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No ambulance for Kashmir's injured

Two decades of insurgency. Tens of thousands killed. Hundreds of thousands injured. For a healthcare system that has handled tens of thousands of blast and bullet victims, how much expertise would it have? How equipped would you expect it to be? How many ambulances would it have? How equipped? Peerzada Arshad Hamid reports.

Srinagar,December 22, 2008:

Inside of a Hospital Ambulance in Kashmir
Ramshackle vehicles without basic life support make Kashmir's ambulances

In Indian administered Kashmir, where thousands of small and big blasts have caused tens of thousands of casualties, the state healthcare system boasts of one ambulance, mostly attached with the state head.

For the rest of folk there are a few carrier vans disguised as ambulances, most of which lack even basic emergency facilities.

Sameer Ahmad of Baramulla lost his father to a grenade blast in 1996. The blast in Baramulla town had critically injured his father. He was removed to District Hospital Baramulla and from there referred to the summer capital Srinagar for treatment.

Sameer believes his father would have survived if the 'ambulance' that ferried him and other injured to Srinagar had been an ambulance.

"There was no first-aid, no trained paramedic in the van. He was left unattended throughout the one-and-a-half hour journey along with several other injured. All of them kept bleeding profusely," said Sameer.

Sameer's father succumbed before reaching SK Institute of Medical Sciences Srinagar. Doctors told him that some timely assistance (inside the ambulance) could have saved him.

This is a usual affair in Indian administered Kashmir, where many injured succumb on way to hospitals for lack of first aid and timely assistance. Health experts say no hospital 'ambulance' in Kashmir is an ambulance in the real sense.

The so-called ambulances of the health services department are simply carrier vehicles.

"These vehicles by no way can be termed as ambulances because they don't have the required facilities available inside to provide first-aid or life support to the patients in critical condition," said Dr Abid Koka, an orthopedic surgeon at SK Institute of Medical Sciences.

Ambulance in Kashmir
Most of the hospital ambulances are nothing more than carrier vehicles

Most of these ferry patients from district hospitals to Srinagar. From blast and shootout sites, victims are generally ferried in police or civilian cars, in absence of an ambulance service.

Health experts argue that the vehicles do not meet the criteria laid down for designated emergency ambulance.

"These so-called ambulances are used for carrying corpses, referring patients from one hospital to other and mostly used as staff conveyance," said a doctor at SMHS hospital in Srinagar.

Most vehicles are worn out, rusty ramshackle and devoid of any essential facility to meet any emergency.

An ideal ambulance designated for health care to tackle emergency should have all facilities available at a casualty department of the hospital. It must have proper couch for patients, splints for immobilization of fractures, first aid kits, emergency care equipment and supplies like airway care, oxygen cylinders, masks, blood transfusion facilities, ECG machine, external cardiac compression, prevention and treatment of shock, life saving drugs and injections, IV fluids, drip sets, blood pints, blood transfusion sets.

Besides this, refrigeration facility, communication facility, emergency childbirth and transportation of newly born infants are necessary for an ambulance.

There should be a highly trained paramedic staff for resuscitation of serious patients.

Usually there are two kinds of ambulance; one is emergency ambulance and the other patient transport ambulance. While the former is necessary for carrying critical patients from accident sites to hospitals, the latter is used for transporting patients from one hospital to another usually non-urgent care centres.

Director Health Services, Kashmir, Dr Muzaffar Jan said the state had only one emergency ambulance.

"Health department in Kashmir does not have any emergency ambulance for civilian population. There is one such ambulance and that is with the Governor of the state," he said.

However the director is optimistic about putting a proper ambulance service in place.

"Right now we have the patient transport ambulances but we are going to revamp the system and I am hopeful we will soon get emergency ambulances," Jan adds.

The official apathy for healthcare has introduced culture of using smaller cars such as Maruti vans and Tata Sumo as ambulances. Most private hospitals, nursing homes and some government hospitals use small cars as ambulances.

"In small cars there is minimum possibility of laying a patient comfortably and no question of equipment," said Burhan Majid, a law student at the University of Kashmir, Srinagar.

Majid is planning to file a Public Interest Litigation (PIL) in the Jammu and Kashmir High Court to bring proper ambulance service in place in the valley.

"They are simply jeopardizing the lives of people. So far thousands of people have died on way to hospital in such vehicles. I think there is no other alternative but to knock judiciary's door," he said.

The smaller vehicles with the hospitals are mostly donated by legislators from their constituency funds but quite a few I have been purchased by the department as well.

SMHS hospital is the main hospital in Kashmir. Among the hospital's fleet of "ambulances", six are Maruti vans, two are Tata 407, one Maruti Gypsy and one ambassador car. Most of the smaller vehicles are used as staff cars.

Health experts in Kashmir suggest that apart from complete emergency ambulances in hospitals, there is a need for full-fledged ambulance on call service, more so because of the conflict in the region.

"There is a dire need to set up a complete ambulance service that would cater to untoward incidents and provide timely help to the people. That way the number of deaths can be reduced in Kashmir," said Shahzada Musharib, a social work professional.

Musharib says even the efficacy of Fire and Emergency Service should have trained paramedics and ambulances.

"Otherwise there is no sense in the word 'Emergency Services' in the department," says Musharib.

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Click here to read this story. For reproduction rights contact Kashmir Newz Desk

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