Care Records (PCRs) Patient information is shared with the hospital on arrival 48 hour follow up with the patients admitted to hospital 108 Emergency = Medical + Police + Fire 30 15
Robust EMS Software ERC Location of Emergency Caller OLMD e- PCR Information of patient arrival through Voice and Data Robust Application Advance data management 31 Nearest Appropriate Hospital location Ambulance Interception for definitive treatment BLS ERO ERC Intimates nearest Definitive ALS Ambulance Patient on board Definitive Having Cardiac Arrest enroute Intercepts BLS Ambulance Trauma Care Ambulance Cardiac Care Ambulance Stroke Care Ambulance Neonatal Care Ambulance Patient on board Advanced prehospital care enroute 32 16
District wise Ambulances: ALS Ambulances 140 BLS Ambulances- 445 33 District No. of Ambulances District No. of Ambulances Ahmedabad 66 Mahesana 16 Amreli 19 Mahisagar 12 Anand 17 Morbi 8 Aravalli 9 Narmada 12 Banas Kantha 23 Navsari 14 Bharuch 17 Panch Mahals 16 Bhavnagar 23 Patan 13 Botad 7 Porbandar 8 Chhota udepur 14 Rajkot 25 Dahod 27 Sabarkantha 13 Devbhumi-Dwarka 8 Surat 38 Gandhinagar 15 Surendranagar 16 Gir Somnath 11 Tapi 12 Jamnagar 15 The Dangs 7 Junagadh 13 Vadodara 28 Kheda 15 Valsad 20 Kutch 28 Grand Total 585 4 Wheel Drive initiative in Gujarat for Hard to reach areas 17
108 EMS Hospital Network Hospital Type Count Government Hospitals 2138 Government Supported Hospitals 414 Private Hospitals 10076 Trust Hospitals 441 Total 13,069 35 Strengthening Govt. Mechanism and Civil Agency roles 36 Key Parameters Emergency Status and update of state and districts SMS notification to Stakeholders Accident Spot identification State Level information channelization and regular meets District level information sharing Interaction with Domain experts from Diverse fields and NGOs: Knowledge shared with Policy makers and voluntary organisations State Road safety councils Respective District Collectorate Regarding Multi-casualty incidents, large road accidents, major disasters Based on surveillance of road accidents and regular analysis of multi-casualty and high speed collisions CMandHMOffices Commissioner of Health Commissioner of Transport Gujarat State Disaster management Authority (GSDMA) integration Emergency Medical Services Authority (EMSA) Gujarat DDO, RDD, Commissioners (Police, Municipal) CDHO, CDMO and state health bodies Indian Red Cross Society (IRCS) CEARCH (Center for Education, Awareness and Research) on Chemicals and Health Indian Institute of management (IIM-A) UNICEF 18
Mobile Health Unit Arogya Sanjivni Mock Drill IOCL Mock drill Baroda GAIL Mock drill Kutch 19
Awareness Activities Demo, Health Check Up & Distribution of Chocolates in Schools Awareness Activity on Police Emergencies Display Boards on Police Stations Boards on SP Ring Road-in every 1.5 Kms World Day Remembrance For RTA Victims -20 th Nov Sadbhavana Mission of Hon ble Chief Minister 108 Display on Digital Screen during Night Hours in Surat Safety Week Surendranagar Jamnagar Rajkot 40 Kutch Rajkot 20
Safety Week Junagadh Gir somnath Porbandar 41 Dev bhumi Dwarka Bhavnagar Botad Mukhyamantri Amritum(MA) Yojana,, RSBY Launched to provide tertiary care treatment for catastrophic diseases to BPL and families with annual income less than Rs 2.5 lacs per annum 100% State funded Assurance Scheme Cashless hospitalization benefit of Rs.2,00,000/- per BPL family per annum on a family floater basis(5 members per family). U-win card holders RSBY Covers treatment cost upto Rs 30,000 per family per year- insurance based To be subsumed with National Health Protection Scheme Health & Family Welfare Department 21
Disaster Preparedness District and Hospital Disaster Preparedness Plans in place with resource mapping including private hospitals, rapid responder medical teams, triage, IMA members, blood banks, overflow plans, transport plans under NABH / NQAS preparedness, control rooms, blood banks, NGOs First Responder Trainings Technical Support from NIOH, IIPH-G Mock drills held in hospitals Mental Health Services for Post Traumatic Stress Syndrome Management Trainings in in various aspects such as Hospital Disaster Preparedness, Dead Management, Ventilator Management with GIDM and others CPR trainings given to laypersons Centre of Excellence planned for Chemical Disasters Response at Medical College Hospital with help of Depts of Pharmacology and Medicine Ammonia Leak Wind Flow Safe Direction To Run Accident Safe Direction To Run Wind Flow 22
Area Specific Approach- Ammonia Leak at IFFCO Kalol Pre Accident Phase: People staying around IFFCO are educated regarding steps to be taken in case of leak Pictorial booklets distributed Computerized programmes ready with IFFCO to predict area affected depending on various variables Mock drills Wish you all A Happy & Successful Disaster Preparedness 23