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Emergency! Emerge unscathed

Emergency! Emerge unscathed

india Updated: Jun 10, 2006 03:29 IST

"Would you take someone from your family to a government hospital in an emergency?" asked Sudhanshu Mittal, when asked why Rahul Mahajan was taken to Apollo when hospitals such as AIIMS and Safdarjang were much closer to the scene of overdosing.

Medical experts say that in the Mahajan case, going to a hospital that was closer would have been a better idea.

"Even if you don't consider the fact that Bibek Maitra died in the car on the long journey to the hospital, I would suggest rushing to the nearest hospital because the sooner you get treated, the better are your chances of survival," says Dr J.N. Pande, internal medicine expert and former head of medicine, All India Institute of Medical Sciences (AIIMS).

"Even though government hospitals are often overcrowded and overburdened, they would have still managed to deal with the emergency very well," he adds.

The AIIMS casualty is certainly equipped, considering 500 patients are treated there every day. "We treated 1.5 million critically ill people in casualty last year. The casualty has 20 doctors working at any given time including four superspecialists in medicine, surgery, orthopaedics and paediatrics, 140 beds and AIIMS faculty superspecialists on call 24 hours a day," says medical superintendent Dr D.K. Sarma, AIIMS.

The 'golden hour' concept — the period in which a patient needs to get medical treatment for best survival outcomes — that was initially associated with treating accident victims, is increasingly being used to stress the need for urgency in treating all medical emergencies, be it heart attack, stroke or drug overdosing.

While most people know how important it is to get treatment in time, they almost always do everything they shouldn't when faced with a medical emergency. Most first call their family physician for advice, and then their friends and relatives for some more advice. Next on the calling list is an ambulance from the nearest nursing home, which, in a city of 1,600 unrecognised nursing homes, is usually not be equipped to handle the emergency.

Instead of doing one or all of the above, the best thing you can do for a patient is bundle him in a car or cab and rush him or her to the closest specialty or multi-specialty hospital as fast as you can.

"The safest position for patients to travel is lying down on their side because this prevents them from choking on vomit or even tongue," says Dr B.K. Rao, chairman of Ganga Ram Hospital and head of Critical Care and Emergency, where 100-150 patients are treated every day.

Experts say that whenever possible, one should rush the patient directly to a big hospital. While all nursing homes need to have a functional emergency to give free first-aid, few are equipped to deal with medical complications.

"Most of the Capital's nursing homes are equipped to just handle deliveries and abortions and have no one trained to handle critical care," says Dr Asif Ali, director, medical services, Fortis Hospital Noida, which handles some 50 cases in its emergency/casualty each day.

"If a person collapses at home, it’s sometimes impossible for the family to figure out what is wrong. In such a case, big hospitals work because they are more likely to have all essential life-support systems and even doctors and nurses trained in critical care," says Dr R.R. Kasliwal, director, cardiology and outreach programmes, Escorts Heart Institute and Research Centre. At Escorts, for example, the ambulances are staffed with trained doctors and nurse who start the treatment on the way to the hospital. "If it's a critical case, they even call the cathlab and ask them to get ready for an angioplasty, so that procedure begins as soon as the patient is wheeled in," says Kasliwal.

Nursing homes and small hospitals should be an option only if you know they are equipped to handle critical cases. "If you don't know how good a neighbourhood nursing home is, don't waste time going there at all," says Kasliwal.

Unfortunately, that's just the thing most people do. Ambulances at hospitals such as Escorts Heart Institute, Apollo and Fortis pick up most patients from nursing homes and hospitals, which have tried and failed to treat the patient. At AIIMS, the situation is better with 30 per cent of the patients in casualty coming from other hospitals and clinics, 10 per cent are accident victims brought in by the police and 60 per cent are people who come from home directly.

Where to go needs to be planned well in advance (see box). "The best time to plan and identify a well-equipped hospital or large nursing home close to your home is when people are well," says Dr Pande.

Look for hospitals with a large patient turnover and support services such as diagnostic imaging capabilities, surgical expertise etc. People with an existing medical problem or family history of a disease should identify a specialty hospital. For example, if you have a history of heart disease or have had a cardiac episode, choose a hospital that offers comprehensive cardiac services — from bypass to rehabilitative therapy — all under one roof.

The care with which you choose a quality healthcare centre can make or break your health. Begin scouting around now, as you can never know when you'll have a first-hand experience of an emergency room.