How fast bikes and small planes are changing India's healthcare landscape

If you're rich and ailing, you can be flown to a hospital in an air ambulance; other critical patients can have bikes reach them in 17 minutes flat to address their health situations

Emergency health services in a country like India, with its teaming population and traffic woes, are maturing at a rapid pace. Timely medical attention to the patient critical and most large hospitals have their own ambulance services. One such is Apollo Hospitals, which has renamed its casualty and road accident services as emergency services. "In time, every city will have its own command centre and if you call 1066, it will direct you to the command centre in Delhi, Mumbai and Chennai or any other city from where the call comes,“ says Dr Hariprasad, President, Apollo  Hospitals. 

The first responder bike is dispatched to take the patient's vitals, followed by the ambulance, which actually transports him to the hospital. Apollo's ambulance services are mostly for treatment at its chain of hospitals. However, if a patient wants to go to another hospital, he will be charged. 

GVK-EMRI, on the other hand, is the largest single-service provider operating under the public private partnership model, in which the patient is first offered a transfer to a government hospital. But if the government hospital isn't equipped to provide the necessary care, the patient will be moved to another hospital of his choice. 

Here are examples of some other services that are making their mark in the Indian healthcare horizon.

Flying Doctors: The air ambulance

If you were in a small and remote town looking to move a critical patient to a hospital in a large metro, and if you could shell out anything between Rs 300,000 to Rs 500,000, you could use and air ambulance. Flying Doctors India, a company promoted by Medanta, offers ambulance services to airlift patients from the remotest part of the country and reach them to any superspecialty hospital across the country. It has carried over 3,000 patients from as many as 150 locations to destinations both within and outside India. There is a group of private operators who lease smaller planes to be used in case a call comes for an air ambulance. A number of such operators also have tieups both, with hospitals and with doctors who are willing to take a flight to ferry the ailing. 

A little known fact is that India has small, functional, but largely unused airstrips at a distance every 100 kilometers, set up by erstwhile maharajas of small kingdoms, or by the British during World War II. Most of these airstrips fall under the jurisdiction of the district magistrate, while some come under the purview of the Defence Services. The air ambulance uses the nearest available airstrip to pick up the patient. 

Apollo has a helipad on the roofs of its hospitals in Chennai and Hyderabad, for patients to land on. While the group does not own any aircraft, and leases them whenever any of its hospitals receives a call, it has a medical team that is always ready to fly down to attend to the patient and ferry him to the hospital. 

Delhi does not have Helipads on the roof as yet. Patients fly to the airport in the air ambulance and have to use the road for rest of the way. Apollo has a helipad on its roof in Hyderabad and Chennai only. Once the flying doctors receive a call and confirm, they depute a team to the airport with an emergency medicine kit. ”We have seven emergency kits and a team ready for take off within 15 minutes,” says Dr Sunil Dubey, Head Medical Services, Flying Doctors India, and deputy GM Emergency operations, Emergency and Trauma Care. The flight however only takes off once the payment has been made. “Air ambulance airlifts are extremely expensive and we cannot go merely on a phone confirmation,” says Dubey. However, the choice of
hospital is left to the patient. The location is identified, the patient's family gets the necessary permission from the district
magistrate, who allows landing at the airfield and clears it of grazing animals or kids playing cricket. An ambulance, a fire
brigade and a policeman are required to be present. The administration charges between Rs 2,000 to Rs 20,000 for these services. 

Dubey of Flying Doctors India says the planes fly at height of 2,700-3,200 feet. “These airstrips are perfect for small planes,
which are usually 89 seaters, though we do two rounds of the field before actually landing,” he adds. 

The decision to airlift the patient is also based on his ability to undertake the journey. “It is only once in a lifetime that a patient will have to be airlifted, but it makes sense to do that only if he is stable enough,” Dubey says. 

Patients using air ambulances are typically very rich. Both jets and propeller aircraft are used. A propeller plane operated by Medanta can cost Rs 40,000 an hour, while a jet could go up to Rs 200,000 an hour. Leased aircraft could cost more. For many destinations, the propeller is preferred since it flies at 12,000 feet and does not need a large strip. However, for some destinations, it makes sense to use a jet since it will reduce flying time. Flying Doctors India has done 3,000 airlifts in the last four years, at a minimum of one and a maximum of five a day. Flying Doctors owns three planes that are fully fitted to be an
Emergency room at the air. A team of five medical professionals takes the plane and at the most two members of the family are allowed to fly with the patient. 

Each plane has special stretchers and emergency medical equipment that can withstand pressure. “We recently paid 17,000 euros for a defibrillator with a battery that could be used 40 times,” says Dubey, adding that the aircraft are equipped with German or US made equipment tested to work in turbulent skies. Cheaper defibrillators could have their battery die out after three uses, says Dubey, even as he insists that the service can never be compromised as the costs are so high. 

Maintaining an aircraft costs Rs 17 lakh in Delhi a month. Mumbai is expensive and even the overnight parking fee is Rs 47,000. 

The first responders: Bike ambulance

With 20 ambulances stationed at various points in NCR, the Max group of hospitals runs its emergency response as a separate network from its flagship centre in Saket. The fleet is supported by 15 first responders on bikes. The emergency number to call is 4055 4055. Once a call lands at the 24 hour command centre, the operators on call have a dashboard that informs them of the status of the ambulance. The ambulance and the bikeborne first responder at the nearest location are alerted through an app that emits a signal and both the pilots move immediately.

“The idea is to get to the patient very quickly, save a life and ensure that immediate treatment also gives the patient a better outcome. Ultimately, first response has a bearing on quality of life. “says Rohit Kapoor, Senior director, Max Healthcare.

The patient has to be reached very, very quickly and 17 minutes is the Max first responders' time since they are placed at different locations in the city, typically in dense areas that are accident prone with traffic hold ups, and with fewer health facilities. Peak time for most calls is between 8 o'clock in the morning and 9 o'clock at night, with fewer calls through the night. Early mornings during the winter have the highest number of chest and CVD calls, says a senior member of the Max’s emergency team. 

The bike responder is a paramedic trained and outfitted keeping his safety in mind. He reaches the spot, takes the vitals and begins emergency procedure, even as he stays in touch with the doctor who delivers instructions from the command centre. In many cases, due to the rapid response, the the patient does not need to be moved to the hospital when the ambulance arrives. The service is free of cost and to deter frivolous calls. Rs 3,000 is charged for a house call for the ambulance, not bike responder. . 

The bike, TVS Apache, chosen after examining various parameters, is fitted with a 3kg kit that comes with emergency care equipment, including a defibrillator. The actual ambulance which comes later, is fully equipped with life saving machines. Kapoor says Max has also tied up with a company called VIOS, which has a remote monitoring system to track the vehicle as it moves the patient from the point of call to the hospital. This is what makes the vehicle a smart ambulance, he explains.

The ambulance has a video feed through which the patient's vitals are transmitted to the command centre. If there is a doctor in the ambulance, he can be guided about what needs to be done, and by the time team reaches emergency at the hospital, the ER is aware of the details and transition to further treatment is quick without time lag. Patient records are entered into the system and as soon as he is brought in, an RIFD tag is attached to his wrist. That is done to track patient movement through various departments as he undergoes treatment. 

The whole emergency care system, consisting of bike paramedics, ambulance and command centre has a strength of 100 personnel. Max currently has 15 bike ambulances. 

Dial 112: the road ahead 

While 'Dial 100' for the police is pretty commonplace in India, the government has now decided to use '112' as the national emergency number to address all kinds of emergency situations, such as calls to the fire brigade, police, domestic violence, rioting.  

Though it will take a while before all PPP emergency services all align at the national level with support from the telecom providers as well.