COVID-19 has exposed the glaring shortages of Critical Care infrastructure in the private and public healthcare system in India. This also includes the Armed Forces Medical Services Hospitals which do not have an adequate number of critical care beds.
COVID health crisis is expected to stay with us for some time to come. The response to the pandemic creates an opportunity to bring about changes in India’s health policy. We need to bring the best in class technology in the healthcare sector with a focus on tertiary care. India’s dependence on imports of medical equipment etc should be reduced and we should create domestic manufacturing capacity. This would also aid in India’s economic recovery.
Healthcare is one of India’s largest sectors - both in terms of revenue and employment. The hospital industry in India is forecasted to increase to Rs 8.6 trillion by FY2022.
Tertiary Health Care
Tertiary Health care refers to a third level of health system, in which super specialized care is provided usually on referral from primary and secondary medical care. Specialised Intensive Care Units, advanced diagnostic support services and specialized medical personnel on the key features of tertiary health care. In India, tertiary care service is provided by medical colleges and advanced medical institutes and tertiary care hospitals. Approximately 25-30% beds in tertiary care hospitals are critical care beds.
Critical Care Bed
A typical Critical Care bed in an Intensive Care setting in a tertiary care hospital has the following:-
Space requirements 14 square metre per bed with a minimum 2 meter distance between ICU beds
Central Monitoring station
Oxygen supply ventilators such as
Invasive Mechanical Ventilators
High flow nasal cannula,
Non-invasive mechanical ventilators,
ECMO ( Extra Corporeal Membrane Oxygenator)
Bed Head panel providing suction, oxygen supply, sufficient numbers of electricity points for connecting syringe pumps, infusion pumps
There should be separate negative and positive pressure ICU rooms in each ICU with minimum of 12 air exchanges in all ICUs
There is a need to have flexible HVAC systems to change or convert from positive to negative pressures within ICU. This change would be based upon need analysis.
PACS( picture archiving and communication system)
HIS(Hospital Information System) connectivity to Hospital Laboratory, Cardiac Cath lab, Imaging department etc.
Support systems such as MGPS (Medical Gas Pipeline System), Central Sterile Services Department, Operation Theatres, Blood Bank, bedside dialysis, UPS backup, Genset back up, Cardiac Cath Lab, Imaging services comprising CT scan , MRI, Digital Radiography systems.
Portable Ultrasound machine, 100 mA bed side X-Ray equipment, ABG Machine, Crash Cart etc.
Besides infrastructure there are round the clock trained nurses, ICU technicians to manage ventilators, resident doctors and Intensive Care Specialists required to manage Critical Care patients.
It is estimated that India has approximately 1.9 million hospital beds, out of which 95 thousand are ICU beds. There is an urgent need to increase the number of critical care beds to 200,000 beds and along with it to increase the number of support and other infrastructure.
This would ensure that the existing healthcare capacity would be able to fill up the existing gaps in the tertiary care system. We also need to appreciate that it takes about 24-30 months to create a greenfield tertiary care hospital, therefore it would be easier and faster to increase the number of tertiary care beds in an existing hospital.
Dr Sunil Khattri
Air Marshal (Dr) Pawan Kapoor
Dr Sunil Khattri and Air Marshal(Dr) Pawan Kapoor are alumni of Armed Forces Medical College, Poona, Maharashtra, India
Dr Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practising Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi
Air Marshal (Dr) Pawan Kapoor, MBBS, MHA(AIIMS), Director General Medical Services(Air Force) (Retired), is currently Vice Chairman, RUS Education and Vice-Chancellor, Lincoln American University, Guyana