Background:

On 24^th of April, SIIP fellows visited head office of BVG-Maharashtra Emergency Medical Services (MEMS) “Dial 108” at Emergency Response Centre, Aundh. Four fellows and their manager interacted with Dr. Dnyaneshwar Shelke who is Chief Operations Officer at MEMS and his team at their office in Sangavi, Pune. MEMS is known for its 24X7 accessible healthcare and emergency response which has been in place since 2014 and is serving the patients through 937 ambulances (233 Advanced Life Support and 704 Basic Life Support) all over Maharashtra. MEMS caters to both the ambulance services and the call centre to facilitate the services under the patronage of BVG India Ltd in collaboration with UK based company UK-SAS.

‘Dial 108’ is totally free of cost service. Government of Maharashtra through National Health Mission (NHM) is funding this service and an excellent example of Public Private Partnership (PPP).  The network of the ambulances and their coordination is unique in its own sense. ‘Dial 108’ service is currently operational in twenty-one states, soon it will be active in Kashmir and West Bengal as these two projects are in the pipeline. Efficiency of this system is maintained by the dedicated professionals and sincere staff of BVG India Ltd. Currently BVG India Ltd. is managing this service in Maharashtra, Andhra Pradesh and Delhi.

Meeting with Dr. Shelke:

Dr. Shelke and the four fellows had a meeting where he gave a brief presentation of MEMS project and the services provided under ‘Dial 108’. It was very interesting to see how the system was managed by the various departments in well-coordinated manner. Dr. Shelke described the interior of an ambulance (Advanced Life Support) which has Defibrillator, Transport Ventilator (Dragor) and medical grade Oxygen Delivery System which are world class equipment from Germany and Spain. Additionally other amenities like statures, sterilized delivery kit, handy emergency kit, medicines, foldable wheel-chair and so on are made available in the ambulance along with a trained doctor. All the ambulances are certified by ARAI.

Dr. Shelke talked about the ‘Training and Knowledge Management’ department which trains the doctors from all parts of Maharashtra in emergency services and then those doctors have to pass the examination to be eligible to handle emergencies. Keeping trained doctors in ambulances to handle emergencies during the transport was a unique idea and it was done first time in India. Pune head office has Emergency Medical services (EMS) treatment protocol for emergency care and separate manual for Maharashtra EMS.

The fellows observed the State of the art Tier III call centre or server room from IBM which is operated 24X7 by more than hundred staff members in shifts every day. Every call is answered within two rings and then the protocol is followed based on the type and severity of the case and accordingly the ambulance is sent to the location. MEMS has developed this centrally monitoring system. The backup system is at Nagpur.

In case of mass casualty, where at least five patients have suffered, two or three ambulances are sent along with the police and fire extinguishers which is an integrated approach to save maximum lives in minimum time.

Apart from daily calls for emergency, this service is provided to major religious gatherings like Kumbhamela and Wari to take care of the mishaps and minimize mortality due to accidents, stampedes etc. MEMS has also started ‘Go Teams’ which is a unit of doctors and paramedics which observes the crowd in mass gatherings and catch the patient/sufferer as early as possible by being a part of the crowd.

Observations:

The four fellows and their manager observed the system, the training department and the ambulance (ALS) with the team of the experts from various departments.

Fellows also observed the mannequins, various medical devices and the control room with online system of portraying live information about all the ambulances in the state.

The fellows asked questions and the instructors/managers answered their doubts and also shared their experiences to understand the system in depth.

 

 

Take home messages:

1. The system is well coordinated and the success of the system lies in the feedback mechanism. After each case, the doctors have to fill up the form and report the events and the choice of the hospital (public/private) to the officers at the head-office before closing that case. Additionally, each patient/the caller is contacted the very next day and asked for a review or the comments so that improvements are made based on the real experiences and user insights. The whole system is being centrally monitored for 24X7.
2. Ambulance is well equipped and well maintained though all the equipment are exported from outside as MEMS do not compromise in quality. However their cost of repairing and replacement is very high as compared to the local market.
3. The ambulances are user centric and user friendly, making them ‘age-friendly’ is a challenge.
4. Among the various cases, majority of the cases are for pregnancy, medical emergencies and accidental cases. Analysis of these cases by categorizing them in new groups adjusted for age and sex might provide a different picture.
5. Monitoring and evaluation of the system is really important in the service delivery system.
6. Bike ambulance is also used by MEMS in case of patchy and remote areas (Currently active in crowded parts of Mumbai). Such innovative solutions must be explored more.