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A look at “India’s medical miracle,” the largest ambulance service in the world

A patient in shock arrives via ambulance at Gandhi Hospital in Hyderabad, India with a gaping wound in his right hand, blood spattered on his blue jeans and T-shirt. Emergency medical technicians wheel him into a dark room in the government-run hospital, where clinicians move quickly to irrigate the wound and pump fluids into the man, who appears to be in his 20s.

With luck, the patient might survive. Ten years ago, he would not have had a chance.

Thanks to some passionate philanthropists, businessmen and medical experts, India today has what we have long taken for granted in the United States: a modern, emergency 911-type system and a cadre of trained emergency responders who have helped save an estimated 1.4 million lives. Begun in 2005, it is now the largest ambulance service in the world and serves more than 750 million people in cities and villages across the Indian sub-continent.

I saw the system in action first-hand in August when I traveled to India, together with about 10 other faculty and staff from Stanford’s School of Medicine, including Dean Lloyd Minor, MD, to celebrate its 10th anniversary amid much color and fanfare. I was there to write a story about the new system for Stanford Medicine magazine.

Begun in August 2005 in the south Indian metropolis of Hyderabad, the service, known as GVK EMRI (Emergency Management and Research Institute), is operated as a public-private partnership, providing its services free of charge, mostly to the very poor. It is a remarkable achievement, given the diversity of India, with its 29 states and more than 120 major languages, and the bureaucracy and corruption that can sometimes impede progress in this vast country of 1.2 billion souls.

“It’s hard to fathom what this system has done in 10 years,” S.V. Mahadevan, MD, interim chair of Stanford’s Department of Emergency Medicine, told me while stationed in one of EMRI’s ambulances. “It could be regarded as one of the most important advances in global medicine in the world today.”

Mahadevan has been involved in the venture from the start and is among a group of Stanford emergency medicine physicians who have been instrumental in bringing it to life. Stanford clinicians trained many of the people who man the ambulances, as well as those who serve as paramedic educators. They developed the medical guidelines that are carried on every ambulance – from how to treat cobra bites and pesticide poisonings to care of women in labor - and conduct research that continually leads to improvements in patient care.

“The contribution from Stanford is something very phenomenal,” Ramana Rao, MD, director of the group’s Emergency Medicine Learning Center and Research, told me. “Back in 2007, there were no programs to train advanced paramedics. I’m proud to say that Stanford physicians have trained advanced clinical educators who have maintained our standards. Down the line, these educators will become the leaders in our country.”

I spent two days riding on EMRI ambulances in Hyderabad, a crazy patchwork of a city that is a modern technology hub as well as a home to ancient monuments built by the Moghuls who ruled the area for hundreds of years. I saw people injured by traffic accidents and suffering from life-threatening wounds and infections who were whisked to local hospitals, where they received medical attention that could be life-saving.

While India has a long way to go before its medical care system meets accepted international standards, GVK EMRI clearly is making a difference in helping bring the country into the modern age of emergency care.

Previously: Pharmaceutical adventures in IndiaStanford journalist returns to old post in India – and finds health care still laggingStanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India and Stanford-India Biodesign fellows develop prototype device to improve success of pacemaker implants

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