Need Help With A Project For India

[CdnSikhGirl]

Ambulance response time in India is atrocious. There's no way to say it nicely. Partly due to drivers failing to give right of way, parking in front of ambulances thus blocking them, heavy traffic etc.  Sadly, in many cases, patients die before help arrives, particularly cardiac incidents, heavy bleeding etc.  This got me thinking, it doesn't HAVE to be this way. There must be a solution that will work in India.  

In Canada, I volunteer with St John Ambulance, as a medical first responder. Here, we only participate in public events like concerts, sports events, large parties etc. Specific events where there will be a large amount of people. We treat anything from cuts / broken bones / dehydration and heat stroke (Summer especially when alcohol involved) leading to syncope (unconscious) etc. right up to providing oxygen therapy for breathing issues, we carry some airway adjuncts like NPA/OPA, non-rebreather masks, we can monitor blood glucose as we carry glucometers and can treat low blood sugar because we carry fast acting glucose, we carry AEDs (automated external defibrillators) for cardiac.  Usually also SAM splints for breaks, C-Collars and back boards at events for spinal immobilization etc.  Here ambulance response time is less than 10 min typically. So we don't use the model the UK does where there are CFRs. 

Community First Responders. They are overseen by St John Ambulance, carry the same equipment as we do, only they take duty rosters in their local communities. When an ambulance is dispatched, they are also dispatched. Since they respond only to their local area (small area), they will arrive on scene within minutes.  This can SAVE LIVES while awaiting the ambulance crew. Once ambulance crews arrive, they are also a valuable extra set of hands.  THIS system if approached the right way in India WILL save lives.

Some things I thought about already:

1. Volunteers are needed to become trained, and take rosters in their areas. The logical target group are stay at home wives since they are the ones who are there consistently. 

2. Training them to be medical first responders will empower them as it will be a skill they will have acquired which is beyond basic domestic housework.  This will give them self confidence.

3. In UK and Canada, St John Ambulance operates as a charity.  I know India is less than enthusiastic about supporting charities.  Some way would need to be found to support having supplies for each "sector" (a full BLS kit (roller gauze bandages, splints, dressings, triangular bandages, etc), tools for vitals (BP cuff, stethoscope etc), AED, Oxygen tanks, airways and masks etc) plus funds to maintain the kits and replenish things from it, refill oxygen tanks etc. The total kit is usually a backpack BLS kit, O2 bag, and the AED (which can often fit in the O2 bag as well).  So one person can easily grab the packs and run.  But kitting up each community would require funding. In North America, and UK, SJA receives donations from the public, from event coordinators etc for coverage. These donations go directly back into purchasing supplies.  What options exist in India??  NGO status?? Would any funding be available for that?

I am working on this idea in one specific area in North India to see if we can trial it and see if it's viable. Once started, the system is self contained in that, some of the members / volunteers will be trained to be instructors of the same course to teach Advanced Medical First Response to SJA standards. They train new volunteers. Some new volunteers go on to become new instructors etc. And the cycle continues.  So only the start up would require instructors from abroad.  I am working with my husband's cousin on trying to make this a reality. He is a doctor in Jammu region and also thinks if this system is possible to be a reality it will save lives.

Just wondering if anyone has any idea on how to get funding in India.  If anyone here is from the UK and has experience with the community first responder setup with SJA please contact me as in Canada we only cover events and do not have community response so I'd like to get more info on how it's run, how it's coordinated with ambulance dispatch etc.

Please set aside our differences, disagreements on DG etc for awhile, and if you have any ideas on how to make this a reality, please share! 

 

 

[CdnSikhGirl]

@Ragmaala I am tagging you in this, because putting differences aside, I seem to remember you are an MD?? Do you have any input on how this system can possibly be adapted for India?

Obviously the need is there.

Ambulance response times are slow. Due to several factors, like traffic and failure of drivers to give right of way to ambulances. Patients often die before paramedics can get to them. This system is not to replace emergency systems already established but to augment them, by having volunteers in local areas dispatched at the same time as ambulances. Since people are dispatched in their local area only they arrive within mins. In UK they have duty rosters where people cover a day every week or so.  The duty person takes the BLS kit, O2 kit, AED.

Obviously for it to work, volunteers need to be motivated to donate their time (convince them what they get in return... free training to AMFR level and their children, elderly etc are protected in those vital minutes before an ambulance can arrive). And donations / funding required to maintain the kits and supplies.

Volunteers themselves would eventually handle training as some would go on to be instructors. They would also handle the duty rosters as one person per locality could take on the duty of making up the schedules. The system will be self sufficient once eatablished.  At first would be trialled in one small area.

Google SJA CFRs for more information on how UK does it.

[Ragmaala]

Start off small, recruit motivated volunteers, over time as it gets more organized it will run better. And go with the flow. You only learn by trial and error.  Projects like these require a lot of emotional & energy investment.  Even the planning itself takes a lot of time, lots of thinking. I don't have much more to add. Talk to the local people , live in that locality to get a feeling. India is very different when it comes to volunteering.

[Guest Jasbir Singh]

 Hi Satkirin, Glad to come across your thoughts about the CFR trial in North India. This had been a topic of interest for me as well, to resolve the situation of ambulance blockades that is so common in India. Going by the concept of bringing care to the patient, the CFR model seems a highly logical move towards mobilizing a community in providing that first level of aid before an ambulance reaches the spot. One of my friend has developed as a measure (mobility solution)  to inform the first responders / emergency contacts of any emergency situation. I see integration of such system into the community that is empowered through training and equipment to tackle most if not all the first level emergency calls. I am from Canada too. 

I certainly would like to help out in this regards.

 

[CdnSikhGirl]

On January-07-16 at 5:09 AM, Guest Jasbir Singh said:

 Hi Satkirin, Glad to come across your thoughts about the CFR trial in North India. This had been a topic of interest for me as well, to resolve the situation of ambulance blockades that is so common in India. Going by the concept of bringing care to the patient, the CFR model seems a highly logical move towards mobilizing a community in providing that first level of aid before an ambulance reaches the spot. One of my friend has developed as a measure (mobility solution)  to inform the first responders / emergency contacts of any emergency situation. I see integration of such system into the community that is empowered through training and equipment to tackle most if not all the first level emergency calls. I am from Canada too.

I certainly would like to help out in this regards.

 

If you could please register so I can send you my personal contact details it would be great! On the India side, my contact is a Doctor there who lives / works in a community several hours outside Jammu and that area being fairly remote would be a great place to trial it.

As for the first responder setup itself, I can help with that as I have actually volunteered with St John Ambulance myself as a first responder for last 6 years. So I have experience with what training is required, and what kit is required - that being full BLS pack - backpack format is best. (My personal kit is packed in a 35L traverse rescue pack made by Ferno and holds all the necessary supplies for taking vitals - bp cuff, stethoscope, pen light, etc, dressings, bandages, sam splints, triangular bandages, chem ice packs, we even carry glucometer and strips and individual lancets, ASA for cardic issues, and fast acting glucose gel. Also in there I have pocket mask and minor airways like NPAs and OPAs. I also carry a finger pulse oximeter so I can get O2 sats at ambient air and then on O2 to pass along on the PCR. And also an adjustable c collar fits in there as well) Additionally, O2 should be part of this for it to be effective along with non rebreather masks and nasal cannulae for pats with COPD to administer lower flow rates. One 'sector' would need likely at least 2 tanks to have a rotation to refill. One D size tank lasts 16 min full out at 15L with a 500 reserve.  That should give enough time for an ambulance to arrive when they would take over with their own O2. And also a basic AED system. Depending on what system the ambulances use, I recommend the Medtronic Lifepack for the main reason that that is usually what Ambulances carry (here anyway) and so the pads are compatible. They can literally unplug from the AED and plug into their full Lifepack system. Zoll AEDs for example are not compatible and requires ripping off the pads from the patient, and putting new ones when Ambulance crews take over.  Also, an easy to fill out Patient Care Report is essential for the first responders for vitals etc. As this info can literally save a life, especially if the Pt initially conscious becomes unconscious before the ambulance arrives. That info that the first resppnder can get (allergies, History ect are vitally important in that case!)

So I can help with the actual first responder system on the India side. The doctor interested there is my husbands first cousin and he is keen on it as well.

Big things we need are: Funding for the supplies and maintenance of them. And volunteers.  The volunteers become trained, donate their time a day here or there on 'duty' with the pager or cell and all the kit.  Some of the volunteers would be trained to be instructors in the same training. So that eventually the system would be self sufficient as far as training new volunteers. So this CAN work!!!

Please register and contact me via PM and I will send you my contact details for whatsapp. And thanks for your interest!!!