Emergency Medical Service Systems: A Global Perspective Shakti Kumar Gupta, Sunil Kant, Angel Rajan Singh
INDEX
ABCDEFGHIJKLMNOPQRSTUVW
Page numbers followed by f refer to figure and t refer to table, respectively
A
Acute coronary syndrome 148
Additional resources for EMS 102f
Advantages of
communication 88
information 88
technologies 88
After prehospital ECG timings by phase 122t, 123t
Agencies
involved in EMS 179t
to dispatches being made, list of 96f
ALS versus BLS-D in OHCA 117
Ambulance 20, 39
applications and RMS 92
choice 200
design and
fabrication 98
fleet management 200
distribution in
Ireland 18f
Romania 26f
layouts 159f, 160f
personnel and equipment 9
response time, causes for delay in 193f
safety 202
specifications in India 157
Antimicrobial copper 127
in emergency medical services 125
Applications and requirements 200
Area of response of HEMS 212f
Atlanta VA hospital 139
Autoinjectors 224f
Autopulse 107
Average annual growth in ED visits 67f
B
Baby with brain stem lesion 147f
Bag value mask 145f
Basic trauma and casualty care 77
Basis of BTACC course 78f
Before prehospital ECG timings by phase 122t, 123t
Bigger
tyres of DOST 208f
windshield 208f
Bioburden on copper surfaces 132f
Biological
management 101
preparedness for chemical in India 45
Bioterrorism 41
Boussignac CPAP 146f
BTACC 77
course, basis of 78f
Burden of emergencies in community 56f
C
Campaign for patient awareness 151f
Canadian study 115
Capacity development 36
Cardiac arrest 15, 115
Causes for delay in ambulance response time 193f
CBRN management 43
CCRTF reports 1997 and 1998 61f
Central interdisciplinary emergency unit 65f
Chain of
emergency medical care call and dispatch 39
patient flow 57f
survival 63f
Challenges 25
for education and training of emergency
medicine personnel in India 177
in developing quality ambulance in India 206
Changing
scenario 196
trends in emergency calls 6f
Characteristics of patients with STEMI
transferred for primary PCI 84f
treated with PPCI 85f
Chassis, choice of 201f
Chemical
agents 42
for screening in special lab, list of 103f
management 101
Choice of chassis 201f
Circulation improving resuscitation
care trial 107, 108
Classification of mass gatherings 165t
Coast guard helicopters to carry emergency
patients 18f
COE construction 207f
Collection of data 49f
Commencement of EMS (1899) 3f
Communication 29
in emergency care 88
advantages of 88
Community health clinics 57
Community-based emergency care 56
Comparison of
DCAS ambulance response time 192
EMS systems 156
Compliance to standards 206
Components of
CAD 91
EMS call 47
Computer aided dispatch systems 90
Consolidated dispatch 95
about communications 94
Constitution of PAROS 153f
Continuum of care 76
Copper in all GLP tests in bacteria 131f
Core values of Falck 37f
County wide coordination 97f
CPR process data 112t
Creativity culture 51
Critical steps 170
Crush syndrome 188f
CT scan bowels full of air 146f
Culture of continuous improvement in hospitals
and emergency medical services 134
Current situation 7
Customer requirements 206
D
Data
analysis 111
collected in EMS system 50f
entry 155
interpretation 189
management goals 138
Decrease in median door-to-balloon time 123f
Dedicated points of actions in cases of
emergencies 171f
Department front door 67
Designing helicopter interiors for air
ambulance 218
Detection capabilities for biological warfare agents
and toxins 223f
Development of prehospital emergency care in
Karachi 170f
Different phases of patient management in ED 68f
Dirty bomb 41f
Disaster
management 31
Act 31
vehicles 201f
mitigation 174
relief 174
Discussion 114
Distribution
network of helicopter emergency medical
services 5f
of EMS in cologne 101f
of oxygen 99f
District hospitals 57
DOST ambulance 207
DRDO's achievements and endeavors 221
Dubai scenario 191
E
E coli 130f
Early care and impact on disease 59f
ECG of STEMI case 149f
ECGs transmitted by month 121t
ED quality impact on overall hospital quality 199
Education and documentation 190
Effect of stopping compressions on blood flow 135f
E-learning platform supporting wider ambulance
emergency preparedness 228f
Elements of emergency response system 90f
Emergencies in community, burden of 56f
Emergency
care system–Karachi 170
core services 38f
department
and bomb blasts 170
overcrowding 58
management exercise 36
medical
care 24
response for Fukushima nuclear power plant
accident 230
services concepts in incident 101
services in
Germany 3
Ireland 17
Italy 20
Singapore 7
various countries 1
services
Indian scenario 88
operation crowded areas—mass
gatherings 165
performance indicators 79, 191
plan in cologne 101
preparedness for mass gatherings 71
system in Japan 12
system in Korea—hospital phase 28
medicine services evolution 177
physician 14f
response 31
system under national rural health
mission 181
EMRI
business model 181
timeliness 184t
type of cases moved by medical category 184
EMS
and medical care cost 14
centers in India 178f
dispatch system 13f
distribution pattern in Germany 4f
evolution in Germany 4
history in western world 39f
in Ireland 17
in numbers 13
planning 167
staffing 20
system in United States 48
EMSS in Korea
interhospital transfer 29
prehospital phase 28
EPAROS 155f
EPCR sheet 19f
Equipment 21, 145, 218, 227
Etiology of patients 14, 15f
Evaluation 228
Event planning 166
Evolution of prehospital emergency services in
India 37
Examples of challenges 206
Extrinsic motivation 51
F
Facts about HAI 126f
Financing 29
models across emergency unit 215
First responder bag 55f
Fixed wing aircraft 213f
Fleet management and funding 202
Fly eye concept 52f
Fukushima nuclear power plant 230
G
General characteristics by arm 112t
Genesis 226
Germany map 210f
Goal 202
Golden hours 214f
Good ambulance 98
Governance of PAROS 152
Government initiative towards EMS 180f
Gradual implementation of PPCI and triage of
patients 85f
GVK EMRI 174
H
H1N1 virus inactivation tests 130f, 131f
Hardware and equipment 54
Haryana Swasthya Vahan Sewa Model 181
Hazardous area response team 226
Headlamps of DOST 208f
Heartstart FR3 136
Helicopter emergency medical services
market requests 218
overview 214
Helicopter EMS floor 220f
HEMS 212
area of response of 212f
challenges 216
crew 212f
stations in Germany 211f
HGV incidents often serious 187f
Hospital consumer assessment of healthcare
providers and systems 199
I
ICT in EMS 89
Ideal STEMI system of care 151
Identification of safety risks 168
Impact 176t
on outcome 84
Importance of
emergency department's front door 67
touch 126
Improvement 63
Incident
location cases analysis 193f
response system 33, 34f
Inclusion criteria 110
Increase in paramedics 12f
India's vulnerability to disasters 31
Indianapolis
system 72
Indiana, USA 71f
Individual
physician and nurse monitoring 199
protection 224f
Infection control, multifaceted challenge 128
Information 29
advantages of 88
in emergency care 88
Initial emergency system in Romania 24f
Innovation 51, 227
Inside
Italian ambulance 21f
of ambulance 29f
view of helicopter for transportation 5f
Integrated
approach 58
computer aided dispatch system 90
emergency system 25f
Interhospital transfer 189
systems 190
Interior of DOST 209f
International regulatory guidance 216
Intraosseous 140
Intrinsic motivation 51
Introduction to American Heart Association 148
Invention 51
and innovation in emergency medical and
trauma services 51
Malaysia 52
Italian ambulance
adult and pediatric spinal board 22
stretcher 21f
transport and evacuation chair 22f
IV bottles 206
J
JAAM activities 232
Janani express business model 182
K
Korean model of financing emergency care 27
L
Legal-institutional framework 32f
Legislation 79
Limitations 123
Load distributing band 107f
CPR 108f
Loss of life per minute 59f
LSPV with booster breaks 208f
M
Maintaining clinical focus missive project
innovative of human patient simulation 227f
Major improvements 64f
Management
algorithm of trauma 64
of algorithm of trauma 65f
Map
epicenter and spread of Bhuj earthquake 173f
of Korea 27f
Mapping system 93f
Mass
casualty
event 33
incident 101
gatherings 72
classification of 165t
Material comes close to antimicrobial copper 129f
Mechanical CPR device 5f
Mechanisms
for creating blood flow during CPR 108f
of injury 187
Medical
management 224
preparedness for
CBRN 43
chemical in India 45
preparedness Indian scenario 31
Methicillin resistant Staphylococcus aureus bacteria 129
Microorganisms on touch surfaces 127f
Mini marathon 72f
Miriam hospital 139
Modern dispatch centre 9f
Monitoring of oxygen 99f
Monthly average response time with respect to
area 192f
Montreal ambulance service 92
Movement to
most competent hospital 80f
nearest hospital and regional hospitals 80f
MRSA viability on copper alloys and stainless steel at 200°C 129f
Multicenter Canadian study of prehospital trauma care 116f
Multidisciplinary
action 205
trauma team 64f
Myocardial infarction 119
N
National
disaster response force 33
equipment strategy 229
guidelines on medical preparedness and mass
casualty management 33
HART activity 227
multi agency 227
preparedness goal in context 75f
NBC
defence
preparedness 222
technologies 221
threat scenario 221f
NDRF battalions 35f
Network membership 153
Nuclear
disaster management 101
emergencies in India 41
Number of
participants of CPR course by fire department 15f
registered doctors and nurses 28t
O
Objectives of emergency response system 90
Obstructed frontal access 188f
Optimization of STEMI care 124
Optimized prehospital treatment 217
Original dispatch center 94f
Outcome to triage of patients 86f
Ownership pattern of Falck 38f
Oxygen, control of 99f
P
Pan-Asian resuscitation outcomes study 152
PAROS sites 156
Participating countries 154f
Patient
awareness, campaign for 151f
stretcher 207
trend in Singapore 58f
with STEMI
transferred for primary PCI,
characteristics of 84f
treated with PPCI, characteristics of 85f
Penetration sites 141f
People dying in terrorist related activities 169f
Percutaneous coronary intervention 82
Philips heartstart FR3 137f, 138f
Planning and design essential components of
emergency medical services system 47
Plans of PAROS 155
Post visit calls 198f
Potential
biological agents 222f
effects of reduced space per person 167t
Potentially dangerous crowd forces and
psychological pressures begin to develop 167t
Power and functions of NDMA 32
Pre-development challenges 206
Pre-fabricated ambulance construction process 100f
Prehospital 140
12-lead ECG 151
ECG transmission 119
emergency care—Five-Year plan (2009–2014) 10
pyramid model for India 40
Preparing
emergency department for victims of bomb 169
for 21st century 226
Present integrated dispatch center 95f
Primary PCI procedures per year 83
Principal structuring of EMS equipment 220
Principles in management 76
Proactive rounding 198
Problem with EMS 88
Process in emergency department 69f
Public private partnership in emergency medical
services 174
Q
Quality
and patient's safety in emergency
department 196
definition 196
improvement 196
measures 199
Quick conversion benefits 219
R
Radiation emergency medical system in
Japan 231f
Radiological
management 101
preparedness for chemical in India 45
Randomization 110
procedure 111f
Reducing door-to-balloon 119
Relationship of door-to-balloon time and
mortality 119f
Reperfusion strategies for STEMI 148
Response time 14f
Results
effectiveness endpoint 113t
mean response time and number of fire stations
and fire posts by month 9
neurologic endpoint 113t
of survey to find grassroot perspective in
EMS 180t
Retrospective quality measures 198
Rise of antibiotic resistant strains 125f
Road casualties in Germany 215f
Roadmap summary 11f
Roadside to critical care continuum of care 76
Role of
advanced life support in Asian EMS 115
central ministries and departments 32
doctors 231
S
Safety
and adaptation to environment 217f
features 207
for safety of doctors/paramedics 98f
of attendants 99f
SCDF annual call volume 1997–2010 8f
Screenshot of EMS data 102f
Secondary triage 53f
Series of
discrete steps-1 77f
very discrete steps 76f
Simulation and modeling 225
Single patient configuration 220f
Sites for IO 141f
Smart CPR 135, 136
Solutions for EMS 88
Specialized medical facilities 36
Specific reasons to
communication 194f
geographical factor 194f
ST elevation myocardial infarction program 81
Stakeholders for specifications of ambulance
interior 219f
Standards of care 19
State trauma committee and working group’s
governance arrangements 62f
State with
EMRI services 182t
government managed services 182t
local tie-ups Janini Express Model 183t
ziqitsa services 182t
STEMI based on prehospital ECGs 122t
Strategic
imperatives 10f
medical intelligence 42f, 44f
Strategies to improve quality 197
Stratified to prehospital triage 85f
Strengths 185
Stretcher for helicopter 219f
Structure and management of trauma patients
military hospital 63
Subgroup analysis 113, 113f
Subject exclusion 111
Successful systems of trauma care 60
Suggestions from guidelines 158
Suitcase nuke 42f
Synergizing 175f
System
delay and
heart failure 87f
mortality 86f
in Romania 24
of care for STEMI patients 149
prior to implementation of prehospital 12-lead
ECG 120f
T
Technologies
advantages of 88
in emergency care 88
Telemedicine 82
and field-triage of patients with STEMI for
primary PCI 82
system in emergency care in Romania 79
Tender requirements for ambulances 204
Tertiary hospitals 57
Threats—UK hazardous area response team 226
Time
in acute ST elevation 119
wise case analysis for 2011 195f
Timeliness dimension 184
Total cases transported 184t
Total emergency ambulance service calls 8f
Touch surfaces 126
replaced with copper 133f
Traditional vs alternative plant 188f
Training 227
Trauma 60
system 60
Trends of EMS calls in Dubai 191f
Triage counter 52f
Trial
data 120
phases 110f
sites 109f
Tsunami damaged FNPP 230f
Turning customer insights into meaningful
innovation 134
Turning disaster into opportunity, Gujarat
experience 173
Two-patient configuration 220f
Two-tier hospital defibrillation 138
Types of membership 154f
U
Understanding current state 68
Use of
information technology in Dubai emergency
medical services 191
self-disinfecting touch surface 125
Utstein analysis in Japan 16f
V
Variation and ED beds 197f
Vehicle level parameters 204t
Ventilation in emergency medical services 145
Victorian road trauma committee 61
W
Wait management 54f
Weaknesses 185
Workload characteristics 165
and conceptual model 166t
Workload prediction 165
×
Chapter Notes

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1Emergency Medical Service Systems2
3Emergency Medical Service Systems A Global Perspective
Editors Shakti Kumar Gupta MBBS MHA FNAMS FIHE FAHA HOD, Hospital Administration and Medical Superintendent All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences New Delhi, India Brig. Sunil Kant VSM, MBBS DCE DCA MBA MHA MPhil Army Medical Corps India Angel Rajan Singh MBBS PGDHHM MHA (AIIMS) Senior Resident Administrator Department of Hospital Administration All India Institute of Medical Sciences New Delhi, India
4
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Emergency Medical Service Systems: A Global Perspective
First Edition: 2014
9789350909942
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5Dedicated to
The memory of Rani (Kamlesh) nee Kamal who devoted her
entire life giving happiness to others and making them comfortable.
She used to feel happy and elated at every stage of my academic excellence.
Shakti Gupta
My parents and brother
whose sublime blessings continue to provide steadfast anchorage and solace.
My lovable wife Sheeba and adorable daughter Dakshita
who constantly inspire and enrich me in life's wonderful journey.
Brig Sunil Kant vsm
My family, teachers and mentors for their unflinching
support and guidance; and to the numerous lives lost due to lack of an
organized Emergency Response, which inspires us to work towards this cause.
Angel Rajan Singh
6
7Contributors 11Preface
An International Congress on Emergency Medical Service Systems—EMS 2012 was held at the All India Institute of Medical Sciences, New Delhi, India, from 9th to 11th February, 2012. The Congress was attended by almost 1,400 participants and included foreign experts/participants from various countries. The main objectives of the Congress were to:
The Congress was able to achieve its stated objectives. A Global EMS Leaders Forum was formed to promote research and knowledge sharing. Various domain experts under the chairmanship of Dr Shakti Kumar Gupta formulated the National Ambulance Code and it has already been notified by the Government of India. Concepts, essentials and requirements of EMS and ambulances deliberated during the Congress provided significant inputs in the finalization of the National Ambulance Code. As a step for knowledge sharing and dissemination, the Editors planned to formulate a document based on presentations made by the speakers during the Congress. The powerpoint presentations and the audio-video recordings served as the resource for this document. It was also in consonance with objective of the EMS Congress for knowledge sharing and enhancement. The chapters have been grouped into four Sections viz:
Section I
Emergency Medical Services in Various Countries
Section II
Planning and Design
Section III
Research Studies
Section IV
Views, Experiences and Perspectives
The book will be a useful guide to the policy makers, administrators, clinicians and other stakeholders related to EMS. It will serve as a reference material for policy making, planning, establishing norms, formulating quantitative requirements, gap analysis, clinical protocols, research studies, historical perspectives, quality assurance, Continuous Quality Improvement (CQI) variables, operational and strategic imperatives related to EMS.
Editors
12Abbreviations ABS
Acrylonitrile Butadiene Styrene/Antilock Braking System
ACEP
American College of Emergency Physicians
AC
Air Conditioning
ACS
Acute Coronary Syndrome/American College of Surgeons
A&E
Accident and Emergency
AED
Automated External Defibrillators
AHA
American Heart Association
AIDS
Acquired Immunodeficiency Syndrome
AIIMS
All India Institute of Medical Sciences
ALE
Airport Viewing Equipment
ALI
Automatic Location Identification
ALS
Advanced Life Support
AMA
Against Medical Advice
AMD
Ambulance Manufacturers Division
AMI
Acute Myocardial Infarction
ANI
Automatic Number Identification
ANMs
Auxiliary Nurse Midwife
AP
Andhra Pradesh
ARAI
Automotive Research Association of India
ART
Ambulance Response Time
ASHAs
Accredited Social Health Activist
ATACC
Anesthesia Trauma and Critical Care
ATLS
Advanced Trauma Life Support
AV
Audio Visual
AWWs
Anganwadi Workers
BCLS
Basic Cardiac Life Support
BIG
Bone Injection Gun
BLS
Basic Life Support
BLS-D
Basic Life Support-Defibrillation
BM
Bone Marrow
BTACC
Basic Trauma and Casualty Care
BVM
Bag Valve Mask
CAD
Coronary Artery Disease/Computer Aided Dispatch
CAT
Combat Application Tourniquet
CBD
Continuous Bladder Drainage
CBRN
Chemical, Biological, Radiological and Nuclear
CCC
Consolidated Communications Committee
CD
Civil Defence13
CFU
Colony Formating Units
CHCs
Community Health Centers
CIRC
Circulation Improving Resuscitation Care
CMC
Christian Medical College
CMVR
Central Motor Vehicle Rules
COE
Cab-Over-Engine
CPAP
Continuous positive airway pressure
CPC
Cerebral Performance Categories
CPD
Chronic Pulmonary Disease
CPR
Cardiopulmonary Resuscitation
CQI
Continuous Quality Improvement
CRF
Case Record Form
CRG
Case Review Group
CRM
Call Reception Module
CRN
Clinical Research Network
CRT
Cardiac Resynchronization Therapy
CT
Computed Tomography
CTI
Computer Telephony Integration
CVL
Cardiovascular Catheterization Laboratory
DANAMI
Danish Multicenter Randomized Study
DCAS
Dubai Corporation for Ambulance Services
DDT
Dessillons and Dutrillaux Tourniquet
DHS
Department of Human Services
DM
Disaster Management
DMA
Disaster Management Act
DMAT
Disaster Medical Assistant Team
DMD
Disaster Management Department
DNA
Deoxyribo Nucleic Acid
DRDO
Defence Research and Development Organisation
DSMB
Data and Safety Monitoring Board
EAB
Events Advisory Board
EAS
Emergency Ambulance Service
ED
Emergency Department
ELSTs
Emergency Life-Saving Technicians
EM
Emergency Medicine
EMA
Emergency Medical Act
EMEX
Emergency Management Exercise
EMR
Electronic Medical Record
EMRI
Emergency Management and Research Institute
EMS
Emergency Medical Services
EMSS
Emergency Medical Service System
EMT
Emergency Medical Technician
EOC
Emergency Operation Center
EPA
Environment Protection Agency
ePCR
Electronic Patient Care Record/Endothelial Protein C Receptor
ERC
Emergency Response Center14
ERCP
Emergency Response Center Physician
ERS
Emergency Response System
ESF
Emergency Support Functions
ESI
Emergency Severity Index
ETA
Expected Time of Arrival
EtCO2
End Tidal Carbon Dioxide Concentration
ETI
Endotracheal Intubation
EU
Emergency Unit
FA
First Aid
FAST
Focused Assessment with Sonography for Trauma
FDMA
Fire and Disaster Management Agency
FEMA
Federal Emergency Management Agency
FMVSS
Federal Motor Vehicle Safety Standard
FNPP
Fukushima Nuclear Power Plant
FQRP
Fluoroquinolone Resistant Pseudomonas Aeruginosa
FRP
Fibreglass Reinforced Plastic
FPPE
Focused Physician Practice Evaluation
GIS
Geographical Information System
GLP
Good Laboratory Practice
GP
General Practitioner
GPS
Global Positioning System
GTN
Glyceryl trinitrate
GVK EMRI
GVK Emergency Management and Research Institute
H1N1
Influenza A virus
HAI
Healthcare-Associated Infections
HART
Hazard Area Response Team
HAZMAT
Hazardous Material
HCAHPS
Hospital Consumer Assessment of Healthcare Providers and Systems
HEMS
Helicopter Emergency Medical Service
HF
Hemorrhagic Fever
HGV
Heavy Goods Vehicle
HSVS
Haryana Swasthya Vahan Sewa
IAN
Integrated Ambulance Network
ICT
Information, Communication and Technologies
ICU
Intensive Care Unit
ID
Identification
IEC
International Electrotechnical Commission
IFR
Instrument Flight Rules
IIEMS
Indian Institute of Emergency Medical Services
IO
Intraosseous
IP
Internet Protocol
IPM
Independent Provider Model
IPPV
Intermittent Positive Pressure Ventilation
ISS
Injury Severity Score
IT
Information Technology
ITACC
In-hospital Trauma & Critical Care15
ITLS
International Trauma Life Support
IV
Intravenous
JAAM
Japanese Association of Acute Medicine
JAMA
The Journal of the American Medical Association
JE
Janani Express
JSY
Janani Suraksha Yojna
KAG
Koronar Angio Grafi (Coronary Angiography)
LED
Light-Emitting Diode
LOS
Length of Stay
LSPV
Load Sensing Proportioning Valve
LWOT
Left Without Treatment
MA
Medical Aid
MAC
Medical Advisory Committee
MAS
Metro Statistical Area
MAST
Military Assistance to Safety and Traffic/Military Anti Shock Trousers
MCI
Mass Casualty Incident
MCPR
Manual Cardiopulmonary Resuscitation
MHA
Ministry of Home Affairs
MHP
Massive Hemorrhage Protocols
MICU
Mobile Intensive Care Unit
MJE
Mini Janani Express
MMR
Maternal Mortality Rate
MoHFW
Ministry of Health and Family Welfare
MoU
Memorandum of Understanding
MRS
Modified Ranking Scale
MRSA
Methicillin Resistant Staphylococcus Aureus
MUSC
Medical University of South Carolina
MV
Manual Ventilation
NAEMSP
National Association of EMS Physicians
NBC
Nuclear, Biological and Chemical
NCC
National Cadet Corps
NDA
National Disaster Authority
NDMA
National Disaster Management Act
NDRF
National Disaster Response Force
NEMA
National Emergency Management Agency
NEMC
National Emergency Medical Center
NGO
Non-Governmental Organizations
NHI
National Health Insurance
NIDM
National Institute of Disaster Management
NIMS
National Incident Management System
NIPP
National Infrastructure Protection Plan
NMC
National Medical Center
NP
Nasopharyngeal
NRHM
National Rural Health Mission
NRP
National Response Plan16
NVIS
National Vision Imaging System
NYKS
Nehru Yuva Kendra Sangathan
OD
Overdose
OEM
Original Equipment Manufacturer
OHCAs
Out of Hospital Cardiac Arrests
OP
Oropharyngeal
OPALS
Ontario Prehospital Advanced Life Support
OPC
Overall Performance Categories
OPPE
Ongoing Physician Practice Evaluation
OR
Odds Ratio/Operating Room
OT
Operation Theater
PAROS
Pan-Asian Resuscitation Outcomes Study
PCI
Percutaneous Coronary Intervention
PCR
Patient Care Report
PDM
Pocket Dosimeter
PDRM
Portable Dose Rate Meter
PDSA
Plan, Do, Study and Act
PEA
Pulseless Electrical Activity
PEC
Prehospital Emergency Care
PHCs
Primary Healthcare Centers
PM
Prime Minister
PNCBRNC
Police National CBRN Center
PPCI
Primary Percutaneous Coronary Intervention
PPE
Protective Personal Equipment
PPP
Public Private Partnership
PPR
Patient Presentation Rate
PTCA
Percutaneous Transluminal Coronary Angioplasty
PTCI
Percutaneous Transluminal Coronary Intervention
PTS
Patient Transport Service
QRMT
Quick Reaction Medical Team
RIC
Rapid Intervention Crew
RIT
Rapid Intervention Team
RITF
Rapid Intervention Task Force
RKS
Rogi Kalyan Samiti
RMS
Records Management System
RNA
Ribo Nucleic Acid
RNs
Registered Nurses
ROSC
Return of Spontaneous Circulation
ROTES
Review of Trauma and Emergency Services
RTACC
Rescue Trauma & Critical Care
RTC
Regional Trauma Coordinator
SAMU
Service d'Aide Médicale Urgente
SCDF
Singapore Civil Defence Force
SC
Stem Cell
SCRI
Singapore Clinical Research Institute
SDMA
State Disaster Management Authority17
SDRF
State Disaster Response Force
SGA
Supraglottic Airway
SMI
Strategic Medical Intelligence
SOP
Standard Operating Procedures
STE
ST Elevation
STEMI
ST-Segment Elevation Myocardial Infarction
TAC
Transport Accident Commission
TAT
Turn Around Time
TCG
Trauma Coordination Group
TCL
Target Capabilities List
TEG
Trauma Education Group
TQG
Trauma Quality Group
TTCA
2-Thiothiazolidine-4-Carboxylic Acid
TTHR
Transport to Hospital Rate
U-EMS
Urban Emergency Management Services
UKRO
United Kingdom Rescue Organisation
UP
Uttar Pradesh
UTKD
Uttarakhand
UTL
Universal Task List
VF
Ventricular Fibrillation
VFR
Visual Flight Rules
VPN
Virtual Private Network
VRE
Vancomycin Resistant Enterococcus
VSTS
Victoria State Trauma System
VT
Ventricular Tachycardia
WB
West Bengal
ZHL
Ziqitza Health Care