What is HEMS?
Helicopter Emergency Medical Services (HEMS)
A highly trained team of Critical care and Emergency medical doctors and paramedics who are transported by a helicopter, to land in the vicinity of a critically ill patient to save a life, stabilise and then transport to a major hospital for further treatment. This intervention helps patients get first aid and survive the journey to the medical center.
It is the most advanced form of Pre-Hospital Emergency Medicine and is a critical part of the medical services in developed countries. HEMS is a service that has proved itself as a single most important factor in reducing the rate of preventable deaths in developed countries during roadside accidents and major disasters.
HEMS not only includes years of medical training but also includes a high degree of operational planning and implementation.
HEMS: Need of the hour in India
- Facts and data suggest a person suffering from an acute life-threatening medical emergency has a better chance of survival if it happens in tier 1 cities (with tertiary medical facilities immediately available) compared to a similar event happening anywhere outside cities without immediate tertiary level care.
- 69% of India’s population are rural dwellers and over 20% live outside of tier 1 cities which means close to 90% of the population do not have access to the medical facilities that the population in some of the tier 1 cities have access to.
- A road traffic accident causing life-threatening injuries to a victim has a better chance of survival if the primary transport (accident site to an appropriate trauma centre) happens within half an hour of injury. This can only be possible if the accident occurs in cities with level 1 trauma centres. This may not be the case if the accident occurs on roads with more than an hour journey from the trauma centre.
- India is prone to natural disasters and floods.
- It is an established fact, in India, that the chances of survival of a person going through an emergency, is primarily dependent on its geolocation, keeping all the other factors constant. That means, time from insult to definitive treatment as a single most important factor, which contributes to a majority of the “preventable deaths” happening in our country which is extremely high if not the highest in the world.
Taking into consideration these facts, the best and only choice for the Government of India is to deploy HEMS. This could be used to save the lives of victims at accident sites or victims of major disasters.
These Helicopters are nothing less than flying ICU units. The Medical staff and the infrastructure onboard have the capability to conduct procedures that are done in super speciality hospitals. By starting treatment within the “Golden Hour”, the victim has a much higher chance of survival.
HEMS crew members (Emergency Doctors and Paramedics across India) are currently getting trained. This batch of medical commandos will lead India in its objective to save lives and provide for a better quality of life to its citizens.
How the initiative is going to benefit the people at large?
In India, 1 person dies on our road every 3 minutes. We have one of the worst road traffic-related death figures in the world. This is not because our hospitals or our doctors are inferior. It is because the Trauma centres and tertiary care hospitals are concentrated in cities. People suffering from non-traumatic medical emergencies also face the same problem. Majority of the population of India live in rural and semi-urban areas not having direct or immediate access to tertiary centres.
During a life-threatening medical emergency, whether brought about by Road accident or a sudden deterioration of a medical condition, the victim is taken to the nearest hospital first. Upon realizing that the condition is beyond the capability of this hospital, the victim is subjected to another journey to the appropriate tertiary centre. Most of the deaths happen in either of these 2 journeys or in the first receiving hospital.
HEMS cuts through this practice in a big way. By transporting skilled Intensive care/Emergency doctors by helicopter, not only provides immediate access to advanced ICU (within the helicopter) but also rapid access to the most appropriate tertiary care hospitals. This has a proven benefit in saving lives of people dying of preventable deaths.
During major disasters like train accidents and natural disasters, where access by road of the state’s health machinery would be impossible, HEMS plays the most crucial role in setting up triage and temporary treatment centres and transporting multiple personnel and equipment in an effective and time critical manner.
The cost of such a service for the entire state to run non-stop for 4 years would be less than the government expenditure in establishing one district general hospital. This initiative is guaranteed to reduce the preventable death-rate by more than 30% if implemented to its optimal capacity.
ICATT is a highly specialized Air Ambulance service founded by Dr Shalini Nalwad and Dr Rahul. Both these doctors are UK trained Intensive care consultants, who have super specialized in Aeromedical services with substantial experience in this field in the UK. They have relocated back to India with the sole purpose of establishing the HEMS – Helicopter Emergency Medical Service. This service does not exist in India, as of now, but has a proven benefit in saving lives in the countries where it is operational. HEMS basically means, transporting a highly trained Doctor and paramedic in a helicopter to a place in the vicinity of a critically unwell patient who needs advanced ICU care immediately. Without this intervention, this patient would not survive for more than an hour nor would he survive the journey to the appropriate medical centre. ICATT proved this concept during the recent floods in Kerala where they positioned their helicopter along with medical teams in the most severely affected part of Kerala and saved multiple lives by airlifting critical patients from relief camps.
Who would be the target audience of this service?
This service will benefit the population using the National and State highways. A road accident on the National Highways, as per their protocol, takes the victims by the National Highway ambulance to the nearest Hospital in the catchment area. Most of the preventable deaths happen due to Head injury, Chest injury or massive bleeding. The catchment area hospitals do not have the capability to intervene effectively in any of these insults. A secondary journey is embarked upon losing valuable life-saving minutes and hours in these transits without reaching definitive care. HEMS would be most beneficial to the road users on National and State highways. For this, the target decision makers would be the Ministry of Road Transport and Highways (MORTH) governing over NHAI.
The rural and semi-urban population living in districts, away from tertiary care centres in the cities, succumb to medical illnesses which the city dwellers survive only because they receive the life-saving treatment in time. This is definitely a political issue and establishment of a service like HEMS for these target population and saving preventable deaths, boosts up the morale of the people at large and the ruling government gains political mileage. Therefore, the target would be the Chief Ministers and the Heath ministries of the States.
How cost effective it’s going to be?
This service is for emergencies. It would be practically impossible and ethically wrong, to ensure payment for the service before deploying it. None of the Medical insurance products covers it at this stage. Therefore, the complete cost of setting the service up and delivering it would have to be covered by the State. As mentioned earlier, the cost of such a service for the entire state to run non stop, for 4 years would be less than the government expenditure in establishing one district general hospital.