Dr. K. Hari Prasad is one of the country’s well- known intensivists. He is credited with setting up the first multi-speciality emergency-care center in 1997 at Apollo hospital, making it the first hospital in the country to provide emergency medicine specialty services. Presently, he also serves as President - Hospitals Division at Apollo Hospitals. He talks to Healthpost about various aspects of emergency care in India  
 
It has been 20 years since you set up the first emergency care center at Apollo. How has emergency care changed over the past two decades? What role has technology played in emergency care in India?

Our first emergency care center was set up in 1997.

An increasing number of hospitals are realising the importance of having trained emergency physicians and nurses to provide emergency medical care. Earlier, apart from Apollo, there were no hospitals who provided emergency medicine specialty services. It was only with a lot of effort over several years, that doctors trained in emergency medicine started practicing independently and built emergency room teams.

Technology will always integrate itself deeply in every aspect of healthcare, including emergency care. The widespread use of mobile phones has put every citizen in a role as a first responder during an emergency. Today anyone can dial emergency numbers like 1066, and get an ambulance within minutes. GPS tracking is being used to dispatch the closest ambulance to the scene of an accident. Within emergency rooms we are using the latest technology in the form of portable ultrasound machines, point-of-care tests, use of online toxicology and  poison references, and more.
 
What are challenges of providing the emergency care in a country where 400 people die in road accidents alone every day?

There are 3 important challenges.
 
The first is to prevent accidents from happening in the first place. The responsibility for driving safely lies with every citizen. People should be reminded every time to wear helmets, seatbelts, follow speed limits, and to follow traffic rules. Road safety must be ingrained in our minds from school and within our families.

The second is developing our emergency departments. As more and more trained emergency physicians and nurses start taking care of accident patients, the survival of seriously injured victims who reach the hospital, also improves. Pre-hospital emergency care is critical for saving lives, we still have a long way to go in this aspect.

The third challenge is to ensure availability of surgical specialty (trauma care) and intensive care services for all accident victims who arrive at the hospital.
 
Every minute counts in an emergency care center. The response time is less. It’s a specialty where you are in a fierce race against time. What kind of training does it take to prepare doctors and nurses?

For a doctor who has chosen emergency medicine, there is no substitute to high quality training in an established emergency department which has strict supervision. Apollo pioneered emergency medicine education when it launched the 1 year Diploma in Emergency Medicine in 1999 and the 3 year Membership of Royal College of Emergency Medicine (MRCEM) residency training in 2005. MRCEM is recognised by the Medical Council of India to be registered as an additional PG qualification. Our trainees undergo rigorous training for 3 years which takes them through both emergency medicine and intensive care rotations as per the curriculum defined by the Royal College. Apart from learning patient care and emergency procedures, they are also groomed in handling administrative and psychosocial aspects of emergency situations.

Pre-hospital response and care during the golden hour is critical. Responding to an emergency victim, reaching the victim at the earliest and providing care on the spot and during transport to the hospital are all important components of pre-hospital care. We have developed an easy response mechanism using 1066, 2-wheeler first-responder vehicles, 4-wheeler ambulances and air ambulance services to ensure quick response and all our ambulances are equipped and staffed to provide optimal pre-hospital care.  

How has the job of an intensivist changed over the years?

Intensivists have traditionally handled both ICUs and Casualty. With the recognition of emergency medicine as a distinct specialty, the intensivists now focus exclusively on managing seriously ill and injured patients who need prolonged care and monitoring in ICU’s. Even intensive care has improved with the advent of new antibiotics, invasive monitoring and remote monitoring of tele-connected ICUs.

What is the most critical aspect of trauma care?

The most critical aspect of trauma care is the concept of trauma team led by an emergency medicine specialist who can rapidly assess patients, identify and treat life-threatening conditions prior to specialist arrival. Specialists would be able to take the patient to the operation theatre and rapidly intervene when the initial resuscitation and investigations have already been completed by the emergency physicians. Early response, reaching a hospital capable of providing advanced trauma care and care within the hospitals save lives of accident victims.
 
Where do you think India stands vis- a- vis other countries as far as emergency care is concerned?

Emergency medicine in India is still in the phase of development, when compared to Western countries. But our speed and adoption of the specialty is faster than any other country in the world.
 
What is the second biggest killer after road accidents that emergency care specialists have to deal with?

This would be the emergencies related to the non-communicable diseases like heart attacks, and strokes and sepsis.  

It is a high- stress job. Doctors, nurses, paramedics—all have to be on their toes and react fast? How does Apollo ensure that they don’t face early burnout, which is a common health issue the intensivists face?

We aim to keep a very healthy atmosphere in the emergency department where the doctors, nurses and paramedics are more like a family. Short duration shifts which can be easily exchanged play an important role in preventing burnout. In addition, our supervising consultants are always watching for subtle signs of burnout or distress in the junior doctors, and intervene early.  

How do you balance between work and home. What helps you deal with stress?

When one enjoys the work, stress becomes secondary. The responsibility keeps you on the toes all the time and one adapts to the professional requirements. Family and children are important stress busters and spending time with them rejuvenates the body and mind to get back to the rigors of professional responsibilities. 

You have been a passionate clinician, and now you are into an administrative role. Do you miss the clinic?

I do miss clinical work. However the administrative responsibility helps in impacting a larger number of hospitals, providers and patients. Despite missing clinical work the satisfaction derived from working in a larger environment keeps me occupied and gives me the professional satisfaction.