LAHORE: The mega project of procurement of 60 ‘cardiac and rural’ ambulances has faced another setback with the reduction of more than Rs200 million in the grant.

The scheme was introduced as pilot project in five districts of Punjab in view of high rate of cardiac patients, a senior official told Dawn. He said the scheme, approved under the Annual Development Programme (ADP) in February 2014 at a cost of Rs433.7 million for the provision of 60 specialised ambulances, had been facing financial cuts from time to time by the authorities.

Recently, the official said, the government had provided only Rs230 million out of the total Rs433.7 million to the health department to materialise the scheme.

Health Secretary Dr Ijaz Munir told Dawn that he had taken up the matter with the authorities for the release of the remaining amount and the matter would be resolved sooner than latter.

He said the Punjab government had last year released only Rs50 million under this scheme but the health department had expressed its inability to initiate procurement process with this small amount requesting the government to release the total allocated cost next year (2014), Dr Ijaz said.

According to the minutes of the Provincial Development Working Party (PDWP) meeting the health department had submitted a PC-I in 2013 at a cost of Rs840.6 million (Rs69.2 million for 10 cardiac ambulances, Rs203 million for 50 DHQ/THQ ambulances and Rs524 million for 406 rural ambulances).

The minutes of the meeting said the scheme was considered in the PDWP on June 5, 2013 but the health department withdrew it. Later, the department submitted the revised PC-I at a cost of Rs435 million making almost half of the cut in the total cost on the project (Rs110 million for 10 cardiac ambulances and Rs325 for 50 DHQ/THQ hospital ambulances) but the scheme was deferred by pre-PDWP on Dec 27, 2013.

The health department again submitted a modified PC-I at a cost of Rs433.7 million (Rs114 for 10 cardiac ambulances and Rs318 for 50 DHQ/THQ hospital ambulances).

The scheme was discussed in pre-PDWP meeting held in January 2014 under the chairmanship of the Planning & Development Member (Social Sectors) wherein the cost of the project was again reduced from Rs433.7 million to Rs433.4 million.

During discussion the Chair inquired about the justification of installation of cardiac monitors instead of ECG machines in cardiac ambulances. The then health secretary had explained that it was a new pilot project and cardiac ambulances with cardiac monitors would be introduced in five districts of the province in view of high rate of patients.

“The main purpose of cardiac ambulances was to refer the patients to nearby health facility with emergency treatment,” the health secretary further informed the meeting.

The documents further said the Chair told the meeting that either ECG machine or cardiac monitor couldn’t reduce the mortality rate, hence, ECG machine would be provided instead of cardiac monitor.

On a point raised by the Member (Social Sectors), it was decided in the January meeting that a fresh summary would be submitted to the chief minister highlighting the deviations/additionality in the items provided in the PC-I compared to earlier approved summary by the chief minister.

After detailed discussion, the scheme was approved at a cost of Rs414.4 million by including the ECG machines in the specifications of the cardiac ambulances instead of monitors.

Some medical experts say the life-saving tools including defibrillator or automated external defibrillator (AED) have been an integral part of ambulances in Europe or other countries but the specifications approved by the PDWP for the ambulances will bring no relief to the patients during pre-hospital care.

“The defibrillator device that monitors the heartbeat gives out a high-energy electrical impulse to stop very fast, abnormal heartbeats,” Dr Amir Bandesha of the Punjab Institute of Cardiology told Dawn. He said “the device returns the heart to a normal rhythm.”

He further said the portable device AED could send an electric shock to the heart to restore a normal rhythm. “The AEDs are normally used to treat sudden cardiac arrest (SCA), a condition in which the heart suddenly and unexpectedly stops beating.

“The application of an electric shock to restore normal heart function is the only way to effectively treat a ventricular fibrillation and prevent death,” he said and stressed that the health authorities make this device integral part of the ambulances otherwise there’s no need to waste resources on the project.

About the reservations of the medics, the health secretary made it clear that the specifications discussed by the PDWP meeting would not be followed. He said the department would modify it and add the life-saving devices like AED in the ambulances.

Published in Dawn, August 21st, 2014