Weak emergency care at peripheries, lives at risk

Lack of trained manpower and other weak links in the delivery of emergency and critical care services in the peripheral hospitals of Kashmir are claiming lives of those patients who stand a chance of getting saved with prompt medical expertise.

A critical care ambulance flanks each district hospital in J&K, and many sub-district hospitals for the past one year. These ambulances are meant to sustain the life of a patient while they are being shifted from a peripheral hospital to an advanced treatment center. However, despite this multi-crore investment in healthcare, the masses that live far from the tertiary care hospitals in J&K are still bereft of the emergency medical care. The ambulances and the hospitals, healthcare experts believe, are not equipped with trained manpower that knows the skills of life support. Dr Shabir Iqbal, who heads the Burn Unit at GMC Srinagar, expressed resentment with the lack of life support training in the curriculum of the medical graduates.

“We need to equip our doctors, at the junior-most level, to do CPR, to intubate, to run life support equipment, to provide DC shock,” he said. “These skills were grossly inadequate in doctors at all levels, across hospitals.” Dr Iqbal said a fellowship in emergency and critical care had been planned in GMC Srinagar a long time ago.

“It is yet to take off though,” he said. Dr Iqbal feels that a doctor who knows how to save a life “will try to save a life”.

“What will they do if they don’t know what to do,” he said. However, many doctors have felt the need to improve the availability of life support equipment “from needle to monitors” across the far-flung and difficult areas.

Senior critical care expert, Dr Showkat Shah said, “First referral units in every area need to have Basic Life Support equipment and supplies.”

Financial Commissioner Health and Medical Education, Atal Dulloo acknowledged the need to strengthen the skill set of doctors and other staff regarding emergency and critical care. “We need to train human resources to do CPR and have basic life saving skills – our doctors, nurses, technicians everyone,” he said.

Dulloo said the government was working on a plan to train more manpower and depute them at every health center and hospital and also for critical care ambulances. “Without a trained person, a critical care ambulance won’t mean much,” he said.

Dulloo said strengthening of ICUs in peripheries with monitors, defibrillators and ABG machines was underway. He said that the need was also to keep the life support system, oxygen and advanced equipment available in the peripheries. “A robust ambulance system – strengthened with trained resources who can handle MI, and then equipment and supplies at peripheral levels could help save lives,” he said.