Tele-Emergency Services in the Himalayas.

INTRODUCTION: Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency Services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months.

METHODS: Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available.

RESULTS: In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208.

CONCLUSIONS: Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.