Hospitals are backbone of disaster management system of any country.The success of a disaster management effort is determined by the final count of dead and disabled victims.The number of dead and disabled victimes is solely decided by hospital system and the level of medical care provided by it.
Physician-led EMS is also known as the Franco-German model, “stay and play”, “stay and stabilize” or “delay and treat”. In a physician-led system, doctors respond directly to all major emergencies requiring more than simple first aid.
In fact,it can also be called hospital led system.In this system,hospital is involved right from movement of ambulance along with the physician to the incident site.
The physicians will attempt to treat casualties at the scene and will only transport them to hospital if it is deemed necessary. If patients are transported to hospital, they are more likely to go straight to a ward rather than to an emergency department. Countries that use this model include France, Belgium, Luxembourg, Italy, Spain, Brazil and Chile.
In some cases in this model, such as France, paramedics, as they exist in the Anglo-American model, are not used, although the term ‘paramedic’ is sometimes used generically, and those with that designation have training that is similar to a U.S. EMT-B.
Physicians and (in some cases) nurses provide all medical interventions for the patient. Other ambulance personnel are not non-medically trained and only provide driving and heavy lifting. In other applications of this model, as in Germany, a paramedic equivalent does exist, but is an assistant to the physician with a restricted scope of practice. They are only permitted to perform Advanced Life Support (ALS) procedures if authorized by the physician, or in cases of immediate life-threatening conditions.
Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing the emergency department to the patient. High-speed transport to hospitals is considered, in most cases, to be unnecessarily unsafe, and the preference is to remain and provide definitive care to the patient until they are medically stable, and then accomplish transport. In this model, the physician and nurse may actually staff an ambulance along with a driver, or may staff a rapid response vehicle instead of an ambulance, providing medical support to multiple ambulances.
Major iniative by hospitals to handle big trauma
The essential decision in pre-hospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The “scoop and run” approach is exemplified by the MEDEVAC aero-medical evacuation helicopter, whereas the “stay and play” is exemplified by the French and Belgian SMUR emergency mobile resuscitation unit or the German “Notarzt”-System (pre-clinical emergency physician).
The use of helicopters was pioneered in the Korean war, when time to reach a medical facility was reduced from 8 hours to 3 hours in World War II, and again to 2 hours by the Vietnam war.
Golden Hour theory
The strategy developed for pre-hospital trauma care in North America is based on the Golden Hour theory, i.e., that a trauma victim’s best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This appears to be true in cases of internal bleeding, especially penetrating trauma such as gunshot or stab wounds.
Thus, minimal time is spent providing pre-hospital care (spine immobilization; “ABCs”, i.e. ensure airway, breathing and circulation; external bleeding control; endo-tracheal intubation) and the victim is transported as fast as possible to a trauma centre.
The aim in “Scoop and Run” treatment is generally to transport the patient within ten minutes of arrival, hence the birth of the phrase, “the platinum ten minutes” (in addition to the “golden hour”), now commonly used in EMT training programs.
The “Scoop and Run” is a method developed to deal with trauma, rather than strictly medical situations (e.g. cardiac or respiratory emergencies), however, this may be changing. Increasingly, research into the management of S-T segment elevation myocardial infarctions (STEMI) occurring outside of the hospital, or even inside community hospitals without their own PCI labs, suggests that time to treatment is a clinically significant factor in heart attacks, and that trauma patients may not be the only patients for whom ‘load and go’ is clinically appropriate.
In such conditions, the gold standard is the door to balloon time.
The longer the time interval, the greater the damage to the myocardium, and the poorer the long-term prognosis for the patient.Current research in Canada has suggested that door to balloon times are significantly lower when appropriate patients are identified by paramedics in the field, instead of the emergency room, and then transported directly to a waiting PCI lab.
The STEMI program has reduced STEMI deaths in the Ottawa region by 50 per cent.In a related program in Toronto, EMS has begun to use a procedure of ‘rescuing’ STEMI patients from the Emergency Rooms of hospitals without PCI labs, and transporting them, on an emergency basis, to waiting PCI labs in other hospitals.
Role of hospitals in disaster Management in India
Most of the government hospitals especially district hospitals are prepared and designated for providing medical care during disasters.India have wide network of medical collages,both private and government operated,which are fully equipped for providing emergency medical care during disasters.NDMA has also awarded some projects to hospital to prepare them for handling mass victims during disasters.
Medical Preparedness and Mass Casualty Management
India has suffered a number of natural and man-made disasters, which have led a large number of casualties. Medical Preparedness and Mass Casualty Management is one of the essential component of the disaster management.
NDMA has taken concerted steps to enhance preparedness in this important domain in partnership with the Ministry of health and Family Welfare and State Governments. Some projects like improving Ambulance Services in the State, up-gradation of Bio Safety Laboratories and creation of Trauma Centers are in the offing. To create awareness amongst stakeholders, mock exercise have also been conducted in Hospitals Prepares and Mass Casualty Management. These aspects have been comprehensively covered in the guidelines issued by NDMA on the subject.
Pilot Project on Advanced Trauma Life Support Project at JPNATC.
NDMA in collaboration with Jai Prakash Narain Apex Trauma Centre (JPNATC) has undertaken a Pilot Project on Advanced Trauma Life Support Project at JPNATC. The project was designed to develop human resources to provide effective trauma care initially in the vulnerable and disaster prone states such as Assam, Bihar and Andhra Pradesh and to develop dedicated and well trained doctors, nurses and paramedics for trauma life support in order to meet the challenges of disaster situations. The Institute has submitted the draft report of the project indicating a total of 129 participants attended and completed training on Advanced Trauma Life Support. Besides 131 participants attended and completed the Rural Trauma Team Development Course. 53 Nurses have also successfully completed Advanced Trauma Care for Nurses course.