印度二级和三级中心急诊和伤害护理现状的国家级评估

Project Report Submitted to NITI Aayog, New Delhi This study was carried out with the financial support of NITI Aayog, Government of India,and conducted by Department of Emergency Medicine, JPNATC, AIIMS. Department of Emergency Medicine, JPNATC, AIIMS has received the financial assistanceunder the Research Scheme of NITI Aayog (RSNA 2018) to prepare this report. While duecare has been exercised to prepare the report using the data from various sources, NITIAayog does not confirm the authenticity of data and accuracy of the methodology to preparethe report. NITI Aayog shall not be held responsible for findings or opinions expressed in thedocument. This responsibility completely rests with the Department of Emergency Medicine,JPNATC, AIIMS. ACKNOWLEDGEMENT We would like thanks to all those who are involved in this endeavour for their kindcooperation for its successful completion. At the outset, we wish to express our sinceregratitude to all those people who helped us to complete this project in an efficient manner. This study was carried out with the financial support of NITI Aayog, Government of India,and conducted by Department of Emergency Medicine, JPNATC, AIIMS. We sincerely acknowledge God almighty, from whom all blessings and knowledge flowed inachieving this study to a completion successfully. We would like to thanks toDr V K Paul, Member, National Institution for TransformingIndia to help in conceive the study, guided through the processes. We would like to thanks toDr Madan Gopal, Sr. Consultant, NITI Aayog for his kindsupport and co-operation, during this study. We would like to thanks to all our research staff and team of national assessors for their kindsupport and help to conduct this study in short duration of time. We would like to say thanks to all selected healthcare facilities for their kind cooperation toconduct this study in their hospitals. We would also thanks to all the nodal persons andassessors, who gave their time and expertise in assessment of all the selected healthcarefacilities. Also, we must extend our sincere thanks to all the stakeholders who agreed and provide theirsupport during this study. EXECUTIVE SUMMARY Medical emergencies including Road Traffic Injuries are one of the majorleading causes ofdeaths in India. RTIs alone contribute to 1.5 Lakh deaths annually.Approximately 2 personsdied of heart attack every hour in 2015-16. Currently, Non Communicable Diseases aloneaccount for ~62% of deaths in India and Communicable infections, Maternal, New bornaccount for ~27% of deaths. Most of these deaths present as emergency conditions. In fact, asper one estimate more than 50% of deaths and 40% of total burden of disease in Low MiddleIncome Countries could be averted with pre-hospital and emergency care. The global totaladdressable deaths and DALYs that can be averted amount to 24.3 million and 1023 millionlives respectively. In fact, in South-East Asia alone, 90% of deaths and 84% of disability-adjusted life years (DALYs) are due to emergency and trauma conditions. Emergency care system in our country has seen uneven progress. Some states have done well,while others are still in the budding stages. Overall, it suffers from fragmentation of servicesfrom pre-hospital care to facility-based care in government as well as in the private sector.The system also suffers from lack of trained human resource, finances, legislation andregulations governing the system. Absence of standalone academic department since its inception is another factor for thecurrent ails in the system. In the light of the above, the present study was conducted. The study aimed to assess theprevailing status of emergency and trauma care at government and private hospital settings ofIndia to bring out the existing gaps and provide a framework for further improvement and theneeded policy directions. Towards achieving this goal, a country-wide study of emergencyand trauma care services of 100 tertiary and secondary level hospitals in 29 States and 2Union Territories from 5 regions of India was conducted. The selected health facilities consisted of 20 hospitals each under the following categories:Govt. Medical Colleges, Private hospitals>300 bed strength, Private hospitals<300 bedstrength, Government hospitals >300 bed strength and Government hospitals <300 bedstrength. The assessments were conducted by trained assessors, selected from all over countrywho followed by the investigators and research team. SALIENT FINDINGS OF THE STUDY Case load Emergency and injury cases annually accounted for 9-13% of all patients presentingto a health facility and 19-24% of admissions in Govt Hospitals and 31-39%admissions in Private Hospitals.Live observations revealed that emergency cases accounted for 11-30% of all OPDpatients on a given day. Spectrum of major medical conditions presenting at Emergency Departments During live observations conducted for 24 hours at the study centres, the followingwere th