‘Strengthen ICUs in new GMCs, ramp up Obstetric HDU capacity’
Timelines fixed for creation of addl healthcare infra
Mohinder Verma
JAMMU, June 6: To mitigate the impact of third wave of COVID-19, which is likely to emerge by October-November this year, a high level Advisory Committee has suggested detailed Action Plan to the Government of Union Territory of Jammu and Kashmir and fixed timelines for creation of additional healthcare infrastructure.
In the Action Plan, main thrust has been laid on strengthening of Intensive Care Unit (ICU) facilities in the new Government Medical Colleges, ramping up of Obstetric High Dependency Unit (HDU) capacity and creation of 10-bedded dedicated COVID-19 Pediatric ward in every District Hospital of the Union Territory.
The Advisory Committee has conveyed to the Government that evidence about the third wave is quite strong and there is likelihood that it may emerge in India by October and November this year and just like the increased intensity of second wave, the severity of the third wave can be more intense or prolonged than the current one.
“In order to ensure that the impact of third wave on the susceptible groups is mitigated, pro-active measures in the form of targeted interventions of capacity enhancement at every level of healthcare-Primary, Secondary and Tertiary Care is the need of the hour”, the Committee has mentioned in the report, the copy of which is available with EXCELSIOR.
Stressing that thorough institutional level audit of ICU areas and available infrastructure should be done as soon as the second wave ends, the Advisory Committee has recommended that the ICU facilities in the Government Medical Colleges of Rajouri, Kathua, Doda, Baramulla and Anantnag should be immediately strengthened to ensure that tertiary care COVID services of the highest order are made available at their respective levels in order to ensure zero referral to Government Medical Colleges of Jammu and Srinagar.
“No doubt ventilator availability is not an issue but ensuring deployment of complete intensive care team including Specialists/ Consultants and skilled paramedics like Anaesthesia Technicians must be ensured”, the Committee said, adding “there are still some serious intensive care staffing gaps which are resulting into non-usage of available ventilators in many hospitals and ICU audits must be dealt conclusively and result in ensuring all equipments are accounted for use”.
Stating that strengthening of secondary facilities is essential, the Committee has suggested that the remaining District Hospitals, given the lack of intensive care, must be fortified to set-up the facility of at least administering high flow oxygen supply so that cases with moderate to high severity can be managed at their end.
“In Jammu division, District Hospitals of Udhampur, Samba and Kishtwar should be strengthened from high-flow oxygen use perspective and in Kashmir division, District Hospitals of Kulgam, Budgam and Ganderbal may be strengthened”, the report said, adding “keeping in view lots of issues particularly availability and fair distribution of newly discovered drugs like Remdesivir and Tocilizumab faced during second wave, it is imperative that an effective pre-determined rationing and pricing mechanism for various types of drugs be evolved”.
Holding late detection and late hospitalization of cases behind comparatively higher mortality in Jammu division, the Advisory Committee has laid stress on robust grass root level surveillance system. “The health care workers must actively work to follow up on the condition of any positive case at home or in Panchayat COVID Care Centre and arrange timely referral in case of any complication”, the report said.
Pointing towards reasonably good job done by 102 and 108 Ambulance Services during the first and second wave, the Advisory Committee has suggested that UT Government should consider investing in negative pressure ambulances which will significantly reduce the risk.
“There may be at least one Advanced Life Support (ALS) Ambulance for every 50,000 population well equipped with transport ventilators and other accessories and is manned by a trained Anaesthesia/OT Technician well versed with handling the shifting of Paediatric patients”, the Committee said, adding “there is also a need of one Basic Life Support (BLS) Ambulance for every 30,000 population with provision for shifting of patients requiring continuous oxygen supply during shifting to higher centres. Moreover, there should be at least one ALS Ambulance at each District Hospital”.
Stressing the need of raking up Obstetric coverage and capacity, the Committee has recommended that Obstetric High Dependency Units in all remaining institutions should be operationalized and strengthened.
For infrastructure up-gradation, the Advisory Committee has fixed June 30, 2021 timeline while as for procurement of required equipment it has suggested time line of July 30, 2021. Further, it has fixed August 15 timeline for placement of required manpower and August 30 for capacity building of manpower.
As far as strengthening of Pediatric care coverage is concerned, the Advisory Committee has recommended creation of 10-bedded dedicated COVID-19 Pediatric ward in every District Hospital and the beds must have provision for oxygen supply (through piped oxygen, oxygen cylinders/concentrator). Moreover, the Government Medical Colleges need to be equipped with Pediatric-cum-Neonatal ventilators in a move to be prepared for the probable third wave.
“An effective long term COVID response strategy needs to ensure that apart from diversion of pre-existing facilities in handling COVID load, the regular non-COVID healthcare service load OPD and IPD should not suffer”, the report said, adding “in case of a short-lived or less virulent COVID wave, it is imperative that all the previous DCHs might not be required to be re-diverted for COVID patients in order to continue maintenance of non-COVID facilities”.
Apart from two new DRDO hospitals, CD Hospital Jammu/Srinagar, MCH New Block Gandhi Nagar, JLNM Hospital Srinagar, Rajiv Gandhi Hospital Gangyal and PHC Chanapora should be notified in that particular order so as to ensure least disturbance of regular healthcare.
The Advisory Committee has further laid stress on training of health personnel in more structured manner than ad-hoc. “Specialized trainings targeting different sets of health workers with the aim for capacity building about COVID management should be organized”, it said.
“No doubt Health Department is being prepared to face the possible third wave, a well-planned integration of various departments with the Health Department will be of paramount importance so that J&K UT is able to achieve its goal of allaying the possible third wave”, the Advisory Committee said.
Main recommendations:
4 Strengthen ICU facilities in new GMCs
4 Ensure usage of all available ventilators
4 Strengthen 3 DHs each in Jammu/Kashmir
4 Create 10-bedded COVID Pediatric ward in each DH
4 Provide specialized trainings to health workers
4 Create mechanism for rationing, pricing of drugs
4 Further ramp up oxygen availability
4 Provide one ALS ambulance for 50,000 population
4 Ensure one BLS ambulance for 30,000 population
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