EMRI model - Indiagovernance.gov.in

Study of Emergency Response Service (EMRI Scheme)lowers the number of cases per ambulance initially and then it starts rising again. If theexpected absolute requirement in a population per one lakh is 22 cases per day, theneven at 70% effectiveness two ambulances are required. (8 cases per day perambulance). We could conclude by saying that though reaching in 20 minutes in urban areas and 40minutes in rural areas is the desirable norm, it is likely that in a large number of areas,for a considerable percentage of trips, this quality of response is as yet unattainable. Ifwe were we to attain universal ERS, we would probably require about two ambulancesper 1 lakh population each doing 8 to 11 trips per day in an area with average populationdensity. With decreasing population densities, progressively more ambulances per lakhpopulation and less number of trips per ambulance with a higher cost per trip would berequired. From this ball park figure we could project future utilisation trends and costs.Today Andhra is reaching 8 trips per ambulance per day with one ambulance per 1.23lakh population at Rs 600 per ambulance trip or Rs 17.5 lakhs per ambulance per yearand for 652 ambulances the current year’s PIP bills Rs 114 crores. If this were toincrease to two ambulances per one lakh population, i.e 1600 ambulances for the stateand 11 trips per day per ambulance and also assume that average cost per trip were tostabilise at a lower Rs 475 per trip (estimate on optimum efficiency) then the costs wouldplateau at about Rs 304 crores - at current rates and without adjusting for the increasedcosts of low population density and high dispersion areas. Thus in Andhra Pradesh theexpenditure is currently about Rs 14 crores per crore of population per year and thiscould plateau at Rs 38 crores expenditure per crore of population per year for theprovision of universal ERS. This matches with EMRI’s internal estimates, which showsthat EMRI in Andhra Pradesh is handling only about one third of all emergencies today.And improved preventive public health action is probably not going to reduce incidencesof emergencies for decline in pregnancies and communicable disease and road trafficaccidents would be offset by increases in non communicable disease emergencies.What about inter-hospital transfers? In all states, transfers between hospitals are notcovered by the MOU. Government owned and operated ambulances were playing thisrole and therefore a parallel fleet of ambulances becomes necessary even where thereis EMRI. There are two views on this. The concern of the government has been thatEMRI or whatever ERS is put in place must take care of inter-hospital transfers too- thussaving the government from a duplicating its expenses. EMRI on the other hand isconcerned that if it agrees to this, a considerable part of its resources would be shifted tothis task - which they estimate at 18% increase over current requirements. This woulddisplace the priority of ERS. Shifting a case from a block to a district hospital wouldmean a longer travel time and therefore for a longer time the ambulance would be busyand unavailable. An even greater concern is that many hospitals would, for a variety ofreasons, decide to pass many patients brought to it either by cherry picking “paying”cases with less complexity, or avoiding the risks of managing more serious andNational Health Systems Resource Centre (NHSRC)23