EMRI model - Indiagovernance.gov.in

Study of Emergency Response Service (EMRI Scheme)potentially fatal cases. This refusal to inter-hospital transfers is in EMRIs view useful toforce the clinic to take ownership and start stabilisation and care.The Public Sector Ambulance; Given the issues raised by EMRI and also the large gapbetween the desired number of ambulances and the numbers we are in a position todeploy, there is case for retaining the public facility’s ambulance in the block level CHCand even introducing it in the sector level PHC - where the IPHS has mandated it.Provided with the same call system and linked to the EMRI call center it could act as aback up in cases where the EMRI ambulance is too busy, as also be available indisasters. It could also help in reducing response and travel time in distant dispersedlocations. One current complaint is that the facility ambulance is too often used fortransporting doctors, for VIP roles and for movement of stores. Instead of seeing theselegitimate uses as problems, the public sector facility ambulance could be appropriatelydesigned to play a multi-purpose function and act as a backup ERS. But for this it needsto be incorporated in the communication links and in the training and HR developmentprocess.What about care at the hospital? This is one of the weakest links of the chain. There aretwo issues here, availability of quality care and the cashless nature of service. Thechoice of hospital to which a patient is transferred assumes great significance. Presentlythe choice is based on proximity of the hospital from the site where the patient is pickedupby the ambulance and within this range the choice as expressed by the patient orattendant. Only those hospitals that are listed/contracted with EMRI and are posted ontheir GIS software are considered. But there is also a need to have matching investmentin strengthening the quality of emergency medical services (as different from emergencyresponse services) at the hospital. Public investment in this crucial aspect is howevernot as visible as is the investment made in 108 services, and there is a need to ensure averifiable strengthening of the emergency care aspect too. We know that both Andhraand Rajasthan are struggling to achieve their minimum goals of emergency obstetriccare providers. If 20% to 40% are trauma cases, what is the quality of trauma careavailable? Are there enough orthopaedicians available? Are the priorities so skewed thatwe would continue to increase investment in transporting patients to hospitals while notincreasing investment in the provision of care in the hospital? Or do we see this as anopportunity, where the increased pressure on the public health facility due to ERS,forces the state to spend more on care at the health facility level. Could EMRI be askedto play a bigger part in gearing up emergency management in the public health facility,especially in some areas like in trauma care.Equity Issues in Utilisation - Cashless service: One of the key features that ensuresutilization is the cashless nature of service. Irrespective of economic status of the userthere are no user-fees. Though there is a lot of discomfort with this, there are alsopowerful reasons to support it. Firstly, user-fees have been found to be exclusionary,especially for the poor and marginalized. Secondly, targeted systems seldom reach theNational Health Systems Resource Centre (NHSRC)24