Tele Emergency Services in the Himalayas: Operational Challenges
Dhavapalani A, Baskar D, Ganapathy K, Arunabh Sarma, Saroj Thakur, Premanand S, Lovakanth N
*Apollo Main Hospital, Chennai & **Apollo Tele Health Services
Himachal Pradesh Tele Health Services Programme, is an initiative to provide access to quality health care services to local communities in Kaza and Keylong. The terrain and topography of both the locations coupled with health seeking behavior of the local population, lead to several emergency situations, for which services are not available at the local hospital. Tele-Emergency services has been an important component of this programme, providing emergency services, for which people would have to travel around 250 kms.
A complete emergency set up including 12 lead ECG, Spirometer, Defibrillator, medications and a console for tele-consultation, have been installed at both the locations. Patients in emergency situations are stabilized by connecting to Emergency physicians located at Apollo Hospitals, Chennai, through a tele-conferencing software, by trained coordinators. A local doctor available at the center manages the patient based on the advice of Emergency Physician and provide medications as per his suggestions.
A total of 284 tele-emergency consultations have been done till July 2016, out of which 96 cases were females and 188 cases were males. Notable consultations include, stabilization of seven cases of Myocardial Infarction (MI), which include a case of Streptokinase administration. 2 cases were stabilized by administering Cardioversion, through tele-mentoring by the Emergency Physician.Patients are being followed up, to know the improvement in their condition. Voice Of Customeranalysis showed the overall satisfaction with the services ranging between 9-10.
Findings & Conclusions:
A major challenge other than connectivity and power issues, is utilization of Tele-Emergency services by even non-emergency cases which was considerably low (43/284). The health seeking behavior of the local population was also a big challenge, because some of the patients referred to higher center denied the service.