108 diverted to minor cases, critical patients left in lurch
As the 108 Odisha Emergency Medical Ambulance Service (OEMAS) revolutionises access to healthcare for the needy public in the State, tertiary care institutions like medical colleges are beginning to feel the pinch.
A trend to refer even minor cases to the referral centres has started to set in, not only increasing the load on the already over-burdened institutions but also threatening to deprive more serious patients of availing emergency response as the ambulances remain away from their designated sites for long hours.
For instance, a person stung by a wasp at a village near Nimapara was picked up by the 108 ambulance and taken to the local PHC, the first point of reference as per protocol. But, the doctors there suspected it to be an animal bite and immediately referred him to the SCB Medical College and Hospital, Cuttack.
The person was treated at the OPD itself and discharged immediately. But in the process, there was no ambulance at Nimapara for more than seven hours.
“The trend is fast becoming a major concern. Very minor cases that can be handled at the primary or secondary level like the DHHs are being brought to us. Though hard-pressed with patient load, we cannot refuse treatment to minor cases or refer them back,” Superintendent of SCBMCH Shyama Kanungo rued.
The OEMAS, launched in March this year covering 15 districts with 280 ambulances, has seen more than 60,669 calls converted to dispatches as on August 23. Of these, 54,443 have resulted in transportation of patients to the hospitals.
As per protocol, the patient is first taken to the PHC or the DHH according to the condition of the patient. While, there seems to be an increasing propensity to refer patients from there to tertiary care institutions despite being capable of treating them, in many cases even the patient and attendants force the ambulances to take them straight to the medical colleges. Around 30 per cent of the cases are being referred to tertiary institutions.
“The issue has drawn the notice of the Government, which has started work on formulating guidelines for inter-facility transfer,” Prof Kanungo said.
Another disturbing development is increasing mob attacks on the ambulance vehicles and also on the crew members over delayed arrival - a charge that is vehemently refuted by the operators. In five months, 10 ambulances have been damaged and more than 30 crew members injured in mob violence.
“Compliance to the response time protocol of 20 minutes in urban areas, 25 in semi-urban and 35 in rural areas has been maintained in more than 99 per cent of the dispatches. Most often, the public angst over any incident is transferred on to the ambulance. If there is immediate police action, this can be controlled. We have taken up the matter with the Government authorities,” project head of 108 OEMAS Sabyasachi Biswal said.