“One-naught-eight” is the most widespread number in India for comprehensive EMS. The program is a private-public partnership operating in 10 Indian states. LIBERIA (CONT’D)
emergency conditions in homes and communities. In Mexico, the training of mothers and first-aid providers led to care being sought more quickly, and deaths in children due to respiratory and diarrheal disease among children <1 year of age decreased by 43% and 39%, respectively. Among children <5 years of age, mortality caused by these conditions fell by 36% and 34%, respectively,4,8 Another concern would be freedom from liability for any help rendered. First responders must feel competent to help and confident that there will be no adverse consequences if they act. Certain non-profit groups recently began to require medical volunteers to carry malpractice insurance at JFK Hospital, meaning that certain laws indemnifying Good Samaritans from liability need to be passed. The need to improve access to emergency care in Monrovia, Liberia is great, but the opportunities for growth are clear. Several low cost rudimentary interventions have been implemented in other low resource countries with impressive outcomes. Many of these concepts could be trialed in Liberia should emergency care become a matter of greater concern for the Ministry of Health.
REFERENCES (CONT’D) 5. Mock CN, Tiska M, Adu-Ampofo M, Boakye G. Improvements in prehospital trauma care in an African country with no formal medical services. J Trauma. 2002;53:90-97. 6. Sodemann M, Jakobsen MS, Mølbak K, Alvarenga IC Jr, Aaby P. High mortality despite good care seeking behavior; a community study of childhood deaths in Guinea-Bissau. Bull World Health Organ. 1997;75:205-212. 7. Samai O, Senegeh P. Facilitating emergency obstetrical care through transportation and communication, Bo, Sierra Leone. Int J Gynaecol Obst. 1997;59 Suppl 2:S157-164. 8. Guiscafre H, Martinez H, Palafox M, et al. The impact of clinical training on integrated child health care in Mexico. Bull World Health Organ. 2001;79:434-441.
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1.2 Billion Population 11 Percentage of all deaths owing to Chronic Respiratory Disease 26 Percentage of all deaths owing to CVD and diabetes 10 Percentage of all deaths owing to Injury 72,718,000 Number of registered vehicles in India (2004) 27% Deaths by road accident occurring by 2- or 3-wheeler riders 71 percentage of all vehicles registered in India that are 2- or 3-wheelers
Sources: World Health Organization; Espicom
Spring 2013 // Emergency Physicians International
INDIA
Subspecialties are growing in India’s expanding EM community, particularly pediatric EM, ultrasound, EMS, and disaster medicine. by tamorish kole, md
E
mergency Medicine is essentially a new medical specialty in India and is being developed to meet the acute care needs of the Indian population, which are somewhat different from other parts of the world where EM is more established. In the United States, EM was only recognized as a medical specialty in 1979, which is much later than other US specialties. Similar to India today, American EM physicians had to develop their own unique curricula and training programs before being accepted as an integral part of hospital care. In India the recognition of the need for EM is increasing, as India has one the world’s highest rates of road traffic accidents. In “Epidemic of Accidental Deaths and Emergence of Emergency Medicine in India,” Hamza et al estimated that 1,050,000 deaths occur each year in India due to poor road conditions and dangerous driving habits. Furthermore, they state that most accident victims arrived at the hospital in an auto rickshaw or a private car. For those who
did arrive in an ambulance, they received no care en route that would benefit the patient. India has one of the highest prevalence rates of heart disease. In addition to pre-hospital care, the need for emergency resuscitation and treatment of stroke is essential. Not only are Indians predisposed to diseases that require immediate attention best provided in an emergency department but the natural surroundings also leave them at risk to snake bites and plant poisonings. The ED is usually the best place to provide treatment quickly, to stabilize the patient, and to make an admission decision. Currently, there are four kinds of EM training programs available in India (Figure 1). The need for strong EM training programs in India has never been greater, and yet they are few and far between. We desperately need more of these programs providing leadership, training opportunities, and helping Indian doctors grow this area of specialty care.