Emergency Service Design by Saurabh Garg

SYSTEMS DESIGN

EMERGENCY AND RESCUE SERVICES Faculty: Praveen Nahar Abhinav Gupta Neha Motghare Saurabh Garg 1

ACKNOWLEDGEMENT

We would like to express our special gratitude to Dr. Praveen Nahar for his guidance and constant supervision as well as for providing necessary information regarding the project & also for his support in completing the project. We would like to express our gratitude towards members of GVK EMRI 108, FIRE department, POLICE for their kind co-operation and encouragement which help us in completion of this project. Our thanks and appreciations also go to our colleague in developing the project and people who have willingly helped us out with their abilities.

CONTENTS Chapter

1 1.1 1.2 1.3 1.4 1.5 1.6

Chapter

What is Emergency? LPHE Model of Emergency ABC Model of Emergency Emergency Services Emergency action principles Vital Facts

2 2.1 2.2 2.3 2.4

Secondary Research

3 3.1

Primary Research

3.2

3.3 4

Introduction

999 Emergency Service 911 services Singapore Emergency services 108 GVK EMRI services

Field Visits: GVK EMRI 108 Office 108 Ambulance visit FIRE Department FIRE Control Room Police Station

Case Studies: Cases with ambulance Paldi Ambulance Bodakdev Ambulance Cases with fire brigade Interviews: Mr. Dastor - Chief Officer Fire Department Mehboob - Fire Brigade Driver

Jayesh Gupta - 108 Management Ms. Bharti - EMT specialist

Research and Analysis Detailed Systems Model Opportunity Mapping Chapter

4 4.1 4.2

Chapter 5 5.1 5.2

5.3

Solutions

Initial Brainstorming Generating Solutions Policy Promotion Process Product Concepts evaluation against key parameters Detailed solutions PROMOTION: CPR Introduction Seminar in NID First Responder Training Program in NID First Responder Basics Card PRODUCT: Emergency First Responders - Medical and Fire PROCESS: Proposed System Model Improved call filteration system Conclusion and References

Introduction

INTRODUCTION

Introduction

LPHE model This model classifies emergencies based on danger to life, health, property and environment.

Emergency

Life

An emergency is a situation that poses an immediate risk to health, life, property or environment. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative care for the aftermath. While some emergencies are self evident (such as a natural disaster), many smaller incidents require the subjective opinion of an observer (or victim) in order to decide whether it qualifies as an emergency.

There can be varoius methods of classfying emergencies. While no one method is wholesome, classifying emergencies gives perspective on the sccope of the topic and helps narrow the design brief to a specific area.

Health

Some emergencies are not immediately threatening to life, but might have serious implications for the continued health and well-being of a person or persons. The range of incidents that can be categorised here is far greater than those that cause a danger to life (such as broken limbs, which do not usually cause death, but immediate intervention is required if the person is to recover properly)

Property

Other emergencies do not threaten any people, but do threaten peoplesâ&#x20AC;&#x2122; property. An example of this would be a fire in a warehouse that has been evacuated. The situation is treated as an emergency as the fire may spread to other buildings, or may cause sufficient damage to make the business unable to continue (affecting livelihood of the employees). Many agencies categorise property emergency as the lowest priority, and may not take as many risks in dealing with it.

Environment 8

Many emergencies cause an immediate danger to the life of people involved. This can range from emergencies affecting a single person, such as heart attacks, strokes, and trauma, to incidents that affect large numbers of people such as natural disasters including tornadoes, hurricanes, floods, and mudslides. Most agencies consider these to be the highest priority of emergency, which follows the general school of thought that nothing is more important than human life.

Some emergencies do not immediately endanger life, health or property, but do affect the natural environment and creatures living within it. Not all agencies consider this to be a genuine emergency, but it can have far reaching effects on animals and the long term condition of the land. Examples would include forest fires and marine oil spills

Introduction

ABC model

Emergency services

This model of classification assigns emergency levels based on extent of threat to life.

A B C

IMMEDIATELY LIFE THREATENING

Emergency services are organizations which ensure public safety and health by addressing different emergencies. Some agencies exist solely for addressing certain types of emergencies whilst others deal with ad hoc emergencies as part of their normal responsibilities.

Level 1: Actual death imminent Level 2: Possible death imminent Level 3: Risk of imminent death or child under the age of 2 (regardless of diagnosis)

The availability of emergency services depends very heavily on location, and may in some cases also rely on the recipient giving payment or holding suitable insurance or other surety for receiving the service.

URGENT BUT NOT IMMEDIATELY LIFE THREATENING

There are three main types emergency services:

Level 1 - Definitely serious (not immediately life threatening, but requires urgent on-scene assessment, treatment and conveyance) Level 2 - Possibly serious (not immediately life threatening and no specific gain from immediate treatment on-scene)

Emergency medical service — providing ambulances and staff to deal with medical emergencies Fire and Rescue Service — providing firefighters to deal with fire and rescue operations, and may also deal with some secondary emergency service duties Police — providing community safety and acting to reduce crime against persons and property

NOT SERIOUS OR IMMEDIATELY LIFE THREATENING Level 1 - Requiring assessment and or transport (not life threatening or serious, but needs assistance) Level 2 - Suitable for telephone triage and/or advice (probably no need for transport, telephone consultation can be used to determine the assistance required)

ABCDE Model

Bravo

LOW PRIORITY

MEDIUM PRIORITY

Coastguard — Provide coastal patrols with a security function at sea, as well as involvement in search and rescue operations Mountain rescue — to provide search and rescue in mountainous areas, and sometimes in other wilderness environments.

This model assigns a code to each inbound request for service. These codes are then used to determine the appropriate level of response.

Alpha

Other specialised emergency services include-

Charlie Delta Echo

Mine rescue — specially trained and equipped to rescue miners trapped by fires, explosions, cave-ins, toxic gas, flooding, etc. Search and rescue — can be discipline-specific, such as urban, wildland, maritime, etc.

ADVANCE LIFE SUPPORT REQUIRED

Bomb disposal — to render safe hazardous explosive ordnance, such as terrorist devices or unexploded wartime bombs.

HIGH PRIORITY, ADVANCE LIFE SUPPORT REQUIRED

Hazmat — removal of hazardous materials

MAXIMUM POSSIBLE PRIORITY

Air search providing aerial spotting for the emergency services. 10

Introduction

Emergency action principles

CHALET

Emergency action principles are the guiding rules to be employed by the first person, or persons, on the scene of an emergency. The nature of emergencies is such that it is impossible to prescribe a specific list of actions to be completed before the event happens, so principles form a framework on which to base forward actions.

CHALET dictates the form in which the receiving control station should get information from the first person or officer on scene.

The key principle principle followed in almost all systems is that It is core to emergency management that gency that must be dealt with.

It stands for:

the rescuer should assess the situation for danger.

rescuers do not become secondary victims of any incident, as this creates a further emer-

A typical assessment for Danger would involve observation of the surroundings, starting with the cause of the accident (e.g. a falling object) and expanding outwards to include any situational hazards (e.g. fast moving traffic) and history or secondary information given by witnesses, bystanders or the emergency services (e.g. an attacker still waiting nearby). Once a primary danger assessment has been complete, this should not end the system of checking for danger, but should inform all other parts of the process. If at any time the risk from any hazard poses a significant danger (as a factor of likelihood and seriousness) to the rescuer, they should consider whether they should approach the scene (or leave the scene if appropriate).

Casualties - Approximate numbers of dead, injured and uninjured Hazards - Present and potential Access - Best access routes for emergency vehicles, bottlenecks to avoid etc. Location - The precise location of the incident Emergency - Emergency services already on scene, and what others are required Type - Type of Incident, including details of numbers of vehicles, buildings etc. involved

ETHANE ETHANE stands for:

Principles for assessing an emergency Once a primary check for danger has been undertaken, a rescuer is then likely to follow a set of principles, which are largely common sense. These assessment principles are the types of information that the emergency services will ask when summoned. This information usually includes number of Casualties, history of what has happened and at what time, location and access to the site and what emergency services are likely to be required, or that are already on scene.

Exact location: The precise location of the incident Type: The nature of the incident, including how many vehicles, buildings and so on are involved Hazards: Both present and potential Access: Best route for emergency services to access the site, or obstructions and bottlenecks to avoid Numbers: Numbers of casualties, dead and uninjured on scene Emergency services: Which services are already on scene, and which others are required

Introduction

Introduction After discharge, 0.90%

VITAL FACTS

Separate studies show that

Injuries constitute 11

percent of the total estimated deaths in India every year. In 2004, 1.1 million deaths occured due to injuries alone. India accounts for about 10% of road accident fatalities worldwide.

At crash site, 29.80%

23% of the deaths are definitely preventable

More than 1 week, 20%

46% of the deaths are possibly preventable 31% of the deaths are Not preventable

In Hospital, 48.60%

There were 127,154 fatalites due to Road Traffic Accidents in India in 2009. This was almost 27 percent of all deaths caused by injuries.

Within 1st hour, 50% during transport to hospital, 20.70%

There were 23,258 fatalites due to Fires in India in 2009. This was almost 5 percent of all deaths caused by injuries.

Between 1 Hr and 1 Week, 30%

The best chance of survival for a serious RTA victim is, if they are brought into the casualty department within the first hour of trauma or the so called Golden hour. The fact that 50% of deaths happen within the first hour highlights the importance of emergency services in delivering early trauma care.

Distribution of Number of Deaths by Injuries, 2009 17534

Unknown

35906

Other Causes

127151

Suicides Dowry

32369

Homicide

25793

Other Accidents

126896

RTAs

Firearms

8997

Falls Electrocution

23268 1467 Other fire accidents, 74%

10622 8539 25911

Drowning Building Collapse

Short circuit, 6%

Cooking Cylinder/ Stove Burst, 18%

1504

Fire Factory

Fireworks, 2%

18599

Poisoning Animals

Distribution of Major causes of Fire

8383

2847

Number of Deaths 14

Major determinant of fatality in fie victims is total body surface burns (TBSB) There is a 70 percent mortality rate in case of percent and more TBSB)

severe burns (20

But, even 60 percent TSBS burn victims had a mortality of 6 percent only in cases where victim reached hospital early and/or received good quality first aid at site of injury. 15

Secondary Research

Procedure A common emergency call 999 or 112 is used to contact the emergency services upon witnessing or being involved in an emergency. In the United Kingdom, the numbers 999 and 112 both connect to the same service, and there is no priority or charge for either of them. An emergency can be: A person in immediate danger of injury or whose life is at risk Suspicion that a crime is in progress Structure on fire Another serious incident which needs immediate emergency service attendance

999

is an official emergency telephone number in a number of countries which allows the caller to contact emergency services for urgent assistance. States using 999 include the United Kingdom, Ireland, Poland, Saudi Arabia, the United Arab Emirates, Macao, Bahrain, Qatar, Bangladesh, Botswana, Ghana, Kenya, Hong Kong, Malaysia, Mauritius, Singapore, Zimbabwe, and Trinidad and Tobago. 999 or 112 can be used to summon assistance from the three main emergency services, the police, fire brigade and ambulance, or more specialist services such as the coast guard and, in relevant areas, mountain and cave rescue. Calls to 112 or 999 are free. Calls to the European Union and GSM standard emergency number 112 are automatically routed to 999 operators. 18

On dialling 999 or 112 an operator at BT, Cable & Wireless or Level 3 Communications will answer and ask, “Emergency. Which service?”[citation needed] Previously operators asked “Which service do you require?” The operator will then transfer the call to the appropriate services’ own call-taker. If the caller is unsure as to which service they require, the operator will default the call to the police, and if an incident requires more than one service, for instance a road traffic collision with injuries and trapped people, depending on the service the caller has chosen, this service will alert the other services for the caller (while the operator has to also contact each emergency service individually, regardless of whether the caller has remained on the line). The caller will be connected to the service which covers the area that they are (or appear to be) calling from. The rooms in which operators work are called operator assistance centres (OACs). The rooms in which emergency response operators work are called Emergency Control Centres (ECCs). Access to the 999/112 service is provided for the hearingimpaired via Textphone and use of the RNID “Typetalk” relay service. The number is 18000. 999 is also accessible via SMS for pre-registered users.

Secondary Research

Location It is important for the caller to be aware of their location when phoning for the emergency services; the caller’s location will not be passed onto the emergency services immediately, and finding the location require a combination of efforts from both parties. However it is possible to trace both landline and mobile telephone numbers with the BT operator; the former can be traced to an address. The latter can be immediately traced to a grid reference according to the transmitter being used, however this is only accurate to a certain wide area — for more specific traces senior authority must be acquired and an expensive operation can be conducted to trace the mobile phone to within a few metres. On some occasions callers will be put through to the wrong area service - this is called a “misrouted 9”. The most common reason for this is when a mobile phone calls 999 and is using a radio transmitter that is located in another force; most frequently these are calls that are made within a few miles of a border. Upon establishing the incident location, the emergency service operator will relay the information to the responsible force for their dispatch. In most areas, other forces will respond to incidents just within the border if they could get there quicker, assist, and then hand over to the other force when they arrive. In the United Kington the Highways Agency have placed blue signs with the location printed on them, at approximately 1 mile intervals on their managed routes, such as Motorways and major A-Roads. These signs contain a code which can be given to the emergency operator to locate you quickly. For example, a sign may say “M1 A 100.1”. This translates as the M1 Motorway, on the “Alpha” Carridgeway, at 100.1 miles from its start. The “Alpha” and “Bravo” carridgeways are designated by the Highways Agency to each side of the road, dependant upon which direction it travels. Abandoned and hoax calls Abandoned and hoax calls An abandoned call is when a caller, intentionally or otherwise, rings 999 and then ends the call or stays silent, this could be for any number of reasons, including coercion or harm coming to the caller. Abandoned calls are filtered by BT operators and are either disconnected or passed to the police. All abandoned calls are checked by the police. The most common reasons for abandoned calls include: Accidental dialling of 999 on mobile phones, even with the keypad locked. Some GSM mobile phones have a feature of still allowing emergency calls to be dialled even with the keypad locked; Faulty phone lines. 20

9-1-1

EMERGENCY RESPOSE SYSTEM 24

is the emergency telephone number for the North American Numbering Plan (NANP). It is one of eight N11 codes. The use of this number is for emergency circumstances only, and to use it for any other purpose (including non-emergency situations and prank calls) can be a crime.

Locating callers automatically In over 98 percent of locations in the United States and Canada, dialing “9-1-1” from any telephone will link the caller to an emergency dispatch center—called a PSAP, or Public Safety Answering Point, by the telecom industry—which can send emergency responders to the caller’s location in an emergency. In most areas (approximately 96 percent of the US) enhanced 9-1-1 is available, which automatically gives dispatch the caller’s location, if available.[18] Enhanced 9-1-1 or E9-1-1 service is a North American telecommunications-based system that automatically associates a physical address with the calling party’s telephone number, and routes the call to the most appropriate Public Safety Answering Point (PSAP) for that address. The caller’s address and information (as recorded by the telephone company) are displayed to the PSAP calltaker immediately upon the site’s receipt of the call. This provides emergency responders with the location of the emergency without the person calling for help having to provide it. This is often useful in cases of fires, break-ins, kidnapping, and other events where communicating one’s location is difficult or impossible. In North America, the system works only if the emergency telephone number 9-1-1 is called. Calls made to other telephone numbers, even though they may be listed as an emergency telephone number, may not permit this feature to function correctly.

Public Safety Answering Point (PSAP) The final destination of an E 9-1-1 call—the location where the 9-1-1 operator is working—is called a Public Safety Answering Point (PSAP). There may be multiple PSAPs within the same exchange, or one PSAP may cover multiple exchanges. The territories covered by a single PSAP are based more on historical and legal police considerations than on telecommunications issues. Most PSAPs have a regional Emergency Service Number, a number identifying the PSAP. The Caller Location Information (CLI) provided is normally integrated into an emergency dispatch center’s computer-assisted dispatch (CAD) system, to provide the dispatcher with an onscreen street map that highlights the caller’s position and the nearest available emergency responders. For Wireline (land line) E911, the location is an address. For Wireless E911, the location may be a set of coordinates or the physical address of the cellular tower from which the wireless call originated.

Stakeholders and technologies involved Funding 9-1-1 services In the United States, 9-1-1 and enhanced 9-1-1 are typically funded based on state laws that impose monthly fees on local and wireless telephone customers. In Canada, a similar fee for service structure is regulated by the federal Canadian Radio Television and Telecommunications Commission (CRTC). Depending on the location, counties and cities may also levy a fee, which may be in addition to, or in lieu of, the state fee. The fees are collected by local telephone and wireless carriers through monthly surcharges on customer telephone bills. The collected fees are remitted to 9-1-1 administrative bodies, which may be statewide 9-1-1 boards, state public utility commissions, state revenue departments, or local 9-1-1 agencies. These agencies disburse the funds to the Public Safety Answering Points for 9-1-1 purposes as specified in the various statutes. Telephone companies in the United States, including wireless carriers, may be entitled to apply for and receive reimbursements for costs of their compliance with federal and state laws requiring that their networks be compatible with 9-1-1 and enhanced 9-1-1. The Customer acknowledges and understands that Wayatone charge a fee of $25.00 US Dollars for each call made to the 911 Service. This is to cover the cost of the service that Wayatone must pay when Wayatone connect such calls. Fees vary widely by locality. They may range from around $.25 per month to $3.00 per month, per line.The average wireless 9-1-1 fee in the United States, based on the fees for each state as published by the National Emergency Number Association (NENA), is around $0.72. Since monthly fees do not vary based on the customerâ&#x20AC;&#x2122;s usage of the network, the fees are considered, in tax terms, as highly â&#x20AC;&#x153;regressiveâ&#x20AC;?, i.e., the fees disproportionately burden low-volume users of the public switched network (PSN) as compared with high-volume users. Some states cap the number of lines subject to the fee for large multi-line businesses, thereby shifting more of the fee burden to low-volume single-line residential customers or wireless customers.

Many pieces of the existing communications and data infrastructure will require modification to make NG9-1-1 a reality. The private companies and public agencies that provide these goods and services will be significantly affected. Chief among these are: Telecommunications equipment and service providers Information technology equipment and service providers Telematics, including Advanced Automatic Collision Notification Hazmat (Hazardous materials) security alerts to or from commercial motor carriers or rail carriers Integration of Intelligent transportation systems with public safety communications systems Security alarm notification system providers Other major stakeholders include: State and local 9-1-1 agencies Public safety and emergency management agencies Emergency services industry Federal departments, including Transportation, Commerce, Homeland Security, Justice and the Federal Communications Commission National organizations with active interests in 9-1-1 IT research community Standards community Major contributors and stakeholders in the standards community include: NENA (National Emergency Number Association) NAED ([National Academy of Emergency Dispatch]) APCO (Association of Public-Safety Communications Officials-International) IETF (Internet Engineering Task Force) TIA (Telecommunications Industry Association)

Accessibility District wise Number of Emergency Calls received since Inception in December 2010 to May 7 2012 is shown below:

Various features of NG9-1-1, including textmessaging and picture messaging, provide accessible features for those who cannot use a regular telephone. It is also considered as a long term replacement for the use of TDD/TTY devices for the deaf, currently in use with 9-1-1. TDD/TTY devices are considered legacy systems, and may be replaced by other real-time text technologies that transmit text as it is being typed.

District

GVK EMRI

(Emergency Management and Research Institute) is a non-profit professional organization operating in the Public Private Partnership (PPP) mode, GVK EMRI is the only professional Emergency Service Provider in India today. GVK EMRI handles medical, police and fire emergencies through the â&#x20AC;&#x153; 1-0-8 Emergency serviceâ&#x20AC;?. This is a free service delivered through state- of -art emergency call response centres and has over 2858 ambulances across Andhra Pradesh, Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh, Himachal Pradesh and Chhattisgarh. GVK EMRI will have more than 10000 ambulances covering over a billion population by 2011. 1-0-8 Emergency Response Service is a 24X7 emergency service for medical, police and fire emergencies. The service is available for the entire state of Andhra Pradesh ,Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh and Himachal Pradesh.

Number of Emergency Calls Received

KANGRA

33588

SHIMLA

33203

MANDI

24533

SIRMAUR

21994

CHAMBA

16249

HAMIRPUR

16236

BILASPUR

15851

SOLAN

15103

KULLU

10763

UNA

9933

KINNAUR

1345

LAHAUL-SPITI

653

The main highlights are

1-0-8 is dialed for the purposes mentioned below:

It is a 24x7 emergency service. Toll Free number accessible from landline or mobile Emergency help will reach you in an average of 18 minutes

To save a life To report a crime in progress To report a fire 33

The three-year-old Emergency Management and Research Institute (EMRI) service is India’s first coordinated response service, at one number across the country, taking a call every two seconds. The 108 service in India is ambulance-based. It has more than 600 advanced life-saving ambulances operating in Andhra Pradesh and Gujarat. The Tamil Nadu government has made available 200 such emergency medical technician-manned ambulances for the EMRI service. “The service is free of charge. Even necessary hospitalisation for the first 48 hours is free.”

Emergency Management requires the integration of three cardinal pillars: Sense, Reach and Care. Emergency Management requires partnership with multiple institutions to provide quick and quality response. GVK EMRI has therefore integrated with Government and private hospitals for timely response in case of medical emergencies. The call centre is in contact with the police control room for easy dispatch of police and fire brigade in case of Police and Fire emergencies

108 GVK EMRI call center, Ahmedabad

HOW IT WORKS Currently its available in the following states: Andhra Pradesh, Tamil Nadu, Kerala, Karnataka, Goa, Gujarat, Rajasthan, Assam, and Jammu and Kashmir

People can call 108 from any phone (landline or mobile) Call lands at the Emergency Response Centre (ERC ) ERC consists of Communication Officer(CO) and Dispatch Officer(DO) The caller call is attended by CO Communication Officer and takes information on the type of emergency, Scale of Emergency, Number of Victims, location and landmark, if any Information is transferred to DO Dispatch Officer. Based on the information, DO will dispatch either ambulance, fire fighters or police depending on the type of emergency Help will reach in 18 minutes in cities and 30 minutes in rural areas. Medical technicians (EMT) and physicians(ERCP) will provide pre-hospital care while transporting the victim in the ambulance to the nearest hospital. 34

SENSE

REACH

CARE

The Sense paradigm of Emergency Management comprises of information capture regarding the emergency situation. A dedicated toll free number 1-0-8 is used to report any of the three kinds of emergencies - Medical, Police or Fire. The 1-0-8 call is received by the Communication Officer who collects and records all facts regarding the emergency. The information is then transferred to the Dispatch Officer who identifies the closest ambulance to the scene of emergency and gives instructions for dispatch of the ambulance. They use CTI (Computer Telephony Integration) solutions for receiving 1-0-8 emergency calls and maintaining records of the caller data.

Reaching on the spot in Golden Hour is crucial for the life of the victim. Ambulances are strategically placed so as to reach the victim at the earliest possible time. In case of Police or Fire emergencies local State Police Station or Fire department is immediately notified with full details. Advanced Life Saving (ALS) ambulances are equipped with advanced medical equipment like defibrillators and ventilators to aid the patient even during transportation to a hospital.

Pre Hospital Care in Ambulance Each ambulance is accompanied by a trained EMT (Emergency Medical Technician) who is responsible for pre–hospital care while transporting the patient to a hospital for stabilization. If required, the EMT can be in conference (via cell phone) with the in house ERCP (Emergency Response Care Physician) who is a qualified medical practitioner , available 24/7 to support the EMT as and when required. Ambulances are equipped with most common medications and equipments to aid the EMT in pre-hospital care. The EMT maintains a record of every case attended and transfers the filled in Patient Care Record (PCR) forms to the hospital authorities. This record is maintained for further research and analysis. 35

TRAINING PROGRAMS 1) Paramedic training A Paramedic is trained professional who extends help to the victim during the transit from site of emergency to hospital where doctor will take over the care of the victim. The paramedics manning “108” ambulance are trained at EMLC.The course includes the following modules: 1.Basic Preparatory course 2.Advanced Paramedic training 3.Refresher EMT training program 4. Long term EMT program

4) Emergency Room physician training / Intensivist Training Doctors involved in emergency care at Emergency rooms and Intensive Care Units need to follow globally accepted standards of care. These specialist doctors will be trained International Program Guidelines (IPG’s) . These activities of EMLC are based on important phases of training cycle 1. Needs assessment 2. Designing of training 3. Implementation of training 4. Assessment

2) First Responder (FR) Training program The training includes First aid for 1.Medical Emergencies 2. Injury Emergencies 3. Environmental Emergencies Skills required for saving life in emergency is known as “Cardiopulmonary Resuscitation” (CPR) , will be taught to participants. First Responder course also offers hands on practice with the help of state of art mannequins for every individual delegate.

3) General Practitioner’s (GP’s) training General practitioners are first point of contact for various emergencies by virtue of their pivotal role as the ‘Family Doctor’ . GP’s are trained at GVK EMRI to handle common emergencies.

5) American Heart Association (AHA), USA All training programs offered by AHA are conducted at GVK EMRI. The programs are as follows 1. Basic Life Support (BLS) Provider and Instructor 2. Advanced Cardiac Life Support (ACLS) Provider and Instructor 3. Pediatric Advanced Life Support (PALS) Provider and Instructor The courses offered at GVK EMRI has obtained recognition / affiliation from international training bodies like American Heart Association (AHA), International Trauma Life Support (ITLS), USA . GVK EMRI already has signed the Memorandum of understanding (MOU) with Academy of Emergency Medicine in India (AAEMI), American Association of Physicians of Indian Origin (AAPI).

AHA CERTIFIED COURSES ACLS, BLS CONDUCTED BY GVK EMRI,AP. AHA The American Heart Association (AHA) is a national voluntary health agency whose mission is â&#x20AC;&#x153;Building healthier lives, free of cardiovascular diseases and stroke.â&#x20AC;?

BASIC LIFE SUPPORT (BLS)

GVK EMRI recieved the ITO (International Training Organisation) status in recognition to the large pool of qualified instructors and technologically advanced simulated laboratory facilities. A series of training programs for Doctors and other currently active healthcare providers is being launched who wish to undergo the AHA certified course. The different courses offered by GVK EMRI and certified by AHA are 1) ACLS (Advanced Cardiac Life Support) 2) BLS (Basic Life Support)

The Basic Life Support course is a one day workshop that will impart basic life support training. The delegates are trained to resuscitate a victim of cardiac arrest without the use of advanced equipment or drugs. The BLS Course will cover the following content. INTRODUCTION BLS / ACLS Provider Course is designed to enhance survival by improving the quality of care provided to the adult victim of a cardiac arrest or other cardiopulmonary emergency. At the end of the course, you will enhance your knowledge and skills to perform cardiopulmonary resuscitation techniques in emergency cardiovascular care, as recommended by the recent ECC 2005 guidelines given by AHA and International Liaison Committee on Resuscitation (ILCOR). ELIGIBILITY BLS - Any interested person who needs to know how to perform cardio pulmonary Resuscitation (CPR) in a health care setting (eg. Doctors, nurses, physician assistants, paramedics, lab technicians etc)

CPR Training in GVK EMRI training center

ACLS - Currently active health care providers ( eg. Doctors - MBBS/ BDS, BHMS, BAMS, general practitioners, doctors of any speciality or super speciality ) 38

1) 2) 3) 4) 5)

CPR for adults / children / infants Adult and child bag mask technique 2- rescuer CPR for adults / children Use of Automated External Defibrillator (AED) Relief of choking / foreign body aspiration

ADVANCED CARDIAC LIFE SUPPORT The BLS course is followed by a two day workshop that imparts intensive training in advanced cardiopulmonary resuscitation. The delgates are trained to resuscitate a victim using advanced monitoring equipment and lifesaving drugs. They are also trained in the resuscitation team concept. 1) 2) 3) 4) 5)

Management of respiratory arrest Pulseless arrest / VF / VT Bradycardia / Asystole / PEA Tachycardia - stable / unstable Megacode & Resuscitation team concept

COURSE DURATION The course is a three day workshop, but self preparation by the candidate is a compulsory requirement to equip him / her with the necessary didactic knowledge with the study material provided.

FIRE DEPARTMENT

PRIMARY RESEARCH Field Visits: GVK EMRI 108 Office 108 Ambulance visit FIRE Department FIRE Control Room Police Station

Fire Stations in Ahmedabad: Danapith Gomtipur Jamalpur Maninagar Naroda Panchkuva Shahpur Fire Station Memnagar Fire Station Sabarmati Fire Station

Case Studies: Cases with ambulance Paldi Ambulance Bodakdev Ambulance Cases with fire brigade Interviews: Mr. Dastor - Chief Officer Fire Department Mehboob - Fire Brigade Driver Jayesh Gupta - 108 Management Ms. Bharti - EMT specialist Jurisdiction & duties The role and jurisdiction of the Brigade is set as the limits of Municipal Corporation of Ahemedabad. Its role include: 1) Promote Fire Safety; and 2) To prepare for fighting fires and protecting people and property from fires; rescuing people from Road Traffic Accidents; and dealing with other specific emergencies, such as flooding or terrorist attack. 3)Any activity which will help them meet their Statuatory Duties 40

Hierarchy

Chief Fire Officer Joint Chief Fire Officer Deputy Chief Fire Officer Divisional Fire Officer Assistant Divisional Fire Officer Station officer This is the main fire station in Ahmedabad. The main control room is located at this fire station. All the calls from 101 and 102 are received at this center. 101 - Fire Emergencies 102 - Medical Emergencies (Government Hospitals)

Assistant Station Officer Sub-Officer Driver/Operator Leading fireman Fireman Trainee firemen

CALL CENTER Location: Memnagar Fire Station

Organisation The A M C Fire and Emergency Services are headed by Chief Fire Officer- Mehrnosh F Dastor. The Regions are each headed by a Deputy Chief (Fire). The Divisions are in the charge of Divisional Officers. Each of the Sub-Division is headed by the Sub-Divisional Officer. The Fire Station is managed by a Station Officer. 42

There are four officers in Call Center, three catering to the Fire Emergencies -101 and the one to the 102ambulance services (government hospitals). When a caller calls the basic info about the caller name, incident address, phone number is noted in a register for records. The officers judge the extend and amount of damage through the tone of the caller. after knowing the address of the incident, the officer calls the nearest call center on common frequency and reports the incident. The Local Fire station takes action. 43

FIRE STATION

FIREMEN DUTY

Fire station is equipped with Fire Brigade B A Rescue van 6,000 liters to 12,000 litres tankers

Daily Routine is divided in four groups: 1)Daily Routine 2)Watch Room Function 3)Fire Station Function 4)Miscellaneous. Daily Routine Procedure:

FIREMEN Firemen in a fire station are according to the number of emergencies, scale and location of the fire Equipment station. The fire stations are equipped with specialised equipment When an emergency is reported the nearest fire such as Fire Fighting and Rescue Vehicles, Ambulances, Breathing Apparatus Sets, Hydraulic Rescue Tools, electric station, a siren alerts the fire men at the station. The chain saw, concrete or steel cutter, chemical protective suits, case in short is announced at the station. All firemen residing in the firestation come down running fire proximity suits, rescue rocket device, self/rope rescue in their uniform. According to the type of emerdevices and search camera. gency, people specialized in their field are selected. Around 4-5 people depending on the scale of emergency go in one fire brigade for the case. Fire Brigade is dispatched in around 10 mins.

Work, which includes general duty, maintenance of fire stations, operational work, drills and such other works carried out round the clock every day and time to time. Watchroom’s Function: Duty Change- It is shift change routine where personnel of the present shift take charge form the previous shift. This procedure is followed after the person’s joining the duty and person’s off the duty conducts ‘Mount dismount’ and every thing is checked according to Inventory List. Each shift is of 8 Hrs duty and in every shift these are about 9.10 personnel and every two person’s take charge of Watch-room duty and Sentry-duty after every two Hrs. Duty/ shift changeWork normally done by Watch-room and sentry duty personnel are as follows.

Fire Station Functions: Routine followed every day to check and impact various appliances and equipments as well as maintenance of Fire Station Group. Fall in for Cleanliness/ Maintenance:All personnel fall-in to keep station ground clean, checking of appliances and equipments etc,. Fall in for Foot/ Fire Drill– Foot Drill and Fire Drill (as per Drill Manual) is conducted everyday Fall in for Maintenance/ Testing- Maintenance of all fire fighting equipments as well as testing of such equipment are done during these Hrs. Fall in for Roll Call- In order to check all personnel are present in station ground and to see personnel on leaves have joined duty and/ or to see which person is going next day leave etc,.

Duty hours The Ahmedabad Fire brigade staff are be placed on 24 hour duty and are provided quarters in the premises of the fire station.

Miscellaneous Other miscellaneous function

AMBULANCE The Advanced Life Saving (ALS) ambulances are equipped with advanced medical equipment like defibrillators and ventilators to aid the patient even during transportation to a hospital. Ambulances are placed at strategic locations to cover a wider area. We visited the Paldi 108 ALS Ambulance

CASE STUDIES:

Suicide Case Area: Jamalpur Onlooker calls 102 and reports man trying to jump in Sabarmati River. Call received by Call center officer at Main Fire Station. Information was transferred on common band frequency to the nearest Fire Station. Emergency is announced on loud speaker at Jamalpur Fire Station. All firemen run down from their residences above to the reporting area. The Leading Firemen decides the vehicle and firemen to be taken for the case and the vehicle is dispatched in 10 mins. Case 01: A man was about to jump in water, firemen and people around after lot of persuasion for aroun 15 mins convinced him not to jump in the river. Case 02: A man already jumped in water and was dead. Firemen went into the river on their boat, using hooks removed the body from the river. Police came half an hour late.

CASE STUDIES: 108 CASE STUDIES: BHOPAL RTA Area: Bodakdev Date: 17th March

Case study 108 emergency case Type: Medical Patient: 25 M Case: severe stomach pain (appendices case) Family helped in getting the patient to the ambulance. Painkiller given by EMT. Patient taken to VS hospital in 10 mins.

Case study 108 emergency case Type: Medical Patient: 48 M Case: passing urine problem Family helped in getting the patient to the ambulance, due to unaccesibility of the place. They got the patient in an auto. Three of the Family Members accompanied in the ambulance. Patient taken to VS hospital in 15 mins. 54

Case study 108 emergency case Type: Medical Patient: 60 F Case: Fell from staircase, Head injury Family helped in getting the patient to the ambulance. Three of the Family Members accompanied in the ambulance. Lot of discussion over which hospital to be taken. Call to family doctor. Patient taken to Apollo hospital.

Case study 108 emergency case Type: Medical Patient: 35 M Case: unconscious

Family helped in getting the patient to the ambulance, in cloth stretcher. Three of the Family Members accompanied in the ambulance. Patient taken to VS hospital in 15 mins.

POLICE

POLICE CALL CENTER Police number is 100. there are 8 phone lines of 100 for

POLICE STATION IN AHMEDABAD Ellisbridge Police Stations Kalupur Police Stations Maninagar Police Stations Maninagar Police Stations Naroda Police Stations Navrangpur A Police Stations Navrangpur A Police Stations Satellite Police Station

The Ahmedabad City Police is responsible for law enforcement and public safety in the city of Ahmedabad, India. It is a subdivision of the state police force of Gujarat, and is headed by a commissioner of police. 60

Maninagr Police Station , Ahmedabad

In road accidents, medical, suicides, building collapase, fire emergencies POLICE acts as a support in helping medical and fire services. Police helps in controlling the crowd and making case investigations about the case. 61

AHMEDABAD TRAFFIC POLICE

Ahmedabad Traffic Police Helpline Number 1095 Ahmedabad traffic department is head under Deputy Commissioner of Police Mr. Nilesh Jajadia. The Traffic Police department has 8 Traffic Police vans in ahmedabad city. Each Van contents 5 persons, 1 Police Sub Inspector and 4 Task Force. The traffic department has 4 cranes for lifting vehicles.

POLICE CONTROL ROOM VAN: PCR van is in direct contact with the Control Room. There are 28 mobile vans in Ahmedabad. These van are located at strategic locations or are taking rounds in a particular area as orders by Commissioner of Police. Each PCR VAN has an Incharge, Driver and a Gunman. These vans are the first to reach on site. As an emergency is reported at the Call Center. Call Center officers sends the PCR van to the site immediately. The main function of the PCR van is to gauge the extent of emergency. The PCR van reaches the site in around 5- 10 mins according to the area and traffic. The PCR van reports the call center about the situation at the site, and accordingly Police force is send from nearest Police Station for action.

INTERVIEWS:

They work for 108 EMRI Service. Its a 24 x 7 free of charge service. The Ambulances are given areas to cover in case of an emergency. Ms Bharti and Mr. Liakhat Malik are given the Paldi ambulance. They attent around 10-17 cases everyday. They have daily 8 hr shift duty. Their duty starts at 8am to 8pm everyday. Due to low staff rate taking an off is difficult. An application should be given before for a holiday.

Mr. Mathin Faraaz Bhai Department: Fire Designation: Station Fire Officer-Jamalpur Fire Station Area: Jamalpur Fire Station Ahmedabad has 14 stations. Fire Department has around 8-10 cases everyday. Majority of the cases are for Bird Rescue. The Fire Department comes under Municipal Coorporartion. Adequate money does not reach fire stations, hence low maintenance of the stations. The station has 600 lt, 6000 lt , 10,000 lt tankers for Fire extinguishing. The hydraulic jacks , chain saw, petrol cutter, electric cutter, Hydrants, etc. are under no maintsnence.

Ms Bharti Department: Medical Designation: 108 GVK EMRI Ambulance EMT Emergency Medical Technician Area: Paldi Ambulance

The call from caller goes to the control room, which transfers it to the nearest fire station. Nearest fire station takes action.

Mr. Liakhat Malik Department: Medical Designation: 108 GVK EMRI Ambulance Driver Area: Paldi Ambulance

All communication of 108 EMRI are done on mobile connections. A person call the call center and reports emergency. The call center calls the nearest ambulance explains the case and the location. The location is told verbally on phone. Incase they donâ&#x20AC;&#x2122;t find the location the EMT calls the call center, which calls the caller and confirms the location. If the location is inside and difficult to locate they ask the caller or someone to stand at landmark to direct the way. Finding location is a problem. During case the staff has a difficulty handling the crowd. Some local people refuse to help the staff in carrying patient from staircases where its not possible for only the driver to carry the patient. In some cases overenthusiastic on-lookers without permis-

The firemen used to have parade and fitness exercise earlier which does not continue now a days, resulting in low fitness of firemen. The firemen are not given any Paramedic training.

sion and guidance of the staff will handle the patient and try to put them in ambulance which damages the health of the patient, as they need to be carried in a particular way due to their emergency. The crowd control need to be done by Police but police majority of the times have not reached the site. In an emeregency case, the EMT Ms Bharti provides the basic medical assistance to the patience in the Ambulance. She needs to be in contact with the Call Center Doctor ( ERCP) which gives her instructions about what to give the patient. As she is a trained medical technician and not Doctor she needs to take permission for all major medical assistance to the patient. As there are only 3 ERCP in the call center, call comes on waiting when trying to contact the ERCP. EMT enters all data from patient and medicine given in a PCR sheet which is submitted to 108 office , hospital and police in case of police. In-case the ERCP is not available, or family doctor has come with the patient in the ambulance he can use the ambulance equipments to help the patient.

Mr. Swaroop Das is working in the Fire Department Control Room Danapeeth Fire Station. The control room officer has 8 hrs shift duty. There are 3 lines for fire number 101. The government ambulance call number 102 also has lines in the main control room. When a caller dials 101, the call centre officer answers the call and takes down details of name, phone number, incident, location and number of people injured. Time of the call and details are noted in the register for future reference. Due to lot of prank calls , the officer judges the extend of emergency on the tone of the caller. There are around 10-12 emergency calls per day. Majority of them are for bird rescue.

The ambulance staff takes the patient according to the preference of the hospital the patient or his family members have. Incase of no family member in ambulance, generally in traffic accidents case, the patient is taken to a government hospital. Many times family members waste time in discussing which hospital to be taken.

When an emergency call comes the officer rings the siren and announces the emergency on loud speaker for the residing firemen in the complex. All of them come down running in their uniform and decide on the vehicle and people who are going for rescue. In 10 mins the fire brigade is dispatched. The location was told to the fire brigade driver by the control room officer. In case the driver is not able to find the location, he calls the officer , which calls the caller to confirm the address of incident and again the officer calls and tells the driver where to go. According to the area of incident, the nearest fire station is contacted and the case is reported on common band frequency to the station, the above same process is followed there.

After the ambulance transfers the patient to the hospital. The staff has to finish formalities with hospital about filling form and giving information about the patient and the treatment given while tranporting in ambulance. In case of suicide or traffic accidents, they need to give information to police to finish formalities with them all this takes around 15-20 mins. During this time if a case comes its transferred to the next closest ambulance. Time taken by an ambulance to reach on location is around 7-10 mins in city and 20 mins in rural areas.

Mr. Swaroop Das Gadwe Department: Fire Designation: Control Room Officer Area: Danapeeth Fire Station

The EMT Ms. Bharti is undergone 2 months training in the 108 EMRI center. She is a science graduate. The salary is low as compared to qualification level. The Driver Mr. Liakhat also has same salary as EMT. He drives an auto at night to cope with less salary. Medical Trained staff have higher resigning rate, due to less salary. Ms Bharti is working since 8 months with 108 while Mr. Liakhat works since the beginning of 108 in Ahmedabad. It gives a pleasure for him to work for social cause, which keeps him loyal to 108. The people who used the service are given a call in 48 hr to ask the health of patient also the service received. Any complaint from the people results in action against the staff. 66

Name: Ishwar Bhai Department: Police Designation : constable (writer) Area: Paldi Police Post

Mehboob Bhai works as a driver for Fire Department since his early age. His father was also working with fire. He and his family stays in the accommodation given by the Municipal Corporation. Mehboob bhai had gone to Germany for training. He has giving all his years for the duty of firemen.

The police control room 100 is located in the main shahibuag office. When a caller calls the control room 100 and reports an incident. The information is given to the PCR van on walky-talky which reaches the spot first, gauges the extent of damage and calls for force from the nearest Police station. The maximum cases which Police have are accidents, theft, cheating and fights. Ishwar bhai is a writer take down the case and maintains a record of cases. He cant take an FIR. Then the FIR investigation team works on the case.

According to the statistics, every 1 lakh of population should have 1 fire station, so for ahmedabad population of 55 lakh there should be 55 fire station ideally but there are only 12 fire station in the city. The whole fire station is under staffed and works under only 25% staff. There are only 5 drivers in Jamalpur fire station. This keeps Mehboob Bhai almost always on duty. When on duty and driving a fire brigade to the site, Mehboob Bhai said they suffer a lot from traffic problem. The attitude of people doesnâ&#x20AC;&#x2122;t not help or give way to the fire brigade, thus causing a delay in response time. Even on site a lot of crowd is assembled and police is not on time to control the people causing problems on site.

Name: Narendra singh khokariya Department: Police Designation : Incharge Area: Kankariya lake Name: Ashwin Kumar Keshawa Department: Police Designation : Gunman Area: Kankariya lake

Name: Mehboob Bhai Department: Fire Designation : Driver Area: Jamalpur Fire Station

They have a 24x7 duty. This hampers the personal and social life of firemen. Everytime an emergency is announced specially night time the whole family is disturbed. Firemen have filed a case in labour court for the life of firemen, which is under process.

The PCR van comes direct under Police control room.

PROPOSED SYSTEMS MODEL

SOLUTIONS 74

Generating Solutions After detailed systems model and mapping various opportunity areas, various quick thumbnail solutions were sketched out. They were categorised into

Evaluating solutions

POLICY

IMPLEMENTATION

Solutions aim at policy level change.

PROCESS

Solutions aim to change current process/ practice of an organisation.

PROMOTION

Location Tracking for all emergency calls

Four criteria were used for evaluating solutions

Ease/feasibility of implementing the proposed solution

IMPACT ON SYSTEM Extent to which the solution is able tackle the targeted problem.

Solutions aimed at publicity and better communication.

RESPONSE TIME

PRODUCT

How much ‘reduced’ - the time taken by emergency services in reaching the ‘site’.

Solutions dealing with products and interfaces for specific tasks.

Mandatory CPR Training for every driving license holder

VALUE

Implementation

How enhanced is the user experience for the patient, public and or emergency service personnel.

Response Time

Impact on System

Value

Total score

Implementation Impact on System Response Time Value

Total score

13 77

eCALL - Automatic Vehicle Collision Warning System

Implementation Impact on System Response Time Value

Total score

Shift Duty for Fireman instead for 24/7 on call

Future 108 services - registered users

Implementation Impact on System Response Time Value

Total score

Implementation Impact on System Response Time Value

Ambulance Assistance by Private Hospitals

Total score

Implementation Impact on System Response Time

Total score

Value 79

Advanced Training Programs for Paramedics

Implementation Impact on System Response Time Value

Advanced Training Programs for Firemen

Total score

Implementation Impact on System Response Time

Improved Call Filteration System

Total score

Value

Implementation Impact on System Response Time Value

Use for Other Media for Emergency Calls

Total score

Implementation Impact on System Response Time

Total score

Value 81

Treating lower level emergencies at Home/ On-Spot

Implementation Impact on System Response Time Value

Total score

Transfer Patient Info to Hospital during transport

Implementation Impact on System Response Time

Work Accountability for Firemen - Feedback System

Total score

Value

Implementation Impact on System Response Time Value

Total score

Resource Management - Separate vehicle for Bird Rescue

Implementation Impact on System Response Time

Total score

Value 83

Dedicated Suicide Helpline

Implementation Impact on System Response Time Value

Dedicated Barracks for 108 Personnel at nearest PS/ FS

Total score

Implementation Impact on System Response Time

Total score

Value

Mock Fire Drills and Safety Camps

Implementation Impact on System Response Time Value

Local First Response Fire Volunteers

Total score

Implementation Impact on System Response Time

Total score

Value 85

Local 108 volunteers

Implementation Impact on System Response Time Value

Courtesy and PR Training - Improved Service Experience

Total score

Implementation Impact on System Response Time

Total score

Value

MotorBike Parameds/ Firemen as First Responder Units

Implementation Impact on System Response Time Value

Total score

Hospital Locator Mobile/Tablet App

Implementation Impact on System Response Time

Total score

Value 87

Smart Communication Devices in Ambulance

Implementation Impact on System Response Time Value

Acoustic Life Detector

Total score

Implementation Impact on System Response Time

Building Evacuation Kits

Total score

Value

Implementation Impact on System Response Time Value

Quick Load Trolleys for carrying heavy tools

Total score

Implementation Impact on System Response Time

Total score

Value 89

River Diving Suits

CPR Introduction Workshop @ NID

Echo Sounders

Cardio Pulmonary Resuccitation (CPR) It is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. Since CPR can delay tissue death and extend the brief window of opportunity for a successful resuscitation without permanent brain damage, it becomes an extremely powerful tool for keeping the patint alive till appropriate emergency service arrive on the scene.

Implementation Impact on System Response Time Value

Total score

Implementation Impact on System Response Time

Total score

Hence, dissemination of CPR procedures became one of our primary soultions. The workshop was held with the assistance of GVK EMRI emergency services.

Value 90

Instructors from GVK EMRI explaining the basic human anatomy and need for CPR.

Hands-on demonstration of CPR procedure on a volunteer Ambulance demonstration in BMW.

Promot iona l Ac t iv it ies pr ior to t he Workshop

Emergency First Responders - Medical and Fire Emergency first responders are tactical units that can be deployed to the scene of emergency in case of shortage of regular service vehicles and/or other situations which prevent access, such as traffic jams and narrow access lanes. These units reach the scene in minimum possibile time because of high mobility. They can provide first aid and basic life saving procedures and manage the scene of emergency, such as crowd control. Their design and integratrion with advanced navigation system form the second detailed solution of our study. 96

Improved Call Filteration System

The Concept

Just like filtering the basic impurities in water increases the chance of success for a water filter, call filteration for Emeregency response systems helps make the system more effcient. GVK 108 services recieve 10,000 calls per day. Of these, only 25% are genuine emergencies. An advanced method of filtering calls will reduce strain on the system and enable a response more appropriate to the type of emergency.

100

101

Numbers are assigned to 36 major ailments which can more or less describe any emergency problem

Additional code assigned for urgency of the emergency call.

THE USER INTERFACE For Communication Officers at 108 Call Centre to better judge the nature and urgency of emerency call and send appropriate response.

Alpha

LOW PRIORITY

Bravo

MEDIUM PRIORITY

Charlie

ADVANCE LIFE SUPPORT REQUIRED

Delta

HIGH PRIORITY, ADVANCE LIFE SUPPORT REQUIRED

Echo

MAXIMUM POSSIBLE PRIORITY

102

103

104

105