M S RAMAIAH MEDICAL COLLEGE COLLEGE REVIEW MEETING

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M.S. Ramaiah Medical College Hospitals
Role of Private Sector in medical care during
disaster Dr. S. Kumar Principal Dean
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Goal

• The goal of care during a Mass Casualty Incident
  is to provide the greatest amount of good for the
  greatest number of potentially survivable
  victims.
• Make the best use of personnel, equipment and
  facility resources.

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Ideal - What resources (inputs) are required?

• 50-60 beds dedicated to disaster services.
• Target 12,000 beds fully equipped, with
  qualified staff necessary infrastructure.
• Cost Approx. Rs.3,600 crores.

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Logical Framework Analysis (LFA )

1. What the project is due to achieve ?
2. What are the planned activities to achieve its
   outputs purpose ?
3. What resources (inputs) are required?
4. What are the hurdles / problems perceived ?
5. Project assessment progress, successes.

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What are the planned activities to achieve its
outputs purpose ?

1. Create awareness in the Community.
2. To empower the community to supplement the
   efforts of the Governmental agencies.
3. To train capable members from the community in
   BTLS, CPR, safe disposal of hazardous
   biological wastes.
4. To enhance confidence levels of the community in
   casualty management.

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What the project is due to achieve ?

• Cost effective, judicious use of available
  reserve capabilities of the private sector.
• Avoid unwarranted burdening of the exchequer (
  estimated at Rs.3600 crores ).
• Addresses the problems perceived in establishing
  disaster beds by the government.
• Manpower mobilization,
• Stock-pile rotation.
• Non disaster time use/misuse of the facility
  created.

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What the project is due to achieve ?

• Convert our ( private sector ) ability into
  responsibility by systematic training.
• To have a system in place across the country by
  which we can respond with grace under times of
  stress.

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What are the planned activities to achieve its
outputs purpose ?

• Capacity identification of private healthcare
  providers.
• Networking of private sector.
• Create a data base of the resources skilled
  manpower available.
• Periodic training capacity development.
• Establish Consortium of Disaster Care.
• Role assignment mobilize commitment of all.

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Health care Scenario

• Government effort
• Hospitals under H FW.
• Hospitals attached to Government Medical
  Colleges.
• Private Sector
• Corporate Hospitals larger Nursing Homes.
• Hospitals attached to Private Medical Colleges.

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Government Hospitals

• Total number of
• Hospitals 7008
• Beds 4,69,672
• Beds per lakh of population 89
• Budget out Lay Rs. 83/- ( Plan out lay
  55,344 crores )
• Medical Colleges 124.
• Beds gt 1,10,000.
• Reserve capacity ?

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Private Health Care

• Major hospitals
• Number 15,367.
• Beds 502,150.
• Reserve capacity - ?
• Medical Colleges
• Number 147
• Beds 95,000.
• Reserve capacity 32,000 beds.( 30 ).

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Aim Assumptions

• Aim
• To ensure timely response and coordinated
  immediate care during a mass casualty event.
• Assumptions
• Trained medical personnel involved in emergency
  management are limited in spite of immediately
  available resources.
• Resources utilization will become appropriate
  only with available trained personnel.
• Hence the need to net work and raise awareness.

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Aim of Private Initiative

• The Mass Casualty Incident (MCI) is managed
  through the Incident Command System (ICS) or
  Incident Management System (IMS).
• The ICS/IMS is a sequence of response to any MCI
  on scene consisting of Scene Assessment,
  Alerting Process, Field Organization, Evacuation,
  Triage, Stabilization, Transport and definitive
  care at the receiving Hospitals.

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Target

• In the event of disaster the receiving hospitals
  who are alerted will need to provide ambulance
  services and personnel as available for
  transferring of patients from the incident site
  to the networking hospitals under the ICS
  according to the hospital disaster plan.
• The receiving hospitals will in principal
  establish a hospital disaster management policy
  which will be communicated to all concerned.

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What are the planned activities to achieve its
outputs purpose ?

• Deliver disaster management concept and training
  through medical students as part of Community
  Medicine field postings.
• By this we will be utilising the services of the
  vast human resource ( 160 thousand students ) in
  the Medical colleges.
• NEED towards this to modify the curriculum to
  deliver this need to the nation.

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Goal is to distinguish between

• Victims needing life-saving treatment that can
  only be provided in a hospital setting.
• Victims needing life-saving treatment initially
  available on scene.
• Victims with moderate non-life-threatening
  injuries, at risk for delayed complications.
• Victims with minor injuries.

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• Thus emergency response in a MCI is a dynamic
  process.
• Needs expedient training of emergency personnel
  in emergencies. It has been field-proven in mass
  casualty incident to follow a structured program.
  
• Program BTLS / ITLS for all eligible people.

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New Initiatives of Private Sector

• Health City Model
• 5000 beds at all state capitals
• 4 of the project Kolkatta, Ahmedabad, Jaipur
  and Bangalore ready by 2010
• 75 of these beds dedicated for below poverty
  line citizens.
• Facility to receive disaster victims including
  piped oxygen at car park

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Dr Shetty, Shaw plan Health Cities in all State
capitals

• DECCAN HERALD NEWS SERVICE, BANGALORE
• Promising a chain of 5,000-bed Healthcities in
  every state capital, Narayana Hrudayala and
  Biocon CMD Kiran Mazumdar Shaw on Wednesday
  announced the launch of the project to supplement
  the countrys public healthcare system.
• Ms Shaw and the Hrudayala Chairman Dr Devi Shetty
  told reporters that 75 per cent of the beds will
  be earmarked for the working and poor. AIG
  Investments and JP Morgan have joined in as
  private equity investors for the project.
• At the Narayana Health City in Bangalore, a 1000
  bed Mazumdar Shaw Cancer Centre is scheduled to
  be commissioned in the next few months. This will
  be scaled up to a 5,000-bed health city
  addressing the needs of 15,000 outpatients a day.
  This model will be replicated in Kolkatta and
  Jaipur.
• Dr Shetty said various state governments had
  allotted land for the project at subsidised
  rates--Jaipur (40 acres), Ahmedabad (37 acres),
  Jameshedpur (where they will be acquiring a
  trust).

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New Initiatives of Private Sector

• Devi Shetty Kiran Mujumdar Shah.
• Sankara Nethralaya.
• Realty Group.
• AMRL group.
• Manipal group.
• Ambuja Realty Neotia Healthciti.
• Mission of Mercy Hospital.

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Article in Economic Times
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Problems perceived.

• Cost Rs.3,600 crores.
• ? Support from Government reimburse the cost of
  participation cost of consumables.
• Problems perceived.
• Manpower / human resource.
• Stock-pile rotation

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Public Private Partnership offer

• Must become a reality in the true spirit.
• NEED A MOU with private stake holders.
• Costing Vs. Billing.
• Advantages
• Cost effective model.
• Address the problems perceived.

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Fund mobilisation

• For community awareness programs through
  participation from philanthropic institutions /
  Industry / NGOs.
• Mobilising Insurance coverage for high risk
  areas through PPP model.

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Other needed efforts

• Training people to allow the head to rule and not
  the heart at the times of disaster need is a
  Harmony of the Heart Head.
• Minimize / Abolish panic created by rumors
• Introduce the concept of ICE / NOK in cell
  phone users.
• Establish distinct command lines for
  communication.

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Hope !

• Healthcare providers of this country need to
  reprogram their minds and start the untried.
• The real voyage of any discovery consists not in
  seeing new land scapes, but in having new vision.

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Contact details
Dr. S. Kumar, Principal Dean, M.S. Ramaiah
Medical College HospitalsMSR Nagar, MSRIT
Post, Bangalore 560 054Tel [phone] /
2360 5190 / 2360 1742 Fax [phone] Email
drskumar16_at_hotmail.com msr_medical_at_dataone.in
Web http//www.msrmc.ac.in
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Thank you