Trauma care comes to Mumbai

By Harsh Kabra in Mumbai

The streets of Mumbai have long needed emergency care services

Despite its alarmingly high road-accident rate, the Indian city of Mumbai (Bombay) has until now had no emergency medical service to treat victims in the vital first hour.

In India overall, medical assistance eludes 80% of victims in the so-called "golden hour" of trauma treatment.

Many have to wait for a good Samaritan or are bundled into available transport, aggravating their injuries.

Now 10 non-resident Indian trauma specialists working in the United States are seeing their proposal for a new service in Mumbai come to fruition.

In the US, trauma victims have an easy-to-remember emergency number. Within minutes, paramedics arrive in advanced life-support ambulances and provide on-the-spot treatment.

At an alerted hospital, a surgeon is ready in a special operating room. In fewer than 30 minutes, the injured are in safe hands.

More than one-third of those who would otherwise have died are saved by the system.

Brainchild

India is a huge contrast. Someone dies on the roads every six minutes with another 10 injured.

According to the India Injury Report 2005, road traffic injuries caused losses of 550bn rupees ($12.5bn), or 3% of GDP.

India has 1% of the world's vehicles, but 6% of vehicular deaths Navin Shah

Currently the ninth leading cause of deaths in India, trauma will take third spot by 2020, warns the World Health Organisation's World Health Report.

A trauma service has certainly long been needed in Mumbai, with its 591 vehicles per kilometre and up to 15 deaths a day in as many as 35 accidents.

And trauma care does not stop at road accidents - as the recent floods and building collapses testify.

The proposal for Mumbai is the brainchild of Maryland-based urologist, Navin Shah, and Los Angeles-based trauma specialist, S Balasubramaniam.

It involves an emergency telephone number, eight fully manned and equipped ambulances, dedicated facilities and round-the-clock staff at the city's eight major and four medical school hospitals.

Three years after the specialists' initial proposal, Maharashtra Chief Minister Vilasrao Deshmukh signalled his backing on a recent US visit.

"We wanted to begin with Mumbai because it has the money and the required hospitals," says Dr Shah.

"India has 1% of the world's vehicles, but 6% of vehicular deaths."

Free help

It is estimated the Mumbai plan will initially cost 130m rupees (nearly $3m) and then 40m annually.

GS Gill, principal secretary of the Maharashtra government's medical education and drugs department, says: "That is not an impossible amount for Mumbai."

Trauma will become India's third biggest killer by 2020, says WHO

Keen on establishing a chain of such centres, India's federal health minister, Anbumani Ramadoss, is reported to have assured Maharashtra of funding assistance.

Mr Gill's department has prepared an internal status paper and is bringing all concerned agencies on to one platform.

The entire process, Mr Gill says, will take around three to four months.

The US-based experts will help establish the facilities, central command and communication centre and train paramedics and surgeons, all for free.

Each of the specialists will spend two to four weeks in Mumbai and return every year to upgrade the facilities.

It is hoped the Mumbai model will become a pathfinder for other Indian cities.

Although under Supreme Court laws Indian hospitals can no longer turn away accident victims, efficient care and formal emergency training are non-existent.

Public hospitals are woefully short of resources and equipment.

Dr Shah and Dr Balasubramaniam are confident they can enlist more non-resident Indian specialists to help expand the model.

"The best way to enhance medical education and patient care in India is to involve the 30-odd alumni groups of Indian medical colleges, 40,000 practising physicians, 15,000 doctors in training and 10,000 medical students of Indian origin in the US," says Dr Shah.