Finnish paramedic Dimitri Lisitsyn travels around the world, meeting people working in EMS in different countries. The blog is published on Asema, a finnish webzine focused on EMS and rescue

Members of the Indian Emergency Medical Services offered me extraordinary hospitality and such an in-depth insight into their EMS that I have included two interviews with people from the Indian EMS, instead of one.

After my time with the EMS in East Timor I stopped by Indonesia for a few weeks to finish my rescue diver certification. My travel plans had arrived at a crossroads; where should I go next after Indonesia? Then it hit me. Earlier that year, I had received a peculiar message on one of my People of EMS posts, saying “visit India .” This message was sent by Dr Abraham George, son of the founder and President of the Indian Institute of Emergency Medical Services, the largest provider of EMS in Kerala, South India. I messaged Dr George and we set a plan in motion. This is how I found myself in the back seat of an iconic Indian Force-model ambulance, at the start of my two-week adventure in Kerala.

IIEMS – Indian Institute of Emergency Medical Services

Kerala, also known as “Gods Own Country”, has 14 different districts. This is a home of 35 million people and is one of the most developed and educated states in India. Pre-hospital care is still in its infancy, however. There is no official law regarding who may work in the ambulances, and the EMS service providers’ level of education varies vastly from a short course up to six years in university. It all depends on the specific organisation and the ambulance service’s requirements.

It is hard to determine how many ambulances are in Kerala because there are many different companies, hospitals, and organizations who provide some level of pre-hospital care or patient transfers. For example, Kottayam has 15 ambulances to service the city’s 137,000 inhabitants. Out of these ambulances, 5 are IIEMS ambulances lead by Wg. Cdr S Jayachandran and A.R. Girish.

Many of the local people don’t realise what an ambulance service is, which can be seen in the amount of emergency calls received by the government’s 102 medical dispatch. Overall in Kerala, a state of 35 million people, dispatch centres receive around 180-200 calls a day. Most of the 102 calls trauma patients due to road traffic accidents. When there is a road traffic accident, a crowd of onlookers gathers and the patients are usually thrown into the backseat of the next available taxi, which hauls the patient to the nearest hospital the driver knows of. Often when the ambulance arrives at the scene, there are no more patients left. With more widespread knowledge of their work, IIEMS hope to educate local people on the importance of pre-hospital care and thus save more lives

IIEMS is one of the biggest emergency care educational course providers in India. It was founded in 2005 by George P. Abraham and it introduced EMTs and paramedics to Indian pre-hospital care for the first time. IIEMS main objectives are to educate, develop, and provide emergency medical care. The organization has educated over 360,000 people and has over 7,000 training programs spread over 250 facilities. IIEMS also has a state-of-the-art simulation centre in the city of Kochi and is actively developing its own teaching technologies, such as IO-mannikins and defibrillator simulators, for future use on these educational courses.

One of the most memorable scenes I witnessed during my time in Kerala was the IIEMS first aid course held for a group of public-school teachers in the capital city of Thiruvananthapuram. Twenty teachers gathered in a school gym, wearing traditional Indian clothing, all listening carefully to Public Safety Instructor Rajasekharan Nair. He was teaching the latest American Heart Association (AHA) guidelines of adult, child and infant CPR to the class. Everyone was given the chance to practice correct chest compressions on different size mannikins. I was mesmerised whilst watching the class performing so well. The lesson ended with a round of applause and a cup of chai. ‘In the future, first aid skills will be considered as a part of the educational programme for students. This is the most efficient way to educate most people in first aid skills,’ explained Rajasekharan.

On top of their broad educational offering, IIEMS provides pre-hospital care across the state of Kerala. IIEMS ambulances are staffed by a nurse with a 3-year university degree in nursing and an emergency vehicle operator (EVO). These ambulances respond to both 102-dialled ‘trauma’ calls and the patient transfers. The ambulances are equipped with the latest technology: respirators, monitors, defibrillators, perfusors, and vast amounts of different medications. Patients are required to pay around 3,500 Indian rupees (44 euros) for the ambulance. If they are unable to pay, the organization forgives the bill. I do a few ride-alongs in the Intensive Care Ambulance of IIEMS. The nurse working the shift is Majo John.

Why did you choose emergency medicine?

‘After my senior year in level 2s, I did not know what to do. My friend asked me to join him on a nursing course. I did not fully know what nursing was, but I joined him. I finished the course and I noticed that I like this line of work. I like to serve the people. Even my wife is a nurse. I also love to work in the emergency situation. I like that there are many different patients, and I’m always ready to learn something new.’


Tell me about your work day!

‘Mainly our calls are transfer calls from hospital to hospital. Most of the local hospitals have our company number and we do many different transfers from private to public hospitals and vice versa. Accident calls are rare, maybe 2-3 times a week.

What kind of advice would you give to a person starting a career in emergency medicine?

‘Sadly, male nurses are decreasing in our region. The management and patients don’t trust male nurses as much as female nurses. This is a shame because we need both male and female nurses in the industry. I would definitely recommend more people to apply for nursing school as there is a shortage. If you are like me, you might not even know how much you will like the job!’


Hospitals in Kerala, India

I was able to visit both public and private hospitals in Kerala state. The massive flow of patients is astounding to hear for a Finnish boy, since Finland has only 5 million inhabitants. I was given the chance to visit a private university hospital (Believers Church Medical College) and a public hospital in Pampady (Taluk Central Hospital).

Big family of IIEMS

In India the paramedics seem like a big family. Everyone from the IIEMS office took good care of me during the two weeks I spent with them in Kerala. This is why I would like to thank everyone who made this Indian visit possible. Your friendliness and generosity will be remembered forever.

This truly was a real Indian EMS experience!