How 108 Emergency Care Functions in Tamil Nadu Government Hospitals

If you want to know as to How 108 Emergency Care Functions in Tamil Nadu Government Hospitals, you can read an earlier report and also this thread from Twitter @kachibhatla, Founder & CEO of AIMPLOY, Previously Founder and CEO of Bijlipay.



Short thread on how kickass our TN Government health services is! I am super impressed and wanted to share this with everyone. @NHM_TN @Vijayabaskarofl 1/n

At 9 pm approx (13 July), my security guard rings my doorbell sweating profusely, complaining of chest pain. We were in the midst of dinner and were totally unprepared for this. 2/n

Managed to get through to 108 in three tries and the ambulance reached us in less than ten minutes. The call centre girl was efficient and patched us to the ambulance driver quickly.

Both of them ask me mandatory Covid related questions and then a few more questions on exact location and asked us to have someone stand on the street, outside my building. 4/n

The Male nurse from the get-go, was extremely good. Handled the patient well… polite, respectful and empathetic. Once in the ambulance (in which I travelled along), he had a tough time with the patient who was unwilling to lie down, wouldn’t keep the oxygen mask on etc. 5/n

Kept his cool through out, while he tried to check his vitals and then put a line in, which was a struggle, as the man was totally uncooperative. Pretty soon, we were at Royapettah Hospital. 6/n

Now, this was perhaps my first time inside a proper government hospital…. I was impressed. The young doctors and nurses in the Triage section were great. The male nurse from the ambulance worked smoothly with them, like he was a member of staff. 7/n

All of them seemed to work hurriedly, as they handled about 15 patients and related attenders in the Emergency room. All with a great sense of purpose and no chaos at all. 8/n

Our patient needed to be pinned down, as he refused O2, pulled out the line which was inserted earlier etc. Big ups to all the nurses, who were super patient while taking his ECG, putting a new line & then calming him down (with some sedative I guess). 9/n

I step out of the emergency room to the car park to meet my driver who has now arrived. The male nurse from earlier has finished all his work and is walking back to the ambulance. 10/n

Now, the MAIN part… I holler and walk up to him… tell him I want to give him something… he says NO… I try again, this time actually bringing out a small wad of notes and he could see it was 500s… but again he said NO and said ’We are not supposed to take, brother!’ 11/n

There was nobody near us. This guy was real!! I couldn’t believe this. I’ve been in similar situations with the upmarket ambulance service (extremely professional), which came at a certain price & ending up in a private hospital, only to be hassled for tips by the lift boy! 12/n

I was so happy that this is the current scene in Chennai and I must say, I am loving it! Respect to these doctors and healthcare workers who are working selflessly, during these trying times. 13/n

Please do not speak disparagingly of TN Health services, if you have never experienced it. Love Chennai! Jai Hind!@Vijayabaskarofl @NHM_TN 14/n

Lastly, for those who asked, the patient is stable now. 15/15



What should be done to protect doctors in India from violence?

There are few ways. Let me Explain One by one

( I) Teach the People that their expectation is unrealistic and can never be met and that if their unrealistic and impractical expectations are not met, it does not become negligence

I will explain this first

99.99 % of Our People who criticize Doctors want

  1. 1. All diseases cured in one day
  2. 2. by the treatment of their choice (if they want surgery, we have to operate : If they don’t want surgery, we have to resect meningioma with tablets) [Meningioma : A Tumour inside Skull]
  3. 3. Free of Cost
  4. 4. In the Hospital of their choice (Treatment of Myalgia in neurosurgery OP, Cardiac Bye Pass in Banavaram PHC) [Myalgia : Muscle Pain, usually due to work]
  5. 5. At the time they like (They will want admission of OA Knee at 11 PM) [OA Knee : Knee pain]
  6. 6. All diseases to be diagnosed at once
  7. 7. With the modality of their choice. If they want MRI Brain, we have to take it even when patient is fully conscious following fall from bicycle. If they don’t want, we shouldn’t get CT Brain done even if there is anisocoria
  8. 8. And doctors say what they like. You should always say that the disease does not need hospitalization if they are not ready for hospitalization. You should always not suggest surgery if they are not ready for surgery.

-oOo-

If any one of these conditions are not met , they will say that

  1. 1. Doctors are Negligent
  2. 2. Doctors are money minded
  3. 3. Doctors are not duty conscious
  4. 4. Doctors do not have accountability
  5. 5. Doctors did not tell me anything
  6. 6. Doctors did not explain treatment plan

eg :

If they want the diease to be cured in one day, but it takes 5 days, and even though the doctor has explained everything, they will still say that doctor did not explain me treatment plan / doctor did not tell me anything

eg
When they are told that Open Heart Surgery cannot be done at Banavaram PHC, they will say that Doctors are money minded (they do open heart surgery in their private clinic but not in PHC), Doctors are not duty conscious, Doctors do not have accountability

-oOo-

In this case, They wanted Neurosurgery in the hospital they first come

When it is not there
They consider that the doctor is negligent
and try to kill him

-oOo-

The issues are two fold

  • 1. Lack of resources
  • 2. Over expectation of people

The second is the main issue nowadays . . and when the people are at fault, they have to be blamed
-oOo-

99.99 % of Our Public distrust is because of their wrong, illogical, impractical expectation

The mistake has to be identified and solved

They need to be educated about reality

-oOo-

You please ask 1000 non medical people to list what they consider as 10 problems in health care

You will have a list of 10000 problems

9999 will come under the eight categories mentioned above

Tell straight on the face of the patients that what they expect is unrealistic and that they have to accept the reality

-oOo-

(II) Exclude Health Care from Consumer Courts

Health care is not consumerism
The Customer is King approach does not work here
Health care is NOT Patient vs Doctor issue
It is doctor + patient on one side and Disease on other side

Patients do have a lot of role to play in evolving a good health care system and if the system is in disarray they do have lot of blame to shoulder

Bringing health care under consumer courts is the single most anti people act in the history of health care

Wherever and whenever there is a blame from patient side, blame it is on patient side
Do not blame the doctor even when the patient is at fault

-oOo-

(III) A strict law absolving a doctor / group of doctors or healthcare professionals,, from any legal implications for any act of self defense while on duty

This is also needed (Suggestion by Mix Doc)

-oOo-

(IV) Increase Severity and Certainty of Punishment

Certainty of punishment is more important and helpful than severity of punishment in preventing a crime. This is what Australia Government has done

(V) Stop Defending the Criminal

Few Men rape

  • They do because of perversion and also because they consider the girl or woman as soft target.
  • They are emboldened because they know that there are people who will blame the girls dress as cause of rape
  • It is perversion to find reasons from the girls side in a rape
  • It is stupidity to suggest that there won’t be rapes if all women wear burqa
  • Rape can never be prevented by changing the dress of woman
  • The man is at fault

He needs to be changed.

-oOo-

Few people attack hospitals and health care professionals

  • They do because of perversion and also because they consider the hospital or health care worker as soft target.
  • They are emboldened because they know that there are people who will blame the hospital bill or overcrowding as cause of attack
  • It is perversion to find reasons from the hospital side in a rape
  • It is stupidity to suggest that there won’t be attacks on hospitals if all govt hospitals give Apollo services or if all private hospitals treat free
  • Hospital attacks can never be prevented by changing the hospital bill
  • The attacker is at fault
  • He needs to be changed.

-oOo-

Imagine two scenarios

Scenario 1 :

A pervert finds a girl child alone on the street and thinks of molesting her.

He has read in the news paper about a hundred similar incidents in past few weeks following which the criminal was given bail immediately and no conviction at all. In addition to the criminal being let free by the legal establishment, he has also seen fools / stupids / perverts wearing mask of intellectuals had discussed the various causes like Dress of the Victim, Victim coming alone, the emotion of the criminal etc as reasons and were talking against punishing the previous criminal and suggested that changes should start from victim’s dress and victims behaviour

He gets emboldened that even if he commits the crime,

  • 1. he will come out in bail in one day,
  • 2. he won’t be convicted
  • 3. there will be enough fools / stupids / perverts wearing mask of intellectuals who will support him directly and indirectly

Scenario 2 :

A pervert finds a girl child alone on the street and thinks of molesting her.

He has read in the news paper about a similar incidents following which all the criminals were convicted and are in jail and every one was unanimous is giving 14 years imprisonment to the criminal

He will just back off if that news comes to his mind

-oOo-

Reason for increase in Sexual Violence against women

  • 1. Perverts
  • 2. Low Conviction Rate
  • 3. Fools / stupids / perverts wearing mask of intellectuals who blame the Victim’s dress, victim’s behaviour and suggest that victim should change

Reason for increase in Hospital Attacks and Assaults on health care worker

  • 1. Perverts in Public
  • 2. Zero Conviction Rate
  • 3. Fools / stupids / perverts wearing mask of intellectuals who blame the Hospital Bill or Hospital Waiting Time

-oOo-

Solution for Reducing Attack on Hospital

Legislature

  • 1. Increasing Punishment to 14 years
  • 2. Making Hospital Attacks as Non Bailable Offence

Executive

  • 3. Time Bound Legal Procedure. 7 days for Filing Charge Sheet

Judiciary

  • 4. Trial within 1 month

Civil Society aka Fools / stupids / perverts wearing mask of intellectuals

  • 5. Stop Justifying the attacks
  • 6. Stop Blaming the Victim
  • 7. Stop Finding Imaginary Reasons

(VI) Include the details of these attackers in their Aadhar Card and form a PIBIL

Soon EMR (Electronic Medical Records) will be linked to Aadhar card. Just like CIBIL ( CREDIT INFORMATION BUREAU (INDIA) LIMITED), We need to have a PIBIL (Patient Information Bureau India Limited) linked with Aadhar Number and Entries made in the Aadhar Database of All the patients and attackers who cause trouble in hospital

So that

Other hospitals can use that to anticipate trouble and be prepared

  • First Attack : The Individual Should be banned from entering any health care facility all over India (Govt or Private)
  • Second Attack : The Individual Should be permanently banned from entering any health care facility, even if it is an emergency

Is this Ethical ?

Yes.
Hippocrates Oath becomes null and void for those who endanger the life of  Other patients in the hospital as well as  Health Care Providers

How Police, Ambulance and Government Hospitals in Tamil Nadu react in an accident. 

A real life narration by an accident victim as to How Police and GH react in an accident.  (Full Narration at the end of the post). Another Incident Regarding response of Government Health Care System to a patient with Chest Pain is narrated here 

Key Points from the Narration & my Comments (in Bold Italics)

1
The police was very very helpful. They asked the crowd to keep away and got hold of the bolero driver.
There is a common misconception among people that Police do not help people or behave mechanically. The reality is always the other way round
2
I immediately gathered all my strength and asked for water & lime juice with salt. The police arranged immediately.
Police go to the extent of Helping the accident victim with the drink of his choice 🙂 🙂 :smiley: That is really appreciable. But at the same time, we need to also educate the police and in case the patient requires surgery, it is better to keep the stomach free of any fluids. Of course, accident victims will feel thirst due to two mechanism (1) Blood Loss –> Hypovolemia (2) Sympathetic System Surge –> Dry Mouth , but don’t give anything by mouth till treatment plan is finalised
3
They also called the 108 and took me to Sankagiri GH.
4
Once inside the ambulance, I asked the attendar in the ambulance to remove my shoes and throw them away as they were out of shape and I could get some fresh air.
5
04:55 pm –
Sankagiri GH team received me with full speed, no time wasted they started first aid. Most painful moment of my life. Just a small pain killer given – no sedation – my big open wound was stitched and packed like a Rambo movie.
Please note that the GH Team had received immediately – 🙂  :+1:
No Sedation Given – :+1: Because head injury is not yet ruled out. Any Sedation will lead to difficulty in accessing the neurological status if the patient’s consciousness goes down either due to head injury or due to blood loss6. Sankagiri GH has completed the First Aid + Wound Management in 20 minutes. :+1: In Singapore and UK, the average waiting time in ER is in hours while in TN we see that
Accident : 4:40 PM
Ambulance takes Patient to Hospital : 4:55 PM
Hospital completes First Aid & Wound Management : 5:15 PM
Very Few Countries can match this efficiency. And Remember. All these are done without patient paying a single paisa or even worrying about payment or having to fill forms etc    
6
05:15 pm – Sankagiri GH process was over. We knew that golden moments should not be wasted. Mahesh bro came in his Thar jeep. The GH team made me sit comfortably on the back of the Jeep and we headed towards KMCH.
The GH team made me sit comfortably :+1:– Shows the Empathy



-oOo-

Full Narration Follows

What happened to me?

Lot of calls, messages enquiring about my health. Something went wrong and it is no fault that people who love me with lot of attention & care want to know what happened to me? – I can very well understand this curiosity is due to the care and affection.

I am bound to explain what happened to all of you. Due to my current position, I am explaining as short as possible about what happened.

Tue 15th Jan

07:00 am – Started on a ride to Pondy with the Lone Wolves
10:00 pm – Met with Pondy paleo friends at the beach

Wed 16th Jan

03:00 am – Had a great peaceful time with friends at the beach. Slept
07:00 am – Went to Vedhapureswarar temple, had a great darshan
11:00 am – Ride out from Pondy headed back home
03:00 pm – Had a good lunch at Ayodhipattinam before Salem
03:45 pm – Refuelled at Salem
04:15 pm – Felt sleepy, slept on the pavement of closed tea shop, was a good power nap
04:30 pm – Got up fresh, started riding back

04:40 pm – 4 kms after Sankagiri, was riding very slow, suddenly a bolero disappeared from nowhere without stopping to see from the other side service lane and came into enter this side service lane. I tried to avoid and ride to the left – could not avoid – got hit by the bolero on my right knee and was thrown yards away landing on the foot of a tea shop on the service lane. After the fall, I tried to get up. I sat up. There was police nearby. They rushed to my rescue. Somebody from the crowd tried to touch my helmet. I yelled at him to stay away and not to touch me. I consciously removed my ray ban, and then slowly my helmet making sure there was no dent in the helmet. The police was very very helpful. They asked the crowd to keep away and got hold of the bolero driver. I could see my right leg almost ripped on into two. How lucky a man is to see his own leg bones. 🙂 🙂 🙂

I immediately gathered all my strength and asked for water & lime juice with salt. The police arranged immediately. They also called the 108 and took me to Sankagiri GH. Once inside the ambulance, I decided not to make any unwanted calls fearing I would faint any time seeing the wound up close and blood that was flowing. I asked the attendar in the ambulance to remove my shoes and throw them away as they were out of shape and I could get some fresh air.

The first call I made was to my friend & brother Maheshwaran Nallaiyan from Tiruchencode as he was the nearest person I could reach from Sankagiri. I was very sure that even if he was not at home, he will arrange someone to take care of me immediately. My luck he was at home & his driver was at Sankagiri already for some work. He said his driver will reach GH first immediately & he will come there in 10 mins. That was a great relief to have a loved one nearby.

The second call I made was to my brother Dr. Dharani Subramaniam explained my situation and asked what to do. Dharani said do not panic. If you can remember me, call me without any chaos in such a situation you are mentally all well. He told me to finish GH first aid and head straight to KMCH, Coimbatore immediately without hesitation. Within 5 mins, Dharani called me back – said that all arrangements to receive me has been arranged by the top medics team at KMCH, Coimbatore at Emergency. He also said that he is on the way already to KMCH.

All this happened in a time of 10 minutes.

04:55 pm – Sankagiri GH team received me with full speed, no time wasted they started first aid. Most painful moment of my life. Just a small pain killer given – no sedation – my big open wound was stitched and packed like a Rambo movie.

Mahesh bro arrived at the GH when the first aid was going on and caught my hand offering strength.

05:15 pm – Sankagiri GH process was over. They called for a private ambulance who said he will come in one hour. We knew that golden moments should not be wasted. Mahesh bro came in his Thar jeep. The GH team made me sit comfortably on the back of the Jeep and we headed towards KMCH.

05:30 pm – I call and inform Mom that i met with a small accident – repeatedly said her not to panic and start immediately to KMCH. Mahesh bro drove me very comfortably keeping me occupied talking all the way so I should not sleep.

07:10 pm – I arrive at KMCH and get admitted at Emergency
07:20 pm – Dr. Dharani arrives check my wound and says not to worry we are in best hands.
07:30 pm – Doctors start checking my wound taking photos sending to seniors – deep discussion starts and Dr.Dharani is with them.
08:00 pm – More pain – they again wash my wound and make new dressing
08:10 pm – Taken to Xray
08:50 pm – Taken to CT scan – discussion continue with results
11:45 pm – Taken to Operation Theatre – Procedure 1 begins

It was a 2 hour long procedure thoroughly cleaning my wound so that no infection spreads in my body due to the external particles from the road

Thu 17th Jan

03:15 am – Reached room
10:00 am – Got up, rest day

Recoup the accident. I knew how i fly. Had there been an impact to my helmet, it should have been fatal. Lucky to be alive. It was my death day. Only Lord Shiva saved my life ending it with just a hit.

Fri 18th Jan

12:30 pm – Taken to Operation Theatre – Procedure 2 begins

It was the ortho procedure. Ortho surprised that my bone was damn strong to take such a beating. Just one minor fracture – fixation done with a bio collapsible tiatinium screw. No further damange – only scratches, will be healed by itself in a month – The effect of regular bone broth & vitamin d

06:00 pm – Reached room

Sat 18th Jan – Rest day

Sun 20th Jan – Doctor visits, remove dressing and fixes next procedure on Monday

Mon 21st Jan

02:00 pm – Taken to Operation Theatre – Procedure 3 begins

Again wound cleaning. Total dead skin removed.

06:00 pm – Reached room

Tue 22nd Jan

11:00 am – Dressing removed and VAC machine fixed to heal the wound faster

Wed 23rd Jan

11:00 am – Discharged and sent home

Thu 24th, Fri 25th, Sat 26th, Sun 27th Jan – Rest

Mon 28th Jan

12:15 pm – Reach back hospital, wound cleaned, redressed, VAC machine removed, readmitted

Tue 29th Jan – Rest Day

Wed 30th Jan

09:30 am – Taken to Operation Theatre – Procedure 4 begins

Plastic surgery grafting done. Skin taken from left leg and grafted on right leg

12:30 pm – Reached room

Thu 31st Jan

Fix VAC machine and discharge

I will have to report once every week as out patient for wound dressing and rehab



I am strong and will emerge back very stronger. Work not affected, infact more concentration on work now. More time for Keto168. More time to read.

Keep me in all your prayers. Love you all.

& we end all post about this accident with this. Let us move on to the positive brighter side.

Om Namah Shivaya!