MEMORANDUM OF UNDERSTANDING
Between Department of Health and Family Welfare,
Government of Karnataka
& Emergency Management and Research Institute (EMRI), Secunderabad
for providing Emergency Response Services(Arogya Kavacha) in Karnataka as the
Sole State Level Nodal Agency and to operationalise
Emergency Response Services.
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.
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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.
THE OBJECTIVES OF THIS MEMORANDUM OF UNDERSTANDING ARE:
The main objective of the Memorandum of Understanding between the
Government of Karnataka and the Emergency Management and Research
Institute, Secunderabad is to provide comprehensive Emergency Response
Services for the entire population of Karnataka in two phases.
EMRI has been providing Emergency Response Services over a period of three
years and is currently operating these services in the states of Andhra Pradesh,
Gujarat and Uttarakhand. These services are unique and comprehensive in nature.
Against this background, pursuant to the above objective, and on broadly similar
terms and conditions, the Government of Karnataka appoints EMRI,
Secunderabad, as the Sole State Level Nodal Agency to operationalise
Emergency Response Services for the entire population of Karnataka and thereby
improve the access to Medical, health care, police and fire services, particularly in
attending the emergency situations relating to pregnant women, neonates, parents
of neonates, infants and children in situations of serious ill-health and all other
health emergencies in the general population; and thereby assist the state to
achieve the critical Millennium Development Goals in the health sector, i.e.,
reduction of Infant Mortality Rate, and Maternal Mortality Rate, and in general
reduce the vulnerability of the people to health emergencies or other
emergencies like police & fire, if need be, by providing access to Emergency
Response Services.
 The Government of Karnataka shall provide adequate funds for these services
under its State Budget, National Rural Health Mission and other relevant
schemes.
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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
November 2008 to March 150 (38ALS & 112 BLS)
2009
April 2009 to March 2010
367 (92 ALS & 275 BLS)
517 (130 ALS & 387 BLS)
Phase II
Total
Number of Ambulances

The scheme will ensure comprehensive Emergency Response Services (Medical,
Health care, Police, Fire) using single toll free number, training facilities and
technology.

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.
RESPONSIBILITIES OF EMERGENCY MANAGEMENT AND RESEARCH
INSTITUTE, SECUNDERABAD
The Emergency Management and Research Institute, Secunderabad shall
1.
Establish and operate Emergency Response Services in Karnataka
State.
2.
Provide technological, leadership, administrative and managerial
support as the Private Partner in an open and transparent manner to
produce mutually agreed outcomes.
3.
Provide the Application Software for the project free of cost.
4.
Serve as a vital emergency management information and assistance
resource and raise societal awareness of, and capability in, Emergency
Management and Response mechanisms and thus save lives and reduce
the economic impact to the citizens, firms and the government
through appropriate awareness, education and capacity building
programs.
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5.
Operate the ambulances and ensure that ambulance services are
available on a 24 hours per day and 365 days a year basis to the
people in Karnataka, through the segment-wise operational
headquarters decided by the Government of Karnataka where the
ambulances will be located.
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.
Provide mutually agreed daily (operational), monthly (administrative
and financial) reports and quarterly (fund utilization) statements to
the Government of Karnataka.
8.
Attend periodical review meetings held by the Government of
Karnataka (physically or virtually) for the assessment of the
operationalization of the scheme.
9.
Maintain separate financial accounts and records of its operations in
Karnataka. These accounts shall be annually audited by a Chartered
Accountant firm as approved by NRHM / Government of Karnataka
and furnished to Government of Karnataka by the end of the first
quarter of the succeeding year in addition to any statutory audit. The
Government of Karnataka reserves the right for special audit as &
when necessary.
10.
Attend emergency calls that are received at the Emergency Response
Center as per the agreed performance benchmarks.
11.
Provide emergency response services to police, fire & medical
emergencies including pregnancy related cases on an average of 30
minutes in rural areas and 20 minutes in urban areas (in Plain areas)
assuming reaching the nearest point of motorable access. However,
EMRI will also identify critical locations on various roads for
connecting to hill terrains and remote areas with appropriate
transportation vehicles.
12.
Bring in technology and service excellence and work towards
improving delivery of emergency response of global standards over a
period of time.
13.
Assist the Government when required in Accreditation of Hospitals in
the state and such other matters from time to time.
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14.
Conduct training programs for paramedics, doctors and other
academic activities (workshops/seminars) as required for
governmental doctors and others.
15.
Strive for continuous improvement in emergency management through
strategic partnerships, innovative programs, and collaborative
policies.
16.
Undertake applied research assignments in implementing Emergency
Response Services in the field.
17.
EMRI shall appoint & position a Chief Operating Officer (COO) to
head Karnataka operations along with the required supporting staff
for Karnataka.
V.
RESPONSIBILITIES OF THE DEPARTMENT OF HEALTH & FAMILY
WELFARE, GOVERNMENT OF KARNATAKA
The Department of Health & Family Welfare, and Government of Karnataka shall
1.
Recognize EMRI as the Sole State Level Nodal Agency to provide
emergency response services across the state, in Public Private
Partnership and in coordination with other public agencies/Government
departments which will help drive greater transparency, agility, and
better citizen service.
2.
Entrust EMRI with the responsibility of operationalization of 517
ambulances by March 10 from the date of signing the MoU.
3.
Permit EMRI to procure ambulances, IT infrastructure including
furniture & fixtures, undertake improvements for setting up emergency
response center (Call Centre) and establish permanent Emergency
Response Centre in accordance with mutually agreed procedure of
procurement process.
4.
Provide ambulances duly Insured and equipped as mutually agreed upon to
provide Emergency Response Services to the needy people requiring prehospital care
5.
Provide adequate funds in advance as required by EMRI to equip
ambulances, which shall be designed by EMRI to suit public safety,
patient care and patient relative/attendant care.
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6.
Allocate at least 10 acres of land for setting up permanent emergency
response center(s) to EMRI.
7.
Provide funds in advance to meet the:
a. Capital expenditure for development & construction of state of the
art building, technology equipment, furniture and fixtures and all
other necessary office equipment, etc on the land allotted to EMRI.
Additional Capital Expenditure will also be provided for furnished
ambulance stations/shelters, offices and night halt facilities in
segment head quarters.
b. Operational expenditure (salaries, ambulance operational costs (fuel,
maintenance, medical consumables, etc.), utilities (electricity, water
and gas), rent, telephone, Awareness Building, Training, recruitment
and administration in advance quarterly installments before the
commencement of each quarter and also facilitate providing GIS maps
free of cost.
c. Any other reasonable unforeseen expenses to be reimbursed on
actual basis.
8.
Take up with the concerned authorities in the Medical Education
department, Health & Family Welfare Department to issue necessary
instructions for making available required emergency medical facilities
and strengthen the facilities in all the Primary Health Centers,
Community Health Centers, Area Hospitals, District Hospitals and
Teaching and other Specialty and Super Specialty Hospitals in the state
that are run by the Government.
9.
Make all efforts to ensure the availability of medical and paramedical
staff, equipment, medical supplies, and drugs for effective handling of
emergencies in the government hospitals and to coordinate with private
hospitals for making the healthcare services available to the
beneficiaries.
10.
Undertake to coordinate with the concerned authorities in the Police,
Fire, Transport and other departments to issue appropriate instructions
to the field officers of these departments for making available required
assistance and resources to handle all emergencies efficiently by EMRI.
11.
Undertake to provide appropriate physical and legal protection to all the
staff engaged in the provision of Emergency Response Services, while
discharging their legitimate duties.
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12.
Issue suitable administrative instructions to the field officers of all
relevant departments in the government, so as to prevent diversion of
the ambulances for any purposes other than providing emergency
response services.
13.
Provide a framework to enable efficient response to emergencies and
establish policies and procedures that enhance better co-ordination
among the multiple government departments and agencies.
14.
Liaise with various departments and agencies of the Government of India
to facilitate easy and early establishment of Emergency Response Center
by allotting toll free 108 number to the state of Karnataka.
15.
Establish or approve various training programs required for efficient
emergency response (such as paramedical and emergency medical
technician courses) and thus establish new employment opportunities.
16.
Establish standards and procedures for accrediting various service
providers such as hospitals and ambulances so that quality standards are
met.
17.
Promote public awareness in emergency response through various state
agencies and departments.
18.
Provide temporary office space at Bangalore required by Emergency
Management and Research Institute until permanent arrangements are
made available and temporary site for training facility including hostel
accommodation.
19.
Provide the data pertaining to hospitals, police stations and fire service
stations.
20.
Facilitate obtaining the data pertaining to telephone subscribers.
21.
Arrange instructions to the telecom service providers to route the calls
through “108”.
22.
Set up an appropriate Council / committee both at state & district levels
as deemed fit to meet periodically & make recommendations to facilitate
effective functioning of emergency response services.
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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
for landline and cellular phones.
108, both
(b) Commits to
-
-
Bring Leadership, Training and Research, Technology and Innovation
to provide high quality Emergency Response Services in Karnataka.
Number of Calls to be taken in 2 rings >= 97%
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-
Response time (Ambulance reach) From the time receiving call to
reach the scene <= 20 minutes on an average in urban areas and <= 30
minutes on an average in rural areas
-
Uptime of ambulances >= 98% (at any point of time so many
ambulances would be attending to emergencies)
-
Number of emergencies/dispatches per day per ambulance >=8 (on
launching the 517 ambulances-at maturity level)
-
Failed transport <= 3% of total emergencies handled
Ambulances without "ambulance stations" <= 5% (As a joint
responsibility and subject to funds made available by Government of
Karnataka)
(c) Confirms that
- 5 % of annual Operational Expenses would be met by EMRI in
addition to the costs of senior management.
- The 24 hour Emergency Response Center would function in 3 shifts
Operation.
- The 24 hour Ambulances in the field would operate in 2 shifts
VII. Project Cost Summary
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
7.00
13.88
5.00
2.50
28.38
•
367 Ambulances
92 ALS@ Rs 18.40 lakhs
275 BLS @ Rs 12.40 lakhs
•
Permanent ERC*
• IT infrastructure
Total
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
250.00
Operations (2008-09: Q2 & Q3)
517.00
Total
2126.00
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VIII. ASSUMPTIONS & EXPLANATIONS:
(A) Assumptions:
S No
A
B
1
LAUNCH
Particulars
SCHEDULE
2009-10
367
2010-11
Nil
25% ALS
75% BLS
20-25
8 Km per litre
3-5
1 for every 1.10 akhs popln.
25% ALS
75% BLS
20-25
8 Km per litre
6
25% ALS
75% BLS
20-25
8 Km per litre
7-9
4000-12000
4-6% of the call Volume
95% of total Dispatches
15000-46000
7% of the call Volume
95% of total Dispatches
46000-52000
8-9% of the call Volume
97% of total Dispatches
AMBULANCE STATISTICS
No of Ambulances - Note 1
2
Ambulance Category-Note 2
3
4
5
C
1
2
3
D
1
2
3
4
E
1
2
3
4
5
6
7
8
F
1
2
G
1
Per Trip Distance in kms.-Note 1
Mileage
Average Trips per Ambulance per day
CALL STATISTICS
Total Call Volumes-Note 3
Emergency dispatches -Note 4
Medical Dispatches-Note 5
CALL CENTRE STATISTICS
No of COs - Note 6a
No of Dos - Note 6b
Team Leader
Asst. Manager
REACH STATISTICS
Number of Pilots - Note 7a
Number of EMTs - Note 7b
Opeartions Executive - Note 8a
Fleet Executive - Note 8e
Office Assistant-Note 8d
District Manager - 8b
Regional Manager - 8c
Fleet Manager Note 8f
CARE STATISTICS
% of medical dispatches handled by ERCPs
Number of ERCPs
MISCELLANEOUS
Annual Increments
Replacement of Tyres
2
3
4
2008-09
150(Beginning Nov 08)
Refurbishment of interiors of Ambulance
Replacement of Ambulances
1 for 500 calls
1 for 500 calls
1 for 500 calls
1 for 100 dispatches
1 for 100 dispatches
1 for 100 dispatches
1 for every 15 CO/ DO
1 for every 15 CO/ DO
1 for every 15 CO/ DO
1 for every 10 Team Leaders 1 for every 10 Team Leaders 1 for every 10 Team Leaders
2.75 per ambulance
2.75 per ambulance
1 for every 10 ambulances
1 for every dictrict
1 for every dictrict
1 for every dictrict
1 for every division
1 for entire state
2.75 per ambulance
2.75 per ambulance
1 for every 10 ambulances
1 for every dictrict
1 for every dictrict
1 for every dictrict
1 for every division
1 for entire state
2.75 per ambulance
2.75 per ambulance
1 for every 10 ambulances
1 for every dictrict
1 for every dictrict
1 for every dictrict
1 for every division
1 for entire state
25% of total dispatches
1 for 80 medical cases
25% of total dispatches
1 for 80 medical cases
25% of total dispatches
1 for 80 medical cases
15%
15%
15%
Every 30000 kms or wear & tear whichever is earlier
On completion of a year or wear & tear whichever is earlier
On completion of 4 years
(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.’
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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
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 & EMRI’s 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
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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.
e.
Apart from these the following personnel will also be deployed:
i. Team Leader for very 15 CO/DO.
ii. Patient Care Record Officer (PCR) - Responsible for analysis of
Patient care record document with a handling capacity of 160 records
per shift.
iii. Team leader for every 15 doctors/PCR Officer.
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.
Operations Executive (OE)-Each OE is in charge of around 10 ambulances &
is responsible for day to day operations of these ambulances. The respective
EMTs & pilots report to the OE.
b.
District Manager (DM) - For every district there is head of operation
called DM & is responsible for all administrative functions within the district
including interaction with hospitals/District govt. officials, etc. Each DM
controls around 20-30 ambulances in his district. All the respective OEs
report to the DM.
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.
d. Administrative Officer (AO) – EMRI would have a small office at each
district provided by the Govt. The AO will provide the administrative support.
e. Fleet Executive – Every District has one fleet executive. He is responsible for
repairs & maintenance of all the ambulances within a particular district.
f. Fleet Manager – He is overall centrally responsible for tie-ups with dealers &
workshops for maintenance and administration of ambulances. All the Fleet
Executives report to the Fleet Manager.
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IX.
FINANCIAL ANNEXURES:
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:
Disclose the Confidential Information of the other party to any third
party; or
Use the Confidential Information of the other party for any purpose.
Either Party must take all reasonably necessary steps to ensure that its
officers, employees, agents and subcontractors do not make public or disclose
the Confidential Information.
B. Relationship:
Either party will not be a partner or agent of the other party and does not
have the power or authority, directly or indirectly, to bind the other party to
any agreement with a potential customer or any other third party or otherwise
to contract, negotiate or enter into a binding relationship for or on behalf of
the other party in relation to any of the areas having a direct or indirect
bearing on the implementation of this project, unless the same has been
agreed upon between the parties in writing.
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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.
- All disputes or differences whatsoever arising between the parties out of or
relating to the construction, meaning and operation or effect of this MoU or
the breach thereof shall be settled mutually by the Government of Karnataka
and Emergency Management and Research Institute. In case of any unresolved
matters, Chief Secretary, Government of Karnataka or his nominee not below
the rank of Additional Chief Secretary shall be the arbitrator whose decision
shall be final.
C.
All the physical infrastructure-movable & immovable assets and software
acquired and created from the funds/grants of GOVERNMENT OF
KARNATAKA will be the property of GOVERNMENT OF KARNATAKA.
.
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:
1……………………………
1……………………………
2……………………………
2……………………………
e-mail: venkat_changavalli@emri.in