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GENERAL TERMS:
I.
PARTIES:
On this 14th day of August, 2008, this Memorandum of Understanding is signed
between the Department of Health and Family Welfare, Government of Karnataka
and Emergency Management and Research Institute (EMRI), a Not-for-Profit
Organization having its Head Office at Devar Yamzal, Medchal Road,
Secunderabad-500014, Andhra Pradesh agreeing to provide Emergency Response
Services [ERS] to the entire population of Karnataka in two phases over a period
of two years commencing from the financial year 2008-09.
II.
PERIOD OF PARTNERSHIP:
The MOU referred to in paragraph I (one) shall be valid for a period of 10 years
and extendable for a further period of 10 years subject to the concurrence of
both the parties.
It is also agreed that the development, management, and functioning of all the
facilities and services provided here within shall be the responsibility of EMRI.
III.
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The Government of Karnataka envisages operationalization of 517 ambulances in
a phased manner spread over a period up to March 2010 from the date of
signing of MoU. The phase-wise schedule of implementation is mentioned below:
Phase
Period
Phase I
Phase II
Total
Number of Ambulances
The Government of Karnataka & EMRI envisages the scheme to be run on a noloss, no-profit basis.
The Government of Karnataka & EMRI shall endeavor to ensure that the
operations are open, transparent and strictly as per the requirement of the
project.
IV.
2.
3.
4.
4
5.
6.
Recruit, train and position the required man power, including Pilots
(drivers), and Emergency Medical Technicians [EMT] who will be
present in the ambulances while shifting an emergency case to a
hospital. Ensure that in every ambulance operated under this scheme,
at least one Pilot and one EMT shall be present at any given point of
time to provide patient-stabilization, first-aid and other pre-hospital
care.
7.
8.
9.
10.
11.
12.
13.
5
14.
15.
16.
17.
V.
The Department of Health & Family Welfare, and Government of Karnataka shall
1.
2.
3.
4.
5.
6
6.
7.
8.
9.
10.
11.
12.
13.
14.
108
15.
16.
17.
18.
19.
Provide the data pertaining to hospitals, police stations and fire service
stations.
20.
21.
22.
108.
VI.
DELIVARABLES:
By Government of Karnataka:
(a) The Government of Karnataka shall extend continuous support to Emergency
Management and Research Institute, Secunderabad for implementing this
project. The nodal department shall be Health & Family Welfare department.
(b) The Government of Karnataka shall release the estimated capital expenditure of
Rs. 87.07 Crores and the estimated operational cost of Rs 134.18 Crores (EMRI
will claim 95% of total operational expenditure) for deployment of 517
ambulances over a period of 3 years ending on March 2010. Ownership of capital
assets under the MOU will vest with Government of Karnataka.
(c) The project would be implemented (deployment phase) over a period 18 months
ending on March 2010, in a phased manner from the date of signing the MOU &
transferring of Rupees 21.26 Crores as advance for both capital & operational
expenditure (Rs 10.00 Crores on the date of signing MOU, Rs 6.00 Crores in the
last week of Sep 2008 & Rupees 5.26 Crores in the last week of Oct 2008).
(d) The project cost summary with details of capital expenditure and operational
expenditure with initial transfer schedule is mentioned in clause VII.
By EMRI
(a) Provide Emergency Response Services (Medical, Police, Fire) to the people of
Karnataka in the phases mentioned above with the Toll Free Number
108, both
9
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Period
Aug 2008
to
Mar 2009
Apr2009
to
Mar 2010
Rs in Crores
Operational
Expenditure**
(95%)
Capital
Expenditure
150 Ambulances
38 ALS@ Rs 18.40 lakhs
112 BLS @ Rs 12.40 lakhs
IT Infrastructure
Temp ERC setup
Total
367 Ambulances
92 ALS@ Rs 18.40 lakhs
275 BLS @ Rs 12.40 lakhs
Permanent ERC*
IT infrastructure
Total
7.00
13.88
5.00
2.50
28.38
16.93
34.10
7.56
0.10
58.69
Total
10.48
38.86
48.29
106.98
10
Apr2010
to
Mar 2011
TOTAL
75.41
87.07
134.18
221.25
* Towards Permanent Building for Emergency Response Center (ERC) 25000 sft
@ Rs 3000 per sft
** Govt. of Karnataka will incur 95% of the total operational costs towards ERC
staff salaries, Ambulance Personnel costs, Care Personnel costs, Fuel Costs,
Repairs and Maintenance, Medical Consumables, Ambulance Mobile telephone
expense, Uniforms, Vehicle Insurance, Training, Annual maintenance, Support
Staff salaries, Marketing Expenses, Traveling Costs, Admin Expenses
(Telephone/ Electricity/ House keeping/Security/office expenses).
The above figures are based on the various assumptions mentioned. However the
reimbursements will be done at actual costs only which could be lower or higher
based on the actual level of operations, which will be shared periodically.
Transfer Schedule:
Rs in lakhs
Ambulances (62)- Phase IA
859.00
(15 ALS @ Rs 18.40 lakhs; 47 BLS @ Rs 12.40
lakhs)
IT infrastructure
500.00
Temporary ERC - Infrastructure
Operations (2008-09: Q2 & Q3)
Total
VIII.
250.00
517.00
2126.00
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(A) Assumptions:
(B) Explanations:
1. Karnataka has a population of 5.29 Crores spread across 29 districts over an area
of 1,91,791 Sq KM s. As per the WHO standards there has to be one ambulance
for every 60,000 population. However, based on the current experience & EMS
(Emergency Medical Services) in India at a relatively nascent stage, it is proposed
to deploy 517 ambulances for the entire State of Karnataka thereby each
ambulance catering approximately a population of 1.00 to 1.10 Lakhs. Deployment
of 517 ambulances also translates to a per trip distance of approx 25 KM s which
results into transportation of the victim within the Golden Hour.
2. There are two types of ambulances. They are Advanced Life Support (ALS) &
Basic Life Support (BLS). BLS with ventilator & defibrillator is known as ALS. The
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prime use of ALS is for trauma cardio related symptoms & ailments. Around 2025% of the total emergencies relate to cardiac cases & hence it is proposed to
have 25% of total fleet strength as ALS & the remaining as BLS.
3. Based on the statistics & EMRIs experience in other states, the call volume is
projected to be roughly 0.07% of the population covered by each ambulance which
scales up at later years due to increased awareness among the masses.
4. In the initial period of ERS (Emergency Response Services), of the total calls,
only 5% turnout to be emergences & the balance are ineffective calls. However,
with the increased awareness levels at later years we expect this 5% to increase
to 11% at the end of the 5 year.
5. Of the total emergencies, 95-97% is related to Medical emergencies including
medico legal cases and the rest are exclusively for Police & Fire cases.
6. The Emergency Response Centre will be manned by 4 categories of personnel.
They are:
a.
Communication Officers (CO) who are responsible for attending all the 108
calls & taking down the basic information related to the caller & emergency.
The capacity of each CO in a shift of 8 hrs is approximately 500 -600 calls.
They undergo 21 days training before assuming the role of a CO. Hence they
are on board one two months prior to launch of services.
b.
Dispatch Officers (DO) who sensitizes the emergencies & decides the
dispatch of ambulance to the emergency site & coordinates with the
ambulance staff/first responder & Emergency Response Centre Physical
(ERCP) for virtual hand holding. The capacity of each DO in a shift of 8 hrs is
approximately 90-100 calls. They undergo 21 days training before assuming
the role of a DO. Hence they are on board one two months prior to launch of
services.
c.
Police Dispatch Officers (PDO) who take care of exclusive Police cases &
and also the legal aspect of medico legal cases. These are the personnel
provided by the Police department.
d.
Emergency Response Centre Physicians (ERCP) are the medical doctors
with specialization in emergency care who are present in the call center round
the clock to provide medical direction to the EMTs. They provide virtual
medical directions for all critical cases which amount to around 25% of the
total medical cases. Each ERCP handles approximately 80-90 cases per shift.
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e.
7. In the operations side, each ambulance is manned by a trained Pilot (Driver) &
Emergency Medical Technician (EMT)/paramedic staff in two shifts of 12 hrs
each. Due to highly stressful nature of work, they get off after every 3 days of
duty & hence 2.75 personnel of each category is considered to execute 24/7
responsibility.
8. The operations & administration of ambulances in the field will be managed by
following personnel:
a.
b.
c.
Regional Manager (RM) Four to Five districts are clubbed into a region &
the regional Manager controls the region. The respective DM s report to the
RM.
FINANCIAL ANNEXURES:
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Enclosed separately as a part of the MOU projecting the costing for five
years.
X.
EXAMINATION OF RECORDS:
The Emergency Management and Research Institute will provide the
Government of Karnataka documents relating to the progress and
implementation of the project as and when required.
XI.
OTHER TERMS:
The Department of Health & Family Welfare, Government of Karnataka shall
not be responsible for any liabilities assumed by the Emergency Management
and Research Institute nor will assume any obligations financial or otherwise,
entered into by the Emergency Management and Research Institute with any
third party, unless these fall explicitly within the terms of this MoU.
A. Confidentiality:
Neither party (EMRI or Government of Karnataka) shall, without the prior
written consent of the other party:
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In the event of either party failing to meet its obligations, it will try to
rectify within three (3) months from the date of such failure. In case of its
inability to so rectify, the other party shall have the option to terminate the
agreement after giving notice of three (3) months.
C.
Place: Bangalore
...
(M. Madan Gopal)
Secretary to Govt. of
Karnataka, Health & Family
Welfare Department
Date: 14-8-2008
.
(Venkat Changavalli)
Chief Executive Officer
Emergency Management and Research
Institute
Mailing Address:
Room No.105,1st Floor,
Vikasa Soudha,
Dr. Ambedkar Veedhi,
BANGALORE-560 001.
e-mail: prs-hfw@karnataka.gov.in
Mailing Address
Devar Yamzal,
Medchal Road,
Secunderabad 500014.
Witnesses:
Witnesses:
e-mail: venkat_changavalli@emri.in