Impact of emergency medical support services on public health delivery system in Goa

Introduction As India is fighting to strengthen its health care delivery system, pre-hospital care (emergency ambulance services) still remains the most neglected part of India’s healthcare service system. The importance of pre-hospital care is especially important in the rural areas where immediate health care is poor and services are distant. Most people in India succumb to death due to nonavailability of quick and good quality emergency medical support. Trauma continues to be one of the major causes of death in India. A report released by the transport research wing of the concerned ministry of the Indian government said that in 2008, the country witnessed 485,000 road accidents in which 120,000 people lost their lives. It is estimated that by 2020, trauma will become the third leading cause of deaths in India from its present position of ninth. Maternal mortality also remains one of the most daunting public health problems in India and its reduction is a prominent component of the rural health programmes of the Indian government. India contributes approximately 20% to 24% of the world’s maternal deaths. One of the ‘3 delays’ identified for this is the delay in reaching an appropriate health care facility due to lack of affordable and accessible emergency transport. A study conducted in Mpumalanga showed that lack of emergency transport between health institutions was a major factor in at least 38% of maternal mortalities recorded in the region. In such scenario, government of India identified the benefits of involving private players under the National Rural Health Mission (NRHM) in ‘public-private partnership model’. The initial success of pre-hospital care services under Emergency Management and Research Institute (EMRI) has further boosted the confidence of policy makers. In this study, we present an assessment of the impact of EMRI services in the state of Goa based on all the emergencies reported in the months from September 2008 to March 2010.