In terms of the available facilities a Central Oxygen facility, ECG machine, and stand-by generators for meeting power failures were available in 80% of the hospitals. Ventilators were available in only 8 of the 23 hospitals. Communication facilities in terms of free telephone for patients was provided in 50% of the hospitals. Intercoms and paging services were available in only private hospitals. Computerisation of hospital services was undertaken in only 4 of the 23 hospitals.
Ambulance services were available in 85% of the hospitals which were available round the clock. 30% of the hospitals had more than 3 ambulances. However, the internal facilities like resuscitation availability of paramedics and communication equipment was available in only 50% of the ambulances. Nearly, 90% of the hospitals also charge a considerable fee for providing ambulance services.
Blood bank facility within the hospitals was available in 60% of the hospitals. A list of voluntary blood donors was available in 50% of the hospitals. With recent mandatory instructions for screening of HIV/ Hepatitis B, all blood banks were routinely screening the patients.
Co-ordination between different units of the hospitals was present in 85% of the hospitals with related units of Bio-chemistry, Microbiology, Radiology and other services. All the hospitals reported the presence of operation theatres, intensive care units and wards for immediate admission of patients. Nearly 58% of the hospitals reported considerable delays in co-ordinating services due to lack of facilities.
In terms of the various protocols of admissions, medico legal issues, investigations and treatment, handling disaster and managing patients without identity, all the hospitals reported presence of these protocols. However, the details in terms of the exact standards or guidelines were not specified.
None of the hospitals except 2% had any ongoing research activities.
It is obvious from the present survey that there is an immediate need for identifying the current status of emergency care services in developing cities of India. The survey has identified the obvious lack of facilities in terms of staff availability, facilities for patients, lack of co-ordination between different units in the hospitals was very evident. The inadequate. The lack of clear guidelines of various aspects of functioning within the casualty services needs further investigation.
Based on these findings, there is an immediate need to strengthen casualty services with more trained man power and facilities, extending ambulance services, communication networking and developing protocols. Establishing referral systems for early and appropriate care will be vital for saving lives.
V.L. Satesh1, G. Gururaj1
1Department of Epidemiology, National Institute of Mental Health and Neuro Sciences Bangalore-29, India