“Hello? Help!” Responding to an emergency

Consider the following situations.
Scenario 1: Imagine that you have gone to the beach along with your friends and enjoying the excursion. A lot of your friends are in a light mood when one of your friends — who did not know much of swimming — is drawn into the sea due to tide.
Scenario 2: Think for a moment that while waiting for a bus at the bus-stop, you see an approaching car colliding head-on with a truck in the process of overtaking another vehicle just ten meters away from you.
Scenario 3: You are walking up the stairs to your house on the third floor and another person is also moving up in the staircase slowly. A couple of moments pass before you observe that the person suddenly holds his chest with both his hands and drops from a higher step in front of you.

What will be your response in each of such incidents?

Baffled?

Your response is not surprising, since we all tend to take for granted that everything would always be normal when it is not so. Something that surfaces very quickly, putting one or more individuals (or sometimes even vehicles/properties) at severe risk, an emergency is said to have occurred.

If a person has never thought of such cases and never prepared for an appropriate course of action, he/she is not educated even if he/she possesses a qualification on paper. This is because a person can have meaningful life only when he//she has a purpose and the purpose can be served only when there is life!

A delay of a few minutes in any of the situations like those cited above can also cause loss of life in certain emergencies.

It is, therefore, imperative to be prepared to face different common types of emergencies and to know what best YOU could do as and while they unfold to minimise harm and loss. This is called ‘response’ to an emergency. Response is different than reaction. A proper response reduces deaths, disabilities, and sufferings.

Note that an emergency can seldom be handled successfully by one person. It needs guidance and active help from many including various agencies such as transport (usually an ambulance), fire department, and a clinic or a hospital. You should, unhesitatingly, play the crucial role of an initiator when a situation demands.

Let us now look at the different aspects of emergencies in some details, in order to be confident about the course of action when they occur.

1. The legal aspect:
Vast majority of Indians is kind-hearted; yet hesitates to act swiftly and allow victims in emergencies to suffer in pain and sometimes even die at the sites of accidents. This hesitation has its root in the feeling of insecurity. They are scared just with the thought that associated government agencies such as the hospital authorities or the police would harass them. This is a myth now. The Supreme Court of India passed an order in March 2016 and approved the Guidelines of the Central Government of India to protect good samaritans helping emergency victims (mainly in road accidents). All state governments have to follow the guidelines since they are not an advisory but a legally approved document now. These guidelines are often called the “Good Samaritan Law”.

Main features of the Good Samaritan Law are that –

• Good Samaritan will not be liable for any civil or criminal action for any injury or death of the victim
• Good Samaritan who informs police or emergency service regarding an injured person not to be compelled to reveal his/her personal details
• Disciplinary action against public officials who coerce Good Samaritan to reveal his/her personal details
• Good Samaritan not to be forced to reveal his/her personal details: Disclosure of personal information including for the Medico Legal Case (MLC) Form to be made optional and voluntary 
• Good Samaritan not to be forced to bear the initial cost of treatment: Ministry of Health and Family Welfare (MoHFW) to issue guidelines that no public or private hospital can demand payment for registration and/or admission costs from the Good Samaritans 
• Hospitals cannot refuse treatment to a victim: Lack of response by a doctor in an emergency situation to be considered as a “Professional Misconduct” and disciplinary action shall be taken against such a doctor (as per Indian Medical Council Regulations, 2002) 
• Good Samaritan can choose to be an eyewitness and cannot be compelled
• Eye witness to be examined in a single occasion 
• Examination of an eye witness to be either through: – Section 284 CrPC: Allows examination of a witness through a commission – Section 296 CrPC: Allows evidence to be given through an affidavit 
• Video conferencing may be used for examination of a Good Samaritan

2. The moral aspect:
As an Indian, you owe responsibility to treat all fellow beings with care and due respect. This is what you have already accepted in your school pledge. Therefore, in an emergency situation, not to avoid taking responsibility to save others is your moral duty.

Types of emergencies

1. Medical Emergencies:
A serious and unexpected situation involving illness or injury and requiring immediate action is called a medical emergency. It can involve:

•  Choking: Partial or complete blockage of the windpipe. 
• Breathing problem — Asthma: A condition in which a person’s airways become inflamed, narrow, and swell and produce extra mucus that makes it difficult to breathe.
• Bad allergic reaction: A condition in which the immune system reacts abnormally to a foreign substance. Common types of it are drug allergy, food allergy, or seasonal allergy where allergic response causes itching, watery eyes, sneezing, and other similar symptoms. 
• Chest discomfort or Heart attack: A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies. Symptoms include tightness or pain in the chest, neck, back, or arms as well as fatigue, light-headedness, abnormal heartbeat, and anxiety. 
• Fainting: A sudden loss of consciousness, usually temporary, and typically caused by a lack of oxygen in the brain. The brain oxygen deprivation has many possible causes, including hypotension (low blood pressure). 
• Diabetes: Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. 
• Stroke: Occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

2. Trauma Emergencies

• Bleeding: Bleeding, also known as haemorrhage, is blood escaping from the circulatory system. 
• External bleeding: Our circulatory system is made up of our heart pumping blood through arteries to deliver oxygenated blood to tiny capillaries that distribute the blood to all of our tissues. Our veins collect the blood from the capillaries and return the un-oxygenated blood back to our heart. External bleeding is when blood is leaving the body through some type of wound. Any incident in which you physically saw blood would be an external bleed. 
• Internal bleeding: Bleeding you cannot see. Injury due to blunt trauma.
• Bleeding from nose
• Bleeding from mouth
• Impaled object: Items that have punctured the body and are still embedded. 
• Amputation: Cutting off of part of the body such as limb or part of limb.
• Fracture: Discontinuity in bony structure. 
• Head and spine injury 
• Joint and muscles injury: – A strain is overstretching of a muscle or a tendon – A dislocation is separation of the head of a bone at a joint (this can have an associated fracture) – A sprain is tearing of a ligament at the joint
• Burns (heat, steam or electricity): Damage to the skin and underlying tissue by heat, chemicals, electricity, or radiation.

3. Environmental Emergencies:

• • • Bites and sting 
    • Rabies
    • Snake bites
    • Drowning 
    • Bad allergic reaction: Your immune system is responsible for defending the body against bacteria and viruses. In some cases, your immune system will defend against substances that typically don’t pose a threat to the human body. These substances are known as allergens, and when your body reacts to them, it causes an allergic reaction. 
    • Heat related emergency – Hypothermia: Reduced body temperature that happens when a body dissipates more heat than it absorbs.

    – Hyperthermia: Elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.

What can you do?

Sometimes it might be necessary and sufficient to reassure a victim through First Aid. We define First Aid as the assessment and intervention that can be performed by a bystander with the minimal or no medical equipments.
The key objectives of first aid are:

• To preserve life. 
• To alleviate suffering 
• To promote recovery 
• To minimise patient’s medical or trauma dilemma 

• General Principles of First Aid that you should always observe are:

• Staying calm while responding to any emergency situation 
• Making the victim occupy a safe and comfortable position — little away from the site of emergency, whenever possible 
• Seeking help by calling EMS helpline (108) at the earliest since emergency response involves team effort 
• Reassurance

Emergency Medical Services (EMS)
EMS is a specialised field where emergency healthcare needs are addressed through a well defined care process by trained EMS professionals. EMS provides emergency medical services in the form of well-equipped life support ambulances for any kind of medical emergencies all across Maharashtra and some other states in the country.

An EMS contingent, Maharashtra.

The EMS team provides integrated response with Police and Fire Department in life threatening situations. This means, if you spot an emergency where medical help might be required, call takers from EMS will coordinate with Police and Fire Department as per the requirement.

Emergency Medical Services in the country can be accessed by dialling toll free number 108 without any suffix or prefix. Control room for 108 Service understands need of the patient and location of the patient, and dispatches the nearest appropriate ambulance for the patient. Emergency Response Centre Physician (ERCP) will provide on-line medical direction for the doctors/paramedics on ambulance during emergency calls.

108 Control Room call process flow
When you identify an emergency and place a call to ‘108’, Emergency Response Officer (ERO) in 108 control room will ask for your name. After confirming the location and need of ambulance, a call to nearest ambulance will be made. Once the ambulance arrives at the spot of medical emergency, necessary actions will be taken to stabilise the patient and patient will be transported rapidly to the appropriate hospital with en-route care.

Information requested by ERO is mandatory and needed to help patient. Stay calm and cool and listen to Emergency Response Officers (ERO). After providing your name to ERO, the following details will be sought: Patient Details: Name / Age / Gender / Patient’s condition Incident Details: District / Tehsil / City-Village / Locality and Landmark
Follow all instructions given by ERO and answer any further questions. Don’t disconnect the phone line until ERO guides you to do so.

Now that you are aware about what is an emergency, various types of emergencies taking place in houses, workplaces, vehicles, and even beyond — practically anywhere — you must respond quickly and properly to any kind of emergency and take pride in discharging your duties as a citizen.

By,
Dr Dnyaneshwar Shelke
Chief Operations Officer,
Maharashtra Emergency Medical Services
BVG India Ltd.