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M. P. Ravindra Nathan
AAPI SILVER JUBILEE CONVENTION: PART 2 -- EMS IN INDIA
By M. P. RAVINDRA NATHAN, MD, FRCP (LONDON AND CANADA), FACP, FACC

AAPI has a string of achievements in India and in USA. “Indian Health Initiatives” was almost the bumper sticker on which this convention rode. The special symposium on this topic was well attended with visiting dignitaries from India updating the status of our joint ventures there. It was indeed a learning experience and a true eye-opener. AAPI’s rural health initiatives in India have started a new and ambitious program called ‘Adopt-a- Village’ trying to bring essentials such as drinking water, electricity, schooling etc into our villages.



From left, Vinod Shah, vice president of AAPI, A. Ramadoss, health minister of India, Dr. S. Balasubromoniam, president of AAPI, and Pawan Rattan of Tampa during a meeting in New Delhi.
Discussion on Emergency Medial Services led by Dr. S. Balasubromoniam, the president, who has put in numerous hours, taken many trips to India to discuss the matter with the Union health minister and others, and set up programs, was the highlight of the session. EMS is much a needed project in India because of the high incidence of trauma and other emergencies. You will be happy to know that finally EMS in India is shaping up well. Emergency treatment in India, with more than 100,000 road accidents and a high mortality rate, ill equipped ambulances when available and ED doctors without training, has been mostly disastrous all these years but finally EMS has taken roots. Helpline numbers like 911 in USA are becoming available – 1,298 in Mumbai, 1,066 in Ahmedabad, 108 in Hyderabad and so on.

Venkat Changavalli, CEO of EMRI (EM Research Institute) from Hyderabad discussed the enormity of the problem in India. With 58,000 kilometers (36,000 miles) of national highways and 135,000 kilometers (91,228 miles) of state highways, auto accidents are bound to be high. Mortality currently is about 58,000 per year, about 140 per 10,000 vehicles whereas in USA it is only 2 per 10,000. The EMRI is looking to standardize and co-ordinate an optimal emergency medical system in India. It is addressing the problems of on-site treatment (most deaths occur in the field), transfer policies, establishing properly equipped facilities, access to care and most importantly, public education. Just to give you a flavor of what it is like traveling in a taxi cab through a busy metropolis in India during peak hours, let me quote a sentence from the diary of my nephew Vineet Venugopal during his visit last year to do a medical rotation at Trivandrum Medical College: “Imagine your car is … like a Pinto with stick-shift and no seat belts. Now, a metro bus with 150 passengers packed like sardines, some hanging out of each door, is barreling straight at you, blaring its horn at a million decibels. Right in front of you is a loaded auto rickshaw, to your left, a scooter with a family of four, to your right, a guy on a bicycle with four propane tanks, behind you is a semi attempting to overtake you, and every other direction is occupied by random pedestrians who are walking against the flow of traffic (ignoring the animals wiggling their way through). That is when things got even more comical. Each of the passengers in the bus as well as the pedestrians start shouting and waving their arms frantically trying to redirect the Pinto – all in different directions. The Pinto's greasy, pan-chewing, potbellied driver is unimpressed, and now toots his horn. Up ahead is a massive pothole. Who will win? I closed my eyes tight for a second and prayed to all the known and unknown Gods.”

Well, in the last two years, three accidents happened to my close family members. My older brother, a passenger in the back seat of a taxi cab, was dozing off after lunch when he was thrown against the window suddenly which smashed his face in many places. A head-on collision with a ‘lorry’ (truck) traveling at breakneck speed. Sadly, he was lying on the road with severe head injuries and intracranial bleeding for two hours unattended, before being taken to the hospital. Not a single car, taxi or pedestrian would stop by to help him! This is the crucial ‘golden hour’ in any emergency where there is a chance to save the victim. Such callous disregard for human life, so much for our countrymen’s conscience these days! With the help of a competent young neurosurgeon and lots of luck, he survived, when he eventually reached a hospital.

New EMS laws are being passed to enforce all of the above. Programs are under way to create EMS in every major town. I know in the Kottayam district of my home state of Kerala, a pilot program has been successfully implemented. There are EMS training programs in several centers for physicians and paramedics. Gujarat has become the first state in India to enact an EMS similar to what is in the U.S., patterned after California. Now, EMS is being established in Delhi, Pondicherry and other places as well.

To be continued.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.




Payal Patel
SWIMMING POOL SAFETY TIPS
By PAYAL PATEL, M.D.

Summer is here, and the hot weather draws everyone to the pool. As we know, children love water and when it comes to swimming pools safety guidelines needs to be discussed.

Living in Florida has its pros and cons. Many homes have a swimming pool and therefore instilling swimming pool safety is the key. Florida is one of the leading states in pool drowning. Each year, about 300 children under 5 years of age drown in swimming pools, but the number grows to more than 2,000 children under 5 years of age who become near-drowning victims.

Seventy-five percent of children in swimming-pool submersion accidents were between the ages of 1 and 3 years old, and most of them were boys.

Toddlers are a special concern and because they move so fast and get into everything, a pool drowning can occur anytime. Most kids this age don’t scream for help and can drown silently. Most victims of near-drowning accidents drown silently in less than five minutes of when the child was last seen.

PREVENTION

1. Always have a pool fence in place that is at least 4 feet high, and completely separates the pool from the home and the play area. A good fence should prevent a child from getting over, under or through the barrier. Have self-closing gate latches that are out of reach for children. (Remember, a pool fence is the law in Florida for all homes)

2. It may be wise to have a pool alarm – a door alarm if the pool gate is opened. Wrist- alarm bands make noise when a child gets wet. A pool alarm also is good, which is activated if anything more than 10 pounds falls into the pool.

3. Discuss basic pool safety rules with children before entering the pool.

4. Never leave children alone or out of eye contact when he or she is in or near a pool.

5. Always have an adult supervising the pool (who knows how to swim).

6. Remove toys, floats, balls from the swimming pool, which may attract children to the pool when they are not supposed to be in it.

7. If you own a pool, learn CPR in order to resuscitate a drowning child.

8. Always use an approved flotation device to keep child afloat, but don’t let this let your guard up.

9. Prohibit any kind of diving or rough play in and around pools.

10. Teach kids how to swim as early as possible (good age is around 3 years of age), but they are not drown-proof. Therefore, close supervision is still necessary.

11. Precautions should be taken for children with seizure disorder who can seize and drown in the pool.

RESCUE

* First and foremost, don’t panic.

* If you see a child drowning, send someone to call 911.

* If a child is in shallow water, turn him or her face up and face out of water.

* If the child is in deep water, get a flotation device before going to him/her.

* Look for signs of breathing (If not breathing, start rescue breathing, which is mouth-to-mouth breathing) while child is in the water.

* Check the pulse. If no pulse, start CPR once child is removed from the pool.

Finally, I hope these guidelines will help parents take charge of swimming pool safety guidelines, to protect children from pool accidents and drowning.

Happy Fourth of July to all.

Payal Patel, a board-certified pediatrician, has recently started her own practice – Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.




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