Losing the golden hour

What does it say about health care if even celebrities don’t get critical first aid?

Dr KK Aggarwal

Reproduced from: https://indianexpress.com/article/opinion/columns/losing-the-golden-hour-timely-healthcare-india-5873843/ (Give hyperlink here when posting)

Will we get timely healthcare when we need it is a question often asked by people in India. The answer, unfortunately, is no. Cardiac arrest revival needs to be done within four minutes, angioplasty in a heart attack needs to conducted within 90 minutes and a road traffic accident victim needs to be provided on the spot first aid within 10 minutes and the victim’s vital parameters should stabilise in an hour. Advanced ambulance care needs to reach the victim within four minutes. But even in Delhi, a patient cannot get such care.

The right to health and right to timely medical care is a fundamental right under Article 21 of the Constitution. But are we getting timely medical care? The December 16, 2012 rape victim, for example, was transferred from Munirka to Safdarjung Hospital — a distance of 6.2 km allegedly covered in 45 minutes — without any help.

The then NDMC chairman, Imtiaz Khan, died on April 23, 1998, at his office in the building which housed the health department. Were advanced resuscitation measures administered to him?

Congress leader, Rajesh Pilot died in 2000 in a car accident in Dausa less than 100 km from Jaipur. He was in a coma when he was admitted to the Sawai Man Singh Hospital, Jaipur. The situation could have been different if he was carried in an advanced ACLS ambulance? The golden hour was lost.

Former president, Giani Zail Singh, died in Chandigarh on December 25, 1994 after receiving multiple injuries in an accident on November 29 that year. The accident happened near Kiratpur Sahib in Ropar district. He was shifted to Chandigarh, 45-km away. Was he shifted in ACLS ambulance or provided a golden hour first aid in Ropar?

Former Delhi chief minister, Sahib Singh Varma, died on June 30, 2007, when his car collided with a truck on the Jaipur-Delhi highway (NH-8). He was taken to the Shahjanpur Civil Hospital, 13 km away from the accident site. Obviously no ACLS care was available for so short a distance.

Gopinath Munde, then the Union Minister for Rural Development, met with an accident at Prithviraj Road-Tughlak Road roundabout in Delhi at 6 am on June 3, 2014. He was brought to the AIIMS by his driver and assistant. The doctors said that Munde was not breathing when he was brought. Why was he shifted to the hospital? The ambulance should have come to him. Did the ACLS ambulance reach the spot?

One report of the death of former president A P J Abdul Kalam quotes his secretary, Srijan Pal Singh. Singh apparently heard a long pause from the former president when he was two minutes into his speech at IIM-Shillong. Singh’s account is a class description of an impending heart attack. Kalam’s eyes were three-quarters closed as he collapsed, according to his former secretary. When there was a doctor at the site, why did the former president’s secretary attempt to revive him?

Singh’s recollection that Kalam’s hands were clenched, his face was still and his eyes motionless, is a classic representation of cardiac arrest caused by ventricular fibrillation. As per Singh’s statement, he was brought to the nearest hospital within five minutes of the cardiac arrest. There are three phases of cardiac arrest. The electrical phase comprises the first four to five minutes and requires immediate defibrillation. The hemodynamic phase lasts about four to 10 minutes following a sudden cardiac arrest (SCA). Patients in the hemodynamic phase benefit from excellent chest compressions to generate adequate cerebral and coronary perfusion and immediate defibrillation. The metabolic phase occurs following approximately 10 minutes of loss of pulse. Few patients who reach this phase survive.

In the first 10 minutes, there are high chances of revival using hands only CPR followed with DC electric shock.

A study in The Lancet has shown that about 15 per cent of patients who survived needed at least 30 minutes of resuscitation. Why was not advanced CPR given to Kalam for the full period?

Former minister of state for external affairs, E Ahamed died on February 1, 2017. He suffered a cardiac problem while the President was addressing Parliament. There were over 30 doctors amongst the MPs at that time. No one was approached. He was shifted to Ram Manohar Lohia hospital, where he died. Why can’t the President’s speech be stopped for such emergencies?

Former Delhi CM, Sheila Dikshit, died on July 20, 2019 at the Escorts Heart Institute. She experienced breathlessness at her home in Nizamuddin and was shifted to Escorts in Sarita Vihar in a car — a distance of six km, which takes up to 24 minutes as per the Google map. She had a cardiac arrest on the way. Why was she not provided an ACLS ambulance at her home?

Amitabh Bachchan was saved because of timely local first aid. On August 2, 1982, on the sets of the film Coolie, he had a near-fatal accident and was shifted to nearby hospital. He was shifted to Mumbai later. The early treatment helped in saving his life.

We have a fundamental right to receive point of care advanced first aid within four minutes. But people in need don’t always get it

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA