Media Release
Mangaluru, Oct 30: “Dr Niraj met with a road traffic accident and profusely bled. His wife, a nurse who also sustained a few injuries took him to the nearest primary health center for immediate care. The doctor at the primary health care receiving them was stressed. The resource limited setting and the fact that he had to treat his professional colleagues, compounded his stress. The treating physician struggled to rapidly assess the situation, was unsure of the intravenous access but decided to shift the patient to a higher center. Predictably, the patient did not reach the higher center."
In a similar emergency, a house surgeon, from BMCRI, had gone to 'Doodh Sagar' falls, Goa. As they trekked along the railway track with a large crowd of visitors, a goods train came along and in the commotion a girl’s leg got caught under a train. The house surgeon having recently completed the JeevaRaksha Emergency Care and Life Support (ECLS) course, went to the police and introduced himself and informed them that he could help the patient. The girl was conscious which gave him hope that he could save her life. The girl’s left leg was totally crushed below the knee and bled badly. He used a plastic bag as a tourniquet and stopped the bleeding. He also called for an ambulance and alerted the trauma centre doctor. They took her to the next train station where an ambulance waited. On getting the girl into the ambulance, he put an oxygen mask and secured an IV line and started maintenance dose of IV fluids. They replaced the plastic bag with a proper tourniquet and sent her to a hospital in Panjim, Goa.
In another emergency, a nursing college professor saved the life of her toddler who had choked himself on toffee. Though she panicked initially not knowing what to do, it occurred to her, she had learnt life saving techniques in Basic Care and Life Support course. One of the skills was about saving babies from choking, she used that technique and saved her toddler.
All these above emergency incidents are real and happen in our everyday lives. The question remains, how many are lucky enough to be saved? A data from 2019 shows that there was a 6% increase in deaths from emergency conditions worldwide. Overall, the rate of deaths from medical emergencies was more than four to five times higher in poor countries than in rich ones. Junaid Razzak, director of the Johns Hopkins Centre for Global Emergency Medicine, in Baltimore, has analysed data from 1990 to 2015 on 30 types of emergency medical conditions in 195 countries. An emergency condition was defined as one requiring treatment within minutes to hours to reduce the chance of disability and death and improve outcomes.
Back here In India, in October 2018, Times of India reported on ‘Lives being lost every year due to lack of emergency care in India’. The doctors spoke about this at a press conference on ‘Emergency care and Intensive Care.’ They opinioned the people are still unaware of ‘the golden hour’ for the treatment of accidents, heart attacks, cardiac arrest, burns, stroke. They strongly felt, everyone should be taught the procedure of Basic Life Support.
Health care in developing countries including India has traditionally had limited focus on emergency medical care. Common medical emergencies like cardiovascular, respiratory, trauma, obstetric and poisoning account for more than 50% of the deaths in the country. Road traffic accident is the third commonest cause among deaths due to non-communicable diseases. There has been a 32% increase in road traffic accidents in India since 2007. Approximately 17 people die every hour due to road traffic accidents. Compounding this is the fact that most of the emergencies and unintentional injuries occur far from the tertiary hospital and closer to communities. Approximately 50% of road accident deaths could have been prevented if 'golden hour' assistance was available.
Emergency medical care has three components:
1. Care in the community
2. Transportation from site of injury/emergency to the health facility
3. Care on arrival at the receiving health facility
Research studies indicate that inadequate provision of pre-hospital emergency care, poor triage system for incoming patients, and inappropriate transport, jeopardized the lives of these patients. Presently, very few in the citizenry are trained to be first responders. Even medical students and post-graduates in training are taught to focus on making the right diagnosis and less on principles of triage and emergency management.
To address this gap, in June 2014, JeevaRaksha programme was initiated collaboratively by Karnataka State Health University - Rajiv Gandhi University of Health Sciences (RGUHS), and Swami Vivekananda Youth Movement, Mysuru in technical collaboration with University of Utah, USA. The team conducted needs assessment among primary healthcare centers and other providers (including private sector) who are the first point of contact in the health care system in medical and trauma emergencies. This stressed on the need of the curricula to be broad based and address all common emergencies that they encounter, namely, Cardiac, Respiratory, Obstetric, Paediatric including Neonates, Trauma, Burns, Poisoning including animal and insect bites.
JeevaRaksha course focuses on recognizing and managing critical illnesses that are common in the Indian setting as mentioned above. This is not only India’s first Comprehensive Emergency Care and Life Support (C-ECLS) training of four days course for medical doctors (for both primary practitioners and specialists), but also the FIRST university recognizing Emergency Care Skills Certificate programme in the World.
The programme was formally inaugurated on June 23, 2014 by the then Governor of Karnataka, Dr Hansraj Bhardwaj and was attended by Dr Vedprakash Mishra, the then chairman of the Academic Committee of Medical Council of India.
The university has also mandated that the one-day Basic Care Life Support Course (BCLS) for all including AYUSH practitioners, Physiotherapists, Allied sciences etc candidates to successfully complete the course are certified by the university and only then they are given their graduation certificate. The RGUHS JeevaRaksha ECLS and BCLS certificates are valid for five years (extendable by a refresher course).
Keeping up with the current pandemic, RGUHS and JeevaRaksha have also initiated a COVID Crash Course (in-class and online) to facilitate all doctors, interns, PGs and nurses in effectively managing COVID patients.
There was high demand from nursing students and faculty alike, to provide a nursing-specific course along the lines of ECLS to deal with the challenges nurses face while caring for patients attending with emergencies. The vice-chancellor, Dr S Sacchidanand on December 20, 2019, directed to create a course catering to emergency nursing components to improve the mortality and morbidity among acute medical-surgical and trauma patients attending Emergency departments across the state. The RGUHS-JeevaRaksha Team along with nurses from academic, clinical, administrative and primary care background have devised a course curriculum which has been submitted to the Government of India for nationwide uptake.
RGUHS has made this three-day course in Emergency Nursing and Life Support (ENLS) mandatory for all the BSc Nursing final year students from 2021. The degree certificate will be issued only after the successful completion of this programme.
To take this forward, JeevaRaksha is conducting its first faculty training programme at Father Mullers Medical College, Mangaluru, from November 3 – 6. The director of Father Muller Medical College has been very encouraging and supportive to conduct the first (ENLS) course at his college. Similarly, the chancellor of Yenepoya Institutions too has keenly taken up the ENLS faculty training course at his campus from November 9 - 12. Both these institutions in Mangaluru will partner with RGUHS-JeevaRaksha in pioneering Emergency Care Training for nurses in India which marks a new chapter in improving Emergency Nursing Care across the nation.