Transporting Snake Bite Victims to Appropriate Health Facility within Golden Hour through Toll Free Emergency Ambulance Service in India, Save Lives

摘要

Background: Snakebite is a neglected public health issue in India. The big four venomous snakes are Cobra, Krait, Russell’s viper and Saw scaled Viper. Estimates of annual snakebite mortality in India are upto 50,000 deaths as exact figure of death due to snakebites is not known due to the fact that snakebite is not a notifiable event in India. Materials and Methods: Computer Telephonic Integrated (CTI) data of snakebite patients transported by ambulances was obtained from Emergency Response Center of 12 states out of 16 Emergency Management and Research Institute (GVK EMRI) operating states for the year 2014. Data analysis was done using Micro Soft Excel. Victims who complained of snakebite and decided to avail the toll free108 Emergency Ambulance Service(EMS)were included in this study from GVK EMRI operating 10 States and 2 Union Territories that constitutes more than half of the country’s population majority of this being rural. Results: A total of 29,231 snake bite cases were enrolled in this study period. Of these 28,206 were included in the study. Out of 28,206 patients 27,805 were admitted to hospital. Out of remaining 401 cases, 168 cases expired before the EMS ambulance arrival, 161 were given first aid and 72 cases expired before admission on way to the hospital. Type of hospitals, patients were transported and admitted to were, Government 25,029, Private 2,583 and Trust 193. Overall mean response time from base to scene was 00:22:56, at scene 00:10:06 and scene to hospital arrival was 00:47:02 (hh:mm:ss), nearer to golden hour. Out of 27,805 admitted cases 8,519 could be followed up after 48 hours, 6,050 were all right and discharged from the hospital, 1879 were stable and out of danger but still in hospital, 9 were with condition still critical-in hospital, 41required only first-aid and 359 expired after 48 hours and status could not be ascertained in 181 cases due to non availability of telephone number as108 EMS was activated by a call from a bystander. Conclusion: The GVK EMRI ambulances that are fully equipped with all life saving equipments and drugs including anti snake venom (ASV) are able to save lives in critical condition of snakebite victims while they are called on toll free number108. This model of free transportation in emergency needs to be replicated in other parts of the country and also in high snakebite incident countries of Asia and Africa.