Behavioral emergencies in India: a population based epidemiological study.

INTRODUCTION: Behavioral emergencies constitute an important but neglected part of emergencies seen worldwide in both emergency departments and by emergency services. Yet research on behavioral emergencies in India has been scarce. METHOD: The study aimed to evaluate the occurrence of acute behavioral problems as an emergency attended by our emergency management service-108 services. During the period of August 1st 2007-July 31st 2008, all behavioral emergencies presenting to our emergency services in the states of Gujarat and Andhra Pradesh, which together account for more than 15% of India's population, were reviewed for data completeness and validity. Key word analysis of recorded case details was carried out to determine cause of emergency. Survival to hospital and 48-h outcome was also evaluated to study risk factors for mortality. RESULTS: A total of 40,541 cases of behavioral emergencies were recorded, in which the male:female ratio was 1.3:1. Most victims were in the 20 and 30 years (42%), from a poor socio-economic background (93%), rural area (74.3%), and backward caste (42.6%). Suicidal attempts, whether in the form of poisoning (60.5%) or otherwise (30.7%) was the most common emergency, followed by acute psychiatric causes (4%) and alcohol intoxication (3%). Victims, who met a fatal outcome, were more likely to be male (p = 0.02), having a better socio-economic condition (p < 0.001) and older (p < 0.001). CONCLUSION: Suicidal attempts, which form the largest chunk of behavioral emergencies, need to be tackled on a war-footing, given the sensitivity it deserves. Acute psychiatric emergencies, which form about 9% of all emergencies, require the emerging role of emergency psychiatric services.

Emergency medical epidemiology in Assam, India.

BACKGROUND: Assam, with its capital in Dispur has one of the highest rates of infant and maternal mortality in India. Being under both tribal and hilly regions, it has lacked adequate healthcare and emergency services. We therefore aimed to conduct a cross-sectional survey of medical emergencies and identify various types of emergencies presenting to emergency departments, prior to launching emergency services across the state. MATERIALS AND METHODS: On a prospective basis and using a stratified random sampling design, all emergencies presenting to the three government hospitals in Guwahati, Assam, which handle 90% of all emergencies currently, were studied on specially designed datasheets in order to collect data. Emergency medical technicians (EMTs) were placed in the Casualty of the medical colleges and recorded all emergencies on the datasheet. The collected data was then analysed for stratification and mapping of emergencies. In addition, retrospective data for a period of 15 days was collected from the emergency case registers of all three hospitals and the adjoining district civil hospitals, in order to give a wider perspective of the nature of emergencies. RESULTS: A total of 2169 emergencies were recorded over a seven-day prospective and fifteen-day retrospective period. Guwahati Medical College Hospital attended to majority of emergencies (42%), which were mainly of the nature of pregnancies (22.7%), accidents (12.2%) or assaults (15.4%) and fever related. Maximum emergencies also presented from the border districts, and occurred among young males in the age group of 19-45 years. Males were also more prone to accidents and assaults, while females presented with pregnancies as emergencies. CONCLUSION: Potential emergency services need to target young pregnant females. Law and order needs to be also tightened in order to curb accidents and assaults among young males.

Neurological emergencies in India--lessons learnt and strategies to improve outcomes.

BACKGROUND: Neurological emergencies account for between 2.6 and 14% of medical emergencies, a number that can be salvaged, if addressed in time. This study aimed to answer the questions of demand, type and outcome of neurological emergencies by conducting a retrospective analysis of neurological emergencies serviced by 108, the first professional emergency service in India. METHOD: During the period between January 1, 2007 and December 31, 2008, a total of 24,760 calls were received by 108, of which confirmed neurological emergencies (n = 14,448) were followed up and evaluated. Risk factor analysis and stratification were done with respect to survival outcome at 48/120 h. RESULTS: The subjects had a mean age of 37.4 (+/-19.5) years, were mainly male (63%) and were victims of seizures (51.5%), stroke (24%) or unconsciousness (21%). Risk stratification observed that rural area (p < 0.001), emergencies of stroke and coma (p < 0.001), age (p < 0.001), lower vital sign measurements (p < 0.001) and time to reach hospital (p = 0.05) were the main risk factors. CONCLUSION: Emergency medical systems should implement a prehospital stroke protocol including the use of vital sign monitoring, point-of-care clinical diagnostics and advance forewarning systems. Geriatric clinics attending to the elderly age group, especially located in rural areas, with better identification of stroke and coma as medical emergencies, either through neuroimaging or clinical diagnostic facilities, will definitely improve outcomes. As seizures form a large chunk of neurological emergencies, genetic testing and counseling to detect hereditary causes could identify and keep most victims on regulated treatment in order to reduce adverse outcomes.