EMRI model - Indiagovernance.gov.in

Study of Emergency Response Service (EMRI Scheme)every rural call within 40 minutes is being achieved. Detailed discussion shows a muchmore varied picture. What is worth noting is that there is an objective, documented andverifiable system in place for measuring the time taken from the moment of receiving thecall, to the moment of reaching the patient, and the time taken to deliver the patient tothe facility. This system is well monitored and supervised. And this information is actedupon regularly to improve performance through a system of detailed analytic reviews. Onrequest, EMRI provided us with figures that showed the range of time taken, as also thecases where there was considerable delay. A common reason for delays was that theambulance was busy attending another. Once the ambulance reaches an average of 8to 10 trips per day, delays become almost invariable - necessitating the addition ofanother ambulance in the same area. We note that Andhra Pradesh wasreported/perceived to have achieved 100% coverage with 502 ambulances, and then afurther 150 ambulances were added and justified as necessary to take it to full coverageand now a further 455 ambulances are proposed- again for reaching 100% coverage. Amore detailed and nuanced understanding after a discussion of this aspect with EMRIshows that at 502 ambulances the coverage was about 85%, rising to 94% with 150more ambulances and to 99% - a 4% increase in coverage with an addition of 455ambulances. Not only does this show that the last mile in terms of geographic coveragerequires a disproportionately high increase of ambulances, but also that in areas alreadycovered density of ambulances would also have to rise with increased utilisation- so asto guarantee quality- in terms of promptness.e. Hospital linkages: One of the key functions that EMRI performs is to recruit privatehospitals who would participate in the ERS and this would imply cashless service for thefirst 24-hours till the patient is stabilized. For this purpose EMRI has met with largenumbers of private hospitals and signed MOUs with them. These MOUs play a limitedrole now - merely to formalise an understanding that the hospital would not refuseadmission if a patient is brought to it. But there is no process of accreditation orcertification and even information about the variety of services available is limited. Wedo know that the percentage of referrals to private sector is 35% in Andhra Pradesh.Rajasthan, being in their 1 st year of operations, is still almost fully dependent ongovernment hospitals and private hospitals are in the process of being engaged byEMRI Rajasthan. EMRI states that the choice of hospital to be taken to, lies only with thepatient. In case the patient is unconscious or not able to exercise choice, then the choiceis assumed to be the nearest public hospital. There is an EMRI plan to gather moredetails of services available in each hospital, but it is not fully functional. There areinstances of private hospitals, even those with MOUs, refusing admission, but these areexceptions and are reported as “usually resolved by interactions”. There is however norecord or track of quality of care on arrival and on refusals to care. Clearly it is not theEMRIs responsibility, if it turns out that the services are not available and the patient hasto be transferred to another facility. What are the numbers that need to move out againNational Health Systems Resource Centre (NHSRC)20