1. HEALTH ON WHEEL – AN AGROGYA KAVACHA SCHEME IN
KARNATAKA
Dr. Shoukat ali M Magalmani1
Introduction:
India being developing country, as it moving towards economic development and
increase urbanization of cities, there is also a parallel need and concern of the public and the
international business community for enhanced public safety services. A major part of which is
the role of the Emergency Medical Services (EMS) System, which is composed of a network of
resources (health care facilities, police, fire department, public health, rescue groups, volunteers,
etc.) linked together for the purpose of providing emergency medical care and transport to
victims of sudden illness and injury. As development progress, the establishment of EMS is
mostly concentrated on urban areas and most often rural areas are not covered or not within the
minimum response time standard.
Meaning of Emergency Medical Service and Its Need:
Emergency medical services may also be locally known as a first aid squad, emergency
squad, rescue squad, ambulance squad, ambulance service, ambulance corps, or life squad.etc.
The use of the term emergency medical services may refer solely to the pre-hospital element of
the care, or be part of an integrated system of care. The term emergency medical service also
reflect a change from a simple system of ambulances providing only transportation, to a system
in which actual medical care is given on scene and during transport emergency medical services
is dedicated to providing out-of-hospital for medical care, transport to definitive care, and other
medical transport to patients with illnesses and injuries which prevent the patient from
transporting themselves.
The aims of EMS is to either provide treatment to those in need of urgent medical care,
with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal
of the patient to the next point of definitive care. In most places in the world, the EMS is
summoned by members of the public (or other emergency services, businesses, or authorities)
via an emergency telephone number which puts them in contact with a control facility, which
will then dispatch a suitable resource to deal with the situation.
In some parts of the world, the emergency medical service also encompasses the role of
moving patients from one medical facility to an alternative one; usually to facilitate the provision
1
Associate Professor, Department of Economics, J. S. S College, Vidyagiri, Dharwad, 580004.
E-mail smmegalmani@yahoo.co.in

2. of a higher level or more specialized field of care but also to transfer patients from a specialized
facility to a local hospital or nursing home when they no longer require the services of that
specialized hospital, such as following successful cardiac catheterization due to a heart attack.
In some jurisdictions, EMS units may handle technical rescue operations such as
extrication, water rescue, and search and rescue. Training and qualification levels for members
and employees of emergency medical services vary widely throughout the world. In some
systems, members may be present who are qualified only to drive the ambulance, with no
medical training. In contrast, most systems have personnel who retain at least basic first aid
certifications, such as Basic Life Support (BLS). Additionally many EMS systems are staffed
with Advanced Life Support (ALS) personnel, including paramedics, nurses, or, less commonly,
physicians.
During sudden emergencies that take place to the threatening of life, health, property,
demands immediate attention. These emergency like situations may arise due to an accident in
the day to day traffic, disturbance of peace & tranquility in the public life, diseases afflicting
individuals like the Cardiac problems, respiratory problems, acute abdominal problems, animal
bite, poisoning or over dose of the drugs, allergic reactions, unconsciousness, epilepsy, fever,
infection, burns, strokes, pregnancy, environmental/ Industrial issues, assault/violence,
behavioral, disaster etc. Unless immediate and effective responses are provided in such
situations, it would be very difficult to contain the loss that may be caused to the life and
properties. Road accidents & life style diseases are increasing day by day and the affected people
need immediate and timely response. Also timely movement of pregnant women to the hospitals
during the period of labour saves both the mother and child. This often requires a coordinated
response from multiple agencies like police, fire and medical service. In this background, the
Government of Karnataka conceived the Arogya Kavacha (108) Scheme 2008.
Arogya Kavacha Scheme (108 Ambulance Service):
The responsibilities of Emergency Management and Research Institute (EMRI),
Secunderabad and the Department of Health & Family Welfare, Government of Karnataka are
spelt out in the Memorandum of Understanding, The Government of Karnataka entered into an
agreement with GVK EMRI on 14th August 2008. The 108 Arogya Kavacha Services in
Karnataka was launched on 1st November 2008 by Sri A P J Abdul Kalam, Former President of
India under the Public Private Partnership (PPP) with EMRI, to provide Comprehensive
Emergency Management Response Services to the people of Karnataka.
Arogya Kavacha Scheme provides a comprehensive emergency service. It integrates
many emergency resources and provides sustainable round the clock safety to the citizens in a
timely and effective manner through three contiguous sectors viz., SENSE, REACH and CARE.
i.e., (i) Collection of the facts about the emergency and assigning the strategically located vehicle

3. to provide relief (ii) ensuring the transport vehicle reaches the site emergency and (iii) providing
pre-hospital care while transporting the patient/victim to the Hospital for stabilization. While
implementing the Scheme some of the conditions laid down by the Government of Karnataka,
those are as follows,
a. Emergency Management Research Institute, Secunderabad is declared as the Nodal
Agency to implement Arogya Kavacha Scheme in the State.
b. The total cost for implementation of this Scheme was Rs.221.25 crores from the period
2008-2009 to 2010-2011.
c. The Nodal Agency and the Health and Family Welfare Department, Government of
Karnataka shall enter into a Memorandum of Understanding. As per MoU, the Nodal
Agency as well as Health and Family Welfare Department, Government of Karnataka,
shall ensure successful implementation of the Scheme.
d. The Nodal Agency shall implement this Scheme by providing 517 ambulance services in
phase wise from November 2008 to March 2010.
Table 1: Phase wise investment for Ambulance
a
s
T
h
e
Note: * ALS means Advanced Life Support, BLS means Basic Life Support
e. Agency should provide the required manpower and train the personnel required for
efficient emergency management response system
f. The expenditure towards the salary of the personnel working under the private partner in
this project should be met out of the funds provided under the National Rural Health
Mission.
g. In order to sort out any major problem encountered in implementation of this Project and
also to suggest further improvements an Advisory Council under the Chairmanship of the
Chief Secretary to Government of Karnataka should be constituted with the following: -
a. The Chief Secretary - Chairman.
b. Principal Secretary,
i. Health & Family Welfare - Convener
c. Principal Secretary, Finance - Member
d. Principal Secretary, Home - Member
Phase Period Number of Ambulances
Phase I November 2008 to March 2009 150 (38ALS & 112 BLS)*
Phase II April 2009 to March 2010 367 (92 ALS & 275 BLS)
Total 517 (130 ALS & 387 BLS)

4. e. Commissioner of Health Services - Member
f. Four nominees of CEO, EMRI - Members
i. The Council shall meet quarterly and the recommendations of which
shall be mandatory.
g. Similarly to redress any problems being faced at the field level, there shall be
Committees in every district under the Chairmanship of Deputy Commissioner
with Superintendent of Police, the District Health & Family Welfare Officer and
District Surgeon of the concerned districts as members. Two Members of the
Chief Executive Officer of Emergency Management Research Institute,
Secunderabad, shall also be Members of this Committee.
Responsibilities of EMRI:
The main duties and responsibilities of GVK EMRI as per MoU are as follows,
 Establish and operate Emergency Response Services in Karnataka State.
 Provide technological, leadership, administrative and managerial support as
the Private Partner in an open and transparent manner to produce mutually
agreed outcomes.
 Provide the application software for the project free of cost.
 Serve as a vital emergency management information and assistance resource
and raise societal awareness of, and capability in, Emergency Management
and Response mechanisms and thus save lives and reduce the economic
impact to the citizens, firms and the government through appropriate
awareness, education and capacity building programmes.
 Operate the ambulances and ensure that ambulance services are available on
a 24 hours per day and 365 days a year basis to the people in Karnataka,
through the segment-wise operational headquarters decided by the
Government of Karnataka where the ambulances will be located.
 Recruit, train and position the required man power, including Pilots
(drivers), and Emergency Medical Technicians [EMT] who will be present
in the ambulances while shifting an emergency case to a hospital. Ensure
that in every ambulance operated under this scheme, at least one Pilot and
one EMT shall be present at any given point of time to provide patient-
stabilization, first-aid and other pre-hospital care.

5.  Provide mutually agreed daily (operational), monthly (administrative and
financial) reports and quarterly (fund utilization) statements to the
Government of Karnataka.
 Attend periodical review meetings held by the Government of Karnataka
(physically or virtually) for the assessment of the operationalization of the
scheme.
 Maintain separate financial accounts and records of its operations in
Karnataka. These accounts shall be annually audited by a Chartered
Accountant firm as approved by NRHM / Government of Karnataka and
furnished to Government of Karnataka by the end of the first quarter of the
succeeding year in addition to any statutory audit. The Government of
Karnataka reserves the right for special audit as & when necessary.
 Attend emergency calls that are received at the Emergency Response Center
as per the agreed performance benchmarks.
 Provide emergency response services to police, fire & medical emergencies
including pregnancy related cases on an average of 30 minutes in rural areas
and 20 minutes in urban areas (in Plain areas) assuming reaching the nearest
point of motorable access. However, EMRI will also identify critical
locations on various roads for connecting to hill terrains and remote areas
with appropriate transportation vehicles.
 Bring in technology and service excellence and work towards improving
delivery of emergency response of global standards over a period of time.
 Assist the Government when required in Accreditation of Hospitals in the
state and such other matters from time to time.
 Conduct training programs for paramedics, doctors and other academic
activities (workshops/seminars) as required for governmental doctors and
others.
 Strive for continuous improvement in emergency management through
strategic partnerships, innovative programs, and collaborative policies.
 Undertake applied research assignments in implementing Emergency
Response Services in the field.
 EMRI shall appoint & position a Chief Operating Officer (COO) to head
Karnataka operations along with the required supporting staff for Karnataka.

6. Box 1: GVK Emergency Management and Research Institute
GVK EMRI (Emergency Management and Research Institute) is a pioneer in
Emergency Management Services in India. As a not - for - profit professional
organization operating in the Public Private Partnership (PPP) mode, GVK EMRI is the
only professional Emergency Service Provider in India today.
GVK EMRI handles medical, police and fire emergencies through the " 1-0-8
Emergency service". This is a free service delivered through state- of -art emergency
call response centres and has over 2858 ambulances across Andhra Pradesh, Gujarat,
Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh,
Himachal Pradesh and Chhattisgarh. With the expansion of fleet and services set to
spread across more states, GVK EMRI will have more than 10000 ambulances covering
over a billion population by 2011s
Achievements of Arogya Kavacha Scheme:
As per the MOU, Arogya Kavacha Scheme has been operationalised with effect from
01.11.2008. It has been successfully operating in the public private partnership model. EMRI has
been allotted a three –digit number - 108 by the Government of India and made it toll-free across
the State for all emergencies and can be accessed from land line and mobile without prefixing
area code. Every emergency call made to the number 108 will be attended to by the emergency
team in the call centre and that centre would ensure that the ambulance with paramedical staff
and necessary equipments reaches the spot and necessary pre-hospitalization care is rendered to
stabilize the victim/patient before being shifted to the hospital.
By now, State has deployed 517 Ambulances out of which 130 are Advance Life Support
ambulances (ALS) and the remaining 387 Basic Life Support ambulances (BLS). These
Ambulances operates covering all the 30 districts. Each ambulance caters to a population of
about one lakh to 1.1 lakh. Deployment of 517 ambulances also translates to a per trip distance
of about 25 KMs which results into transportation of the patient/victim within the ‘Golden hour’.
Out of the total emergencies, 95-98% is related to Medical emergencies including medico legal
cases and the rest are exclusively for Police& Fire Cases. Since inception, the EMRI call centre
has received 2.77 Crore calls by 21st Feb.2012 of which about 29% are ineffective calls.
Following table2 shows the cost of ambulance which is used under 108 Arogya Kavacha
Scheme in Karnataka. The advance life support ambulance cost about Rs. 18.40 lacks where as
basic life support ambulance cost about Rs. 12.40 lacks. In BLS model ventilator and
defibrillator facilities will not found. This BLS model is used for ordinary type patients. If it is
very serious patients like cardiac arrest, severe accident patients ALS ambulance is used.

7. Table 2: Cost of Ambulance used under 108 Arogya Kavacha Scheme
(Rs. In Lacks)
S No. Particulars of Cost Elements
Type of Ambulance
Advance Life
Support (ALS)
Basic Life Support
(BLS)
1 Basic Price 5.70 5.70
2
Fabrication including AC &
Stickering 3.22 3.22
3 Ventilator 2.00 -
4 Defibrillator 4.00 -
5 Medical Equipment 2.00 2.00
6 Insurance & registration 0.28 0.28
7 AVLT 0.20 0.20
8 Shelter Cost 1.00 1.00
TOTAL 18.40 12.40
Source: Government of Karnataka, Directorate of Health and Family Welfare Service.
Following table 3 shows the percentage break-up of various categories of medical
emergency calls attended under the Arogya Kavacha Scheme. Pregnancy related problems
attended by 43 percentage then followed by14 percentage attended for various injuries due to
accidents and 13 percentage patients belonging to acute abdominal problems. It clearly indicates
that large numbers of delivery deaths have come down due to this 108 ambulance service
scheme. From this Arogya Kavacha Scheme the State has been able to provide a highly effective
comprehensive emergency response service to the people of the State.
Table 3: Medical Emergency Calls Attended under the Arogya Kavacha Scheme
S.No.. Medical Emergency Category Percentage
1 Injury 14
2 Pregnancy 43
3 Respiratory Problems 5
4 Cardiac 4
Th Diabetes 1
6 Acute Abdominal Problem 13
7 Animal bite 2
8 Poisoning / Drug overdose 3
9 Others (include Allergic Reactions,
Assault/violence, behavioral, disasters,
environmental, epilepsy, fever, infection, burns,
Stroke/CVA, Industrial, Unconsciousness etc.
15
Total 100
Source: Government of Karnataka, Directorate of Health and Family Welfare Service

8. Problems Faced by Arogy Kavacha Scheme:
In an emergency, everyone wants to help the victim. If an emergency occurs, then people
immediately rush to the spot, to help and provide medical help as soon as possible so that the live
is saved. Every second in emergency counts and demands the appropriate medical help. The
situation is so sensitive, that even a single wrong move can result to death of a person or to a
lifelong disability. In this sensitive and urgent situation, to reach the hospitals the roads are not
up to the mark. The traffic jam is one of the major problems in urban areas. Lack of awareness
about the scheme in rural masses, lack of education, proper telephone facilities in remote
controlled areas, lack of technical skilled workers in the ambulance etc, are the major challenges
faced by 108 ambulance service. Apart from this unnecessary calls made by the people for fun is
also one of the serious problems faced by the workers in Arogya Kavacha Scheme.
Suggestions for further Improvement:
For further improvement and modification and modernization of the Arogya Kavacha
Scheme some the recommendation can be made. Those are as follow
 Every hospital should develop its capacity and capability to manage emergency patients
at the time of arrival to the facility and without delay or interruption in the continuity of
care delivery.
 First-Aid skills can save many lives and therefore this should be considered as a priority
in training staff of all agencies being involved in the management of situations where
emergency patients can potentially be met.
 In rural areas the staff of the primary health care stations should be trained in First-Aid.
All medical and paramedical staff should be trained accordingly.
 The appropriate management should be arranged for emergency patients during transport
towards hospitals.
 Ambulances can be divided into two classifications depending upon its function and
purpose into Basic Life Support and Advance Life Support Ambulances.
 The medical emergency call center should have a permanent capacity to link with all the
facilities of the network and to make appropriate decision for transfer of patients if no
medical dispatching center is in charge of that activity.
 The medical emergency call center and the hospital network must have an efficient
coordination mechanism with the other emergency centers (police, rescue, etc.).
 Physician input, leadership, and oversight are essential in ensuring that the medical care
provided is safe, effective in accordance with accepted standards.
 The coordination of the activities of the various agencies dealing with medical emergency
patients should be organized within an inter-sectoral network.
 Education of the public on the appropriate use of hospital emergency services or of
emergency medical call centers is an important aspect that is usually neglected.

9.  Public support is invaluable in constructing a successful EMS system; involvement is
required to plan a system that works for everyone. Consumers need to be well informed
of the benefits of having an EMS system and how to gain access to it.
 Another issue on adaptability is the effective use of resources.
Conclusions:
As India is fighting to strengthen its health care delivery system, pre-hospital care
(emergency ambulance services) still remains the most neglected part of India's healthcare
service system. The importance of pre-hospital care is especially important in the rural areas
where immediate health care is poor and services are distant. Most people in India succumb to
death due to non-availability of quick and good quality emergency medical support. Access to
health care and equitable distribution of health services are the fundamental requirements for
achieving Millennium Development Goals and the goals set under the National Rural Health
Mission (NRHM) launched by the Government of India in April 2005, and Karnataka Health
System Development & Reform Project. Many areas in the district predominantly tribal and
hilly areas, lack basic health care infrastructure limiting access to health services to vulnerable at
present. Taking the primary health care to the doorsteps is the principle behind this initiative and
is intended to reach underserved areas. So for lacks of lives were save in this scheme.
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