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How I learned that the right mind-set, the right skill-set and the right tool-set are the key to survival

Way back in 1992, in the aftermath of the conflict between the Indian Peace Keeping Force and the Sri Lankan rebels, the Indian Navy decided to conduct aerial surveillance, as well as, surface surveillance by small teams along the coast of Tamil Nadu. An old World War II airfield was reactivated near the temple town of Rameswaram and a couple of helicopters and small planes were to be based there. I, as a young naval doctor, was assigned there on temporary duty. I was told to pick up medical supplies from the small naval station in Chennai. The doctor there was willing to share his meager stock of medicines but flatly refused to give any instruments, not even a pair of forceps, having none to spare himself ! So, I landed up at the airfield to provide medical cover for flying operations and boat patrolling with a first aid bag with some medicines and bandages. The next day flying operations were to commence. I informed the Commanding Officer of my inability to deal with even minor wounds and  refused to permit flying on medical grounds. He got on the phone to Headquarters. An hour later he gave me the equivalent of 50 dollars in cash and said, “Doc, take my van, go to town, get what you need and get back by noon. I have to fly today or the Admiral will have my guts.”“Not all that I need with this money, but only to make do” I said. So I got a Guedel’s airway, a couple of forceps, needle holder, scissors, bowl and some injectables ( all that could be bought in the small district capital and within my budget)  and we started flying operations.

A few days later, we were told over the radio that a sailor from one of the surveillance detachments had been injured and we were to evacuate him to Chennai by helicopter from a hospital in a small town two hours flying time from Chennai. No further details were available.  I took my little first aid bag and the stretcher from the fire tender and we took off. We landed in an empty rice-field surrounded by hundreds of excited villagers looking on and a police jeep took the CO (Commanding Officer) and I to the ‘hospital’ which, turned out to be a rural primary health centre whose assigned doctor had never even been seen! To my horror, the patient had sustained a gunshot injury to his throat and head about 3 hours before, the bullet entering below the chin and exiting through the right eye. The paramedic had just tied a bandage and the patient was semi-conscious with no active bleeding. I thought of doing a tracheostomy, but considering the prognosis, the principle of “Primum non nocere” and the fact that I had never seen one done, let alone done, decided to leave that well alone. None of the staff there had even heard of a tracheostomy kit anyway. I tied the patient to my stretcher in a semi-prone position so he wouldn’t choke and told the CO ,”Let’s go! Just pray he doesn’t die on the way”.

We were flying in the naval version of the small French-made Alouette III helicopter which carries a rescue diver and is not normally fitted with doors as one is flying over the sea. I was sitting in the diver’s seat facing backwards with the stretcher tied to the floor of the helicopter (supported on bricks as it was not a flight stretcher). About an hour into the flight, the patient woke up and started struggling. He managed to free his arm and hit the pilot’s hand holding the collective which controls the power to the rotor. The helicopter bounced wildly during the three- way battle. I was trying to hold the patient’s shoulder down with the right hand to keep him in position, the left wrestling with his right arm. The pilot was trying desperately to keep the aircraft steady as his elbow was struck repeatedly. I had to tie down the patient’s arm but my seatbelt did not allow me to reach far enough and loop the bandage around the stretcher handle. So I opened the seatbelt and managed to loop the bandage around the handle. Pulling it tight, my elbow struck the door handle and the door flew open. The cabin filled with a blast of air and the roaring sound of the rotors as I looked down between my feet at emerald green rice fields 3000 ft below. Balancing on the edge of my seat. I managed to pull the door close, tied the bandage securely and fastened my seatbelt. The patient eventually calmed down and we got him to hospital alive. However, he died on the operation table. Upon analysis, I realized that though I had the will to save life, I lacked the requisite knowledge, the training, the specific skill-set and the tools. I was fighting for life with my hands tied behind my back.

Today, there is much progress in terms of knowledge, training methodology, medical equipment, drugs availability, the internet and mobile technology, etc., one does not have to agonise about emergency tracheostomy anymore like I had to. Today, there are instruments with which even a paramedic can do a crico-thyroidotomy for securing an airway in such cases in 30 seconds with minimal training.  It is now possible to put a whole emergency room in your backpack. Backed up by a network, one can now deliver quality emergency pre-hospital medicare as well as routine medicare anywhere, anytime!

In few other places on earth is there more need for this than in India. After leaving the service, I decided to take up the challenge. Our young start-up company- Golden Hour Emergency Medicare Solutions Pvt Ltd. is devoted to providing customized solutions for pre-hospital emergency medicare in any environment and situation as well as routine medicare in remote and rural areas. We are looking for allies in the war for life!

OUR MOTTO:    The devil is in the details, and so is salvation

OUR ETHIC:       Much more with much less

- Dr. Sangram Singh Pundir, MD, DMM. Surgeon Commander, I.N. (Retd),                    Chief  Medical Officer