Medical Infrastructure in Medical Infrastructure in Medical - - PDF document

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Medical Infrastructure in Medical Infrastructure in Medical Infrastructure in Medical Infrastructure in Gujarat Gujarat Gujarat Gujarat

Dr N B Dholakia

Additional Director, Medical Services Department of Health and Family Welfare Gandhinagar 14 March 2018

Emergency Medical Response Emergency Medical Response Emergency Medical Response Emergency Medical Response

Prehospital Phase Hospital Phase

Coworkers Laymen Wards ICU Emergency Department Organization Ambulances 108 Ambulances Organization Emergency No 108 Security Police Firebrigade First Responders Interhospital Transfers Rehabilitation Lessons Learnt

Pr e p ar e d n es s

Inc ide nt

Aim: To prevent & reduce Mortality and Morbidity with intact survival

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Institutional Structure in Gujarat Institutional Structure in Gujarat Institutional Structure in Gujarat Institutional Structure in Gujarat

Sub Sub Sub Sub-

• Centers

Centers Centers Centers -

• 9156

9156 9156 9156 Mobile Health Units Mobile Health Units Mobile Health Units Mobile Health Units -

• 118

118 118 118 Primary Health Centers Primary Health Centers Primary Health Centers Primary Health Centers -

• 1427

1427 1427 1427 Community Health Centers Community Health Centers Community Health Centers Community Health Centers -

• 351

351 351 351 Sub Sub Sub Sub-

• District Hospitals

District Hospitals District Hospitals District Hospitals -

• 33

33 33 33 District Hospitals District Hospitals District Hospitals District Hospitals -

• 22

22 22 22 Medical College Hospitals Medical College Hospitals Medical College Hospitals Medical College Hospitals – – – – 21 21 21 21 (

( ( ( Govt Govt Govt Govt-

• 6 , GMERS

6 , GMERS 6 , GMERS 6 , GMERS -

• 7 , Corp.

7 , Corp. 7 , Corp. 7 , Corp. -

• 3 , Pvt.

3 , Pvt. 3 , Pvt. 3 , Pvt. -

• 5 )

5 ) 5 ) 5 )

Super Specialty Facility Super Specialty Facility Super Specialty Facility Super Specialty Facility -

• 03

03 03 03

First Aid, Stabilization, Primary Treatment + Definitive Treatment

Institutional Structure in Gujarat

4 H & FW Deptt.

Grant-in-aid Hospitals 119

Private Sector/NGOs/ Central Govt. Institutions

Health & Family Welfare Department

Industry based hospitals: ESIC Hospitals and Tie-up Hospitals ONGC Hospitals and Tie-up Hospitals IFFCO Facility- Kalol Reliance Hospitals- Adani Hospitals- Mundra, Bhuj

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• Govt. Services

5

• Sr. No.

Particular of Services Provision of 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

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• 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

Department Overview

Health & Family Welfare

• 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

and First Aid Posts / Units

• Training of Ground Level workers – ASHA, Female and

Male Health Workers, Medical Officers and through them training the people

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Main Focus Area and Activities- Public Health

Health & Family Welfare

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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
• 108 Services / Rapid Response Team
• Nursing Services
• Disability Certificates

Medical Education

• Medical/ Dental/ Physiotherapy UG/PG Education
• Tertiary care through medical College affiliated Hospitals
• Medical Research

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Main Focus Areas

Health & Family Welfare

Vital Statistics :

• Registration of Births, Deaths & Marriages

SIHFW

• FHW/ANM School
• Training to In-Service Health Staff
• Self Finance Institute ( SFI ) for ANMs

GMSCL

• Procurement of Drugs & medical equipment

PIU

• Construction, Repair, renovation and maintenance of medical

infrastructure NHM

• Umbrella for RCH/National Health Programmes/ASHA/ HR

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Main Focus Areas

Health & Family Welfare

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Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited Gujarat Medical Service Corporation Limited (GMSCL) (GMSCL) (GMSCL) (GMSCL)

• Procurement of quality Drugs/

Drugs/ Drugs/ Drugs/ Promotion of GENERIC Drugs GENERIC Drugs GENERIC Drugs GENERIC Drugs

• Procurement of Medical Instruments

Medical Instruments Medical Instruments Medical Instruments and Maintenance Maintenance Maintenance Maintenance

• Diagnostics

Diagnostics Diagnostics 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 timely timely timely supply of Drugs supply of Drugs supply of Drugs supply of Drugs & Instruments Instruments Instruments Instruments to Health Institutes.

• Rational use of Drugs

Rational use of Drugs Rational use of Drugs Rational use of Drugs

• To develop, devise and enable real time monitoring

real time monitoring real time monitoring real time monitoring system of Drug Stock management up to PHC level

• Will be involved in procurement and stocking of antidotes

Will be involved in procurement and stocking of antidotes Will be involved in procurement and stocking of antidotes Will be involved in procurement and stocking of antidotes

Food & Drug Control Administration ( FDCA) Food & Drug Control Administration ( FDCA) Food & Drug Control Administration ( FDCA) 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 ( Price Control ) Order 2013.

25 District Offices, 4 State Laboratories (for analysis of Food & Drug Samples) Coordinate with major antidote manufactures from Pharma Industries in Gujarat and outside.

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Antidote Manufacturers in Gujarat Activated Charcoal Ambrosia remedies pvt.Ltd., Vadodara Atropine Morvel Laboratories Pvt. Ltd, Mehsana Geevet Remedies, Mehsana Cyanide Antidote Kit Troika, Ahmedabad Edetate calcium disodium Shanpar Industries Pvt. Ltd Pralidoxime Dishman Pharmaceuticals & Chemicals Limited Troika, Ahmedabad Sodium thiosulfate Shakti Chemicals, Halol

22

Launch Dt: 29 Aug 2007

Launch of EMS in Launch of EMS in Launch of EMS in Launch of EMS in Gujarat

Gujarat Gujarat Gujarat

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108 - Emergency Medical Services - Gujarat

24

Innovation Sustainable Scalable

Capacity Building (Leadership, Skill, Attitude, Quality Assurance)

Community Education Awareness Media Support Strengths of Public & Private Sector Technology Integration

Communication IT Fleet Medical

Processes for efficiency and effectiveness in performance delivery

Synergizing

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World class State-of-the-Art - 108 Infrastructure

Gujarat Emergency Response Centre, Ahmedabad

108 Emergency Service 108 Emergency Service 108 Emergency Service 108 Emergency Service

• Ambulance Specification

Ambulance Specification Ambulance Specification Ambulance Specification

Ambulance Basic Specification Force : Tempo Traveler Winger ST VOLUME 10.15 cubic meters 10.31cubic meter LENGTH 3300mm 3200mm HEIGHT 1830mm 1820mm

Force – Tempo Traveller TATA Winger – ST

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High-tech and Equipped Ambulance : 108 Emergency Service

• Ambulance Interiors & Equipments

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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 “Golden “Golden “Golden Hour” Hour” Hour” Hour” of Emergency Customized to Indian needs – 108 ambulance with view to rescue victims impacted due to high energy collisions “Extrication “Extrication “Extrication “Extrication kit” kit” kit” 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

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Key Components Key Components Key Components Key Components -

• CARE

CARE CARE CARE

30

108: Innovative Process

Sense Reach Care Follow up after 48 hrs

• Developed detailed process understanding and well defined responsibilities through
• ut 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

Medical Police Fire

+ + =

108 Emergency

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31 Robust EMS Software ERC Location of Emergency Caller

Nearest Appropriate Hospital location Information of patient arrival through Voice and Data

Robust Application e- PCR Advance data management OLMD 32

Ambulance Interception for definitive treatment

ERC

ERO Definitive BLS Patient on board

Having Cardiac Arrest enroute Intimates nearest Definitive ALS Ambulance Intercepts BLS Ambulance

Patient on board

Advanced pre- hospital care enroute

• Trauma Care Ambulance
• Cardiac Care Ambulance
• Stroke Care Ambulance
• Neonatal Care Ambulance

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33

District wise Ambulances:

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

ALS Ambulances – 140 BLS Ambulances- 445

4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat 4 Wheel Drive initiative in Gujarat for Hard to reach areas for Hard to reach areas for Hard to reach areas for Hard to reach areas

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Hospital Type Count Government Hospitals 2138 Government Supported Hospitals 414 Private Hospitals 10076 Trust Hospitals 441 Total 13,069

108 EMS Hospital Network

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Strengthening Govt. Mechanism and Civil Agency roles

Key Parameters Knowledge shared with Policy makers and voluntary organisations Emergency Status and update of state and districts State Road safety councils Respective District Collectorate SMS notification to Stakeholders Regarding Multi-casualty incidents, large road accidents, major disasters Accident Spot identification Based on surveillance of road accidents and regular analysis of multi-casualty and high speed collisions State Level information channelization and regular meets

• CM and HM Offices
• Commissioner of Health
• Commissioner of Transport
• Gujarat State Disaster management Authority

(GSDMA) integration

• Emergency Medical Services Authority (EMSA) –

Gujarat District level information sharing

• DDO, RDD, Commissioners (Police, Municipal)
• CDHO, CDMO and state health bodies

Interaction with Domain experts from Diverse fields and NGOs:

• Indian Red Cross Society (IRCS)
• CEARCH (Center for Education, Awareness and

Research) on Chemicals and Health

• Indian Institute of management (IIM-A)
• UNICEF

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Mobile Health Unit – Arogya Sanjivni Mock Drill

IOCL Mock drill Baroda GAIL Mock drill Kutch

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Awareness Activities

108 Display on Digital Screen during Night Hours in Surat Demo, Health Check Up & Distribution of Chocolates in Schools World Day Remembrance For RTA Victims -20th Nov Awareness Activity on Police Emergencies Display Boards on Police Stations Sadbhavana Mission of Hon’ble Chief Minister Boards on SP Ring Road- in every 1.5 Kms 40

Safety Week

Surendranagar Jamnagar Rajkot Kutch Rajkot

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41

Junagadh Gir somnath Porbandar Dev bhumi Dwarka Bhavnagar Botad

Safety Week

Mukhyamantri Mukhyamantri Mukhyamantri Mukhyamantri Amritum Amritum Amritum Amritum (MA) (MA) (MA) (MA) Yojana Yojana Yojana Yojana, RSBY , RSBY , RSBY , 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

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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

Accident Wind Flow Wind Flow Safe Direction To Run Safe Direction To Run

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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