For the partial

fulfilment of the Degree

MBA in Hospital Management

Submitted To :- Ranjan Mondal

Submitted By :- Sourav Mondal

Stream :- MBA in Hospital Management

Session :- 2022 – 2024

Semester :- 2 nd Semester

University Enrolment No. :- 220755206699

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 Acknowledgement

I would to express my profound gratitude to Mr. Ranjan Mondal of our Hospital and
Healthcare Management department and Mr. Manoj Ghosh for their contribution to complete
my assignment titled Telemedicine, Hospital Ambulance Service, Waste Disposal
Management in Hospital, Overview of a Super Speciality Hospital.

I would like to express my special thank to our HOD Mr. Ayan Banarjee for his time and effort
he provided throughout the year. Your Useful advice and suggestions were really helpful to
me during the assignment completion. In this aspect, I am eternally grateful to you.

I would like to thank My parents and my classmate who help me all the year.

I would like to acknowledge that this project was completed entirely by me and not be
someone else.

Sourav Mondal :- Student of Hospital Management

Dated :-

Mr. Manoj Ghosh Mr Ranjan Mondal Mr. Ayan Banarjee

(Director CIHHM Foundation) (Asst. Professor Hospital Department) ( HOD Hospital Department)

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 Self Declaration
.

I hereby declared that your project report on Telemedicine, Hospital Ambulance Service,
Waste Disposal Management in Hospital, Overview of a Super Speciality Hospital
submitted by me in the result of my original and independent research work. The date and
information is provided in this assignment is truly original and valid and was not been
influenced in any other work done in the same field before. It is provide by observation and
discussion with the stuffs and other executive on the concerned department the fact and the
findings presented in this assignment are true to the best of my knowledge and belief.

Sourav Mondal

Dated :-

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 Table of Contents

Topic Name Page No.

Telemedicine 5 – 26

, Hospital Ambulance Service 27-46

Waste Disposal Management in

47-69
Hospital

Overview of a Super Speciality

70-91
Hospital

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5
  INTRODUCTION:

Telemedicine refers to the provision of remote clinical services, via real-time two-way communication between
the patient and the healthcare provider, using electronic audio
and visual means.

Telemedicine refers to the practice of caring for patients

Remotely when the provider and patient are not physically

Present with each other. Modern technology has enabled

Doctors to consult patients by using

HIPAA compliant video-conferencing tools.

 DEFINITION:

A tool that makes healthcare more accessible, cost-effective, and that increases patient engagement – is
telemedicine. Since making its debut in the late 1950’s, advances in telemedicine have contributed to seniors
having the choice to age in place. In addition, the patients that reside in rural areas that previously had
difficulties accessing a physician, can now reach them virtually.

Physicians and patients can share information in real time from one computer screen to another. And they can
even see and capture readings from medical devices at a faraway location. Using telemedicine software,
patients can see a doctor for diagnosis and treatment without having to wait for an appointment. Patients can
consult a physician at the comfort of their home.

The concept of telemedicine and telehealth could be still new to providers and physicians given the especially
slow adoption of technology in healthcare.

However, the continue advances in technology and healthcare innovation has greatly expands its usability.
Moreover, the demand from new generation of tech savvy population has pushed for its rapid adoption due to
convenience, cost saving and intelligent features it brings.

It’s now a matter of time for healthcare system, medical group; providers and even solo practitioner integrate
telemedicine as part of their medical services offering.

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  What is Telemedicine Healthcare:

Telemedicine is simply defined as, “the remote delivery of healthcare services“. There are 3 common types of
telemedicine, which include but not limited to:

1. Interactive Medicine – Integrative medicine

combines the most well-researched
conventional medicine with the most

well-researched, evidence-based complementary therapies to

achieve the appropriate care for each person.

 How Interactive Medicine Done?

Integrative medicine can help people who have symptoms such as

fatigue, anxiety and pain. It can help people deal with conditions

such as cancer, headaches and fibromyalgia. Examples of common practices include:

 Acupuncture
 Animal-assisted therapy
 Aromatherapy
 Dietary and herbal supplements
 Massage therapy
 Music therapy
 Meditation
 Resilience training
 Tai chi or yoga

2. Store and Forward - which permits providers to share patient information with a practitioner
in another location.

3. Remote Patient Monitoring – Remote patient monitoring (RPM) is a subcategory of

homecare telehealth that allows patients to use mobile medical devices and technology to gather
patient-generated health data (PGHD) and send it to
healthcare professionals. Common physiological data that
can be collected with RPM programs include vital signs,
weight, blood pressure and heart rate. Once collected,
patient data is sent to a physician’s office by using a special
telehealth computer system or software application that
can be installed on a computer, smartphone or tablet.

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  Some Example of Remote Patient Monitoring.

RPM technology can range from handheld medical devices to online platforms that allow patients to input data.
A few examples include:

 Glucose meters for patients with diabetes.

 Heart rate or blood pressure monitors.
 Continuous surveillance monitors that can locate patients with conditions like dementia and alert
healthcare professionals of an event like a fall.
 Remote infertility treatment and monitoring.
 At-home tests that can keep substance abuse patients accountable for and on track with their goals.
 Caloric intake or diet logging programs.

 What Services Are Provided Through Telemedicine?

Telemedicine may be best understood by the services provided and the methods used to provide those
services. The following are some examples.

 Primary care and referral services for specialist care may

require consultation between a primary care or allied
healthcare professional and their consultation with the
patient or specialist, who will assist the physician in
determining a diagnosis. This may occur via live
interactive video or with technology to save and
forward diagnostic images, patient vital signs and/or
video along with the patient’s data to review later.
 Patient monitoring at remote locations, which includes
home health services. Devices are used to collect and
send patient data remotely to the home health agency
or a diagnostic testing facility. The information might
include vital signs for homebound patients, such as
blood glucose testing results, ECG information, or a host
of other information about the patient. The services provided via telemedicine help supplement
services provided by visiting nurses.
 Health and medical information for consumers may include the use of wireless devices or the internet,
which allows consumers to access specialized health information and discussion groups to engage in
peer-to-peer support.
 Continuing medical education credits can be obtained by health professionals and specialized medical
education can be more accessible for people in remote locations.

 How is telemedicine set up?

It can be simple or complex for a provider to implement telemedicine into their practice. For solo practitioner
and clinic, most just require a basic HIPAA compliant video conference software to start delivering telemedicine
consultation.

For providers looking to have a more complete virtual clinic solution, they need to consider their existing
workflow and incorporate the telemedicine software solution into their practice. Usually these software need
to have waiting room, EHR and payment function.

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For large medical group or hospitals, they usually requires custom telehealth solution to fit into their existing
workflow to lessen the disruption of adopting telemedicine as its harder to train large number of physicians to
change their behaviour.

Besides the software part, it’s advisable for provider to do due diligence on the telehealth regulations, and
reimbursement policy for their country or state, which will be discussed later in this article.

Organizations will have to change operationally and have knowledge of the regulations, legalities, and
technological aspects of implementing telemedicine. Many organizations decide to partner with a telemedicine
company to make the transition and implementation easier.

 How Telemedicine is it Conducted?

Telemedicine is conducted in a number of ways. The most basic is just a simple video call (like you normally do
with family and friends), however most countries
required secured HIPAA compliant video conference tool,
so telemedicine company such as VSee also provides this
kind of secure and simple to use solution for providers.

There are also some telemedicine is conducted with

portable telemedicine kits that include a computer and
mobile medical devices, such as ECGs or vital signs
monitors. High resolution digital cameras are also
available for physicians to send detailed medical images
to specialists.

Lastly, there is robust telemedicine software that allows

everything from data storage to live video conferencing. Overall, there are many innovative telemedicine
equipment to meet the various needs of patients today.

 What is Telehealth?

Telehealth is the use of digital information and communication technologies to access health care services
remotely and manage your health care. Technologies can include computers and mobile devices, such as
tablets and smartphones. This may be technology you use from
home. Or a nurse or other health care professional may provide
telehealth from a medical office or mobile van, such as in rural
areas. Telehealth can also be technology that your health care
provider uses to improve or support health care services.

 The goals of Telehealth

sometimes called e-health or m-health (mobile health), include

the following:

 Make health care easier to get for people who live in

communities that are remote or in the country.
 Keep you and others safe if you have an infectious
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  disease such as COVID-19.
 Offer primary care for many conditions.
 Make services more easily offered or handy for people who have limited ability to move, time or
transportation.
 Offer access to medical specialists.
 Improve communication and coordination of care among health care team members and a person
getting care.
 Offer advice for self-management of health care.
Many people found telehealth helpful during the COVID-19 pandemic and still use it. Telehealth is being used
more often.

 Difference between Telehealth and Telemedicine

Telehealth Telemedicine
Telehealth covers a wide range of remote clinical and Telemedicine is just a part of Telehealth.
non-clinical services.
This is more than the physician-patient conversation. This is restricted only to the physician-patient dialogue

This includes services provided by Healthcare Only HCPs play a vital role here.
Workers (HCWs), Healthcare Professionals (HCPs),
educators, pharmacists, and Frontline workers
(FLWs).
Telehealth includes a wide range of lab test reports, Telemedicine limits to digital mode of service
healthcare education, training, a collaboration provided by physicians
between technology and the healthcare sector, etc.
Telehealth’s tracking and communication services This only extends the coverage of physician reach.
help patients with chronic diseases participate in
their treatment.

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  History of Telemedicine

Contrary to popular belief, telemedicine is not a new practice. In fact, the concept of telemedicine is dated back
to the 19th century! What began as a few hospitals wanting to reach patients in remote locations became an
integrative system across the care continuum. The history of telemedicine will unveil how we got to where we
are today.

 Telemedicine in the 19th Century

The creation of telemedicine began with the inception of the telecommunications infrastructure, which
included the telegraph, telephone, and radio. Casualties and injuries were reported using the telegraph during
the Civil War, in addition to the ordering of medical supplies and consultations. This is considered one the
earliest adoptions of telemedicine technology.

By 1879, a Lancet report discussed how using the telephone can reduce the number of unnecessary office
visits. This was only the beginning of what would be a patient care transformation.

 Telemedicine in the 20th Century

In 1922, Dr. Hugo Gernsback featured the teledactyl in a science magazine. Gernsback predicted that this
sensory feedback device would permit
physicians to see their patients through a
television screen and touch them from miles
away with robot arms.

The first radiologic images were sent via

telephone between two medical staff at two
different health centers in Pennsylvania by
1948. The health centers were 24 miles apart
from one another! Then in 1959, physicians
at the University of Nebraska transmitted
neurological examinations across campus to
medical students using two-way interactive
television. Five years later, a closed-circuit
television link was built that allowed physicians to provide psychiatric consultations 112 miles away at Norfolk
State Hospital.

 Telemedicine Today

Today, most people have access to basic telemedicine devices like mobile phones and computers. With
improved accessibility, individuals in rural areas and busy urban areas can connect with a provider with ease.
Home-use medical devices make it possible for caregivers to monitor everything from vitals to glucose levels.
Physicians can gather essential medical information and make a diagnosis without patients stepping foot in a
doctor’s office.

By 2020, telemedicine is expected to be a $35 billion industry and be an imperative piece of modern healthcare
delivery. The history of telemedicine shows that we’ve come so far from where we started, and yet still have a
long ways to go.

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  What are the benefits of telemedicine
Known as a technological advancement that is changing the entire healthcare infrastructure, telemedicine is
here to stay. Today, patients, providers, and payers alike are able to benefit from the emergence of
telemedicine. Read on to discover how telemedicine is enhancing the healthcare system across the continuum.

 How Telemedicine Benefits Providers

Healthcare systems, physician practices, and skilled nursing facilities are using telemedicine to provide care
more efficiently. Technologies that comes integrated with telemedicine software like electronic medical
records, AI diagnosis and medical streaming devices, can better assist providers in diagnosis and treatment. The
latter allows providers to monitor patients in real-time and adjust treatment plans when necessary. Ultimately,
this leads to better patient outcomes.

Providers can also benefit from increased revenue. By utilizing telemedicine, physicians can see more patients
without the need to hire more staff or increase office space. Experts in telemedicine like VSee help provider’s
set-up HIPAA-compliant telemedicine solutions that will streamline workflows and enhance patient care.

 How Telemedicine Benefits Patients

Because of telemedicine, patients who previously had limited access to health care services can now see a
physician without leaving their home. Seniors who would prefer to age in place can now do so with the use of
medical streaming devices. The spread of disease is reduced as individuals with contagious diseases don’t have
to expose it to others in crowded waiting rooms.

Telemedicine also benefits patients in the following ways:

Transportation: Patients can avoid spending gas money or wasting time in traffic with video consultations.

No missing work: Today, individuals can schedule a consultation during a work break or even after work hours.

Childcare/Eldercare Challenges: Those who struggle to find care options can use telemedicine solutions.

 How Telemedicine Benefits Payers

Although this is more difficult to prove, big payers like Blue Cross Blue Shield and Aetna are benefiting from
telemedicine too. Patients with substance abuse disorders who are treated using various telemedicine
strategies provide cost-savings for payers. The cost per treatment is cheaper overall and offers cost savings
across the board. As technology continues to improve, the cost savings will become more visible.

 Advantages and Disadvantages of Telemedicine

Telemedicine is the use of medical information exchanged from one site to another through electronic
communications to improve a patient’s health. It is also known as e-health, m-health, telehealth, or e-care.

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  Advantages of telemedicine

1. Increased access to care

Telemedicine can help to improve access to care, especially for patients in rural and underserved areas.

2. Improved continuity of care

Telemedicine can help to improve continuity of care by providing more frequent and regular contact between
patients and their care providers.

3. Cost savings

Telemedicine can help to save on costs by reducing the need for travel and accommodation for patients and
care providers.

4. Flexibility

Telemedicine can offer more flexible appointment times and locations.

5. Increased convenience

Telemedicine can be more convenient for patients as they can receive care from the comfort of their own
homes.

6. Improved patient satisfaction

Telemedicine can help to improve patient satisfaction by providing a more convenient and personalized care
experience.

7. Increased access to specialists

Telemedicine can help to increase access to specialists, who may not be available in a patient’s local area.

8. Improved communication

Telemedicine can help to improve communication between patients and care providers.

9. Enhanced care coordination

Telemedicine can help to enhance care coordination by providing access to a patient’s medical records and care
plan.

10. Increased efficiency

Telemedicine can help to increase efficiency in the delivery of care by reducing waiting times and
appointments.

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  Disadvantages of telemedicine

1. Limited evidence

There is limited evidence to support the efficacy of telemedicine.

2. Lack of regulation

There is a lack of regulation surrounding the practice of telemedicine.

3. Security and privacy concerns

There are concerns about the security and privacy of medical information exchanged via telemedicine.

4. Technical problems

There can be technical problems with the equipment used for telemedicine.

5. Limited access

Telemedicine may not be available to all patients due to limited access to technology.

6. Inequitable access

There may be inequitable access to telemedicine if it is only available to patients who can afford it.

7. Geographic barriers

There may be geographic barriers to the use of telemedicine.

8. Time zone differences

There may be time zone differences between the patient and care provider which can make it difficult to
coordinate care.

9. Language barriers

There may be language barriers between the patient and care provider which can make it difficult to
communicate.

10. Social isolation

There is a concern that telemedicine may lead to social isolation.

 Telemedicine Services
Did you know that there are different types of telemedicine? That’s right, there are a few different ways that
healthcare systems can use telemedicine to assist patients. As discussed in previous articles, telemedicine is the
method of using telecommunications to connect patients and providers over a distance. Today, there are three
different types of telemedicine used and it includes the following:

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  Interactive Medicine

Interactive medicine, also known as “live telemedicine”, allows patients and physicians to communicate in real-
time while also maintaining HIPAA compliance. Communication methods include both phone consultations and
video conferences. Physicians can assess a patient’s medical history, perform psychiatric evaluations, and more
using interactive medicine.

Telemedicine solutions provided by VSee ensures that interactive medicine is HIPAA compliant in two ways:

 Audio/video communication is encrypted and transferred from point-to-point. Identifiable health

information is only shared on a need to know basis.
 VSee offers a HIPAA-required
business agreement, which states
that they are responsible for keeping
all patient information secure. VSee
must immediately report any breach
of contract.
 Store and Forward

This type of telemedicine allows providers to

share patient information with a practitioner
in another location. For example, a primary
care physician can now share patient records and medical data with a specialist without being in the same
room. Systems can transmit information across vast distances and different systems (sometimes) so one
physician can know what another has already done. This leads to less duplicate testing and fewer instances of
poor medication management.

 Remote Patient Monitoring

Likely a favourite among patients aging in place, telemedicine permits providers to monitor their patients in
their own homes. Using patient portals, a physician can gather and share information with their patient. In
addition, medical devices can send vital signs and more to providers so they can make adjustments to care as
needed. VSee offers their clients the following telemedicine solutions:

 EKG
 Ultrasound
 Dermatoscope
 Pulse oximeter and more!

These medical devices also allow physicians to travel to rural and developing countries to provide necessary
patient care.

 Applications of Telemedicine

Thanks to telemedicine, physicians have the wonderful opportunity to connect with clients wherever they are.
Patients who once could not see a physician due to access to care issues, can now do so almost seamlessly.

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However, many may wonder what is telemedicine’s most valuable applications? We’ll discover a few popular
ways that telemedicine is used today.

 Chronic Disease Management

With high-tech medical devices, physicians can now monitor their patients health over long distances. Touch
screen technology allows providers to access heart rate, blood pressure, glucose levels and more through the
transmission of data from one device to another.

Leading telemedicine companies like VSee, assists healthcare organizations in being able to treat patients with
chronic diseases. They recognize that 75% of the United States healthcare spending is dedicated to treating
heart disease, cancer, and diabetes. As a result, they’ve created telemedicine solutions that can keep physicians
abreast from hospital to home. In addition, the patient, their family members, and other healthcare
professionals can collaborate in the patient care process.

Today, when readings fall out of range, a physician can intervene in real time, which leads to better health
outcomes.

 Medication Management

Those in the healthcare industry recognize that medication management is a big deal, especially among seniors.
Older adults are more likely to forget to take their medications, which is where telemedicine comes in.
Providers and other healthcare professionals can use telemedicine technology to monitor when and if their
patients took their medicine. As a result, this leads to fewer hospital readmissions and enhances medication
compliance.

 Sharing Medical Information

Store and forward, a type of telemedicine that allows providers to share information over a distance, has been
a game changer. Today, primary care physicians can connect with specialists who are in another location than
them. Healthcare information like diagnostic images, blood analysis, and more can be shared for appropriate
patient assessment in real time.

 Emergency Room (ER) Diversion

Without a doubt, the emergency room is one of the most expensive, overcrowded, and stressful environments
in healthcare. With telemedicine, overcrowded emergency rooms can be reduced by having patients see a
remote physician using video chat first. The remote physician can determine if that individual should seek care
in an emergency department, which increases ED efficiency.

 2nd Opinion

Today, there are telemedicine solutions that allow patients to seek a second opinion from the comforts of their
home. Sending another physician copies of your medical images and more can easily be done by uploading the
content to their secure website. This is very convenient for those who need a specialist but do not have the
resources to drive thousands of miles away or wait a long time.

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  NICU/ICU

In the NICU/ICU, telemedicine can be used in a variety of ways.

One approach is by using HD webcams to see the baby from
different angles. High-risk infants can be seen by a specialist at
another hospital by simply sharing the video within seconds. This
decreases the need for infants to be transferred to another
hospital, which is costly and time consuming.

Some facilities have also set-up telemedicine follow-up visits that

take place one week after a baby is discharged from NICU.
Hospitals that did this noticed a significant decrease in extra
visits or calls from worried parents.

 Disaster Relief

When a disaster occurs, the local healthcare resources are immediately pulled in to provide both emergent and
non-emergent care. This usually results in a shortage as the demand for services is much higher than what can
be supplied.

With telemedicine, physicians in other locations can provide assistance by conducting video visits. In fact, when
Hurricane Harvey occurred in 2017, healthcare professionals provided emergency and behavioral health video
visits. This allowed practitioners to focus on high demand, complex cases in-person versus low level cases that
can managed remotely.

 Paramedic/Ambulatory

It’s not uncommon for an emergency department to shut down after reaching capacity. This leads to
ambulances taking patients to hospitals that are farther away and this ultimately affects their outcome.

By using telemedicine, paramedics can use technology to see the capacity of an emergency room in real-time
instead of heading to the hospital and then being diverted later.
Also, when emergency rooms begin using video consultations to triage their patients, it gets the non-emergent
cases out sooner. This leads to less ambulance diversion and better patient outcomes.

 Telemedicine for Remote Clinics

In many Walmart stores, retail consumers can walk up to a kiosk for a doctor consultation. The doctor is not
physically present inside the store. Instead, the customer uses a touchscreen computer to type in their
symptoms and enter a virtual waiting room. They are then connected by a video link to a doctor. This use-case
is HIPAA-compliant because the video link is encrypted to protect patient health information.

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  Mobile Health

Sometimes the answer to the question “What is telemedicine?” is simply mobile medicine. It doesn’t require a
heavy desktop computer or a lot of equipment. Activities that used to happen only in person are now easy to
do on a smartphone. Modern
consumers are accustomed to
downloading apps and using their
smartphones for simple transactions.
The same is true for doctor visits. For
example, with MDLIVE the patient
simply opens the app and clicks to
choose a doctor, with whom they can
speak either by phone, instant
message, or video.

More recently, we are starting to see

small scopes and other peripherals that can plug into a mobile phone. These devices transform the phone into
a pocket-sized diagnosis tool, excellent for point-of-care tests.

 Device Streaming

Medical devices that can stream their data long-distance include, but are not limited to:

 Digital stethoscope
 EKG
 Pulse oximeter
 Ultrasound
 Blood pressure cuff
 Otoscope
 Dermatoscope

These devices can be packed into a kit and sent out into the field. In this way, telemedicine has proved
extremely useful in rural and developing countries like Gabon, Iraqi Kurdistan, and Nigeria, where there is very
little access to high-quality medical care. Telemedicine eliminates the barrier of distance and improves access
to medical services that would otherwise not be available in distant rural communities.

In this category of medical devices we can also include wearables like FitBit. Data from wearables can be
captured via Bluetooth and displayed on a digital dashboard, which allows doctors to monitor their patients’
vital stats.

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  Which medical specialties can use telemedicine

Although telemedicine has been most beneficial to the primary care arena, it also benefits various medical
specialities. Consider the following ways that VSee implements their telemedicine solutions to benefit multiple
medical specialities.

 Radiology

A radiologist specializes in using medical imaging techniques to both diagnose and treat disease. Their day-to-
day responsibilities include working with other healthcare professionals, which can be extremely time-
consuming. With telemedicine, radiologists can receive high-quality images and provide feedback on where
ever they are. They no longer have to be in the same area as the provider sending over the images, which
allows for a more streamlined process.

VSee technology uses radiology software like the VSee Clinic, to:

 Schedule patient appointments

 Allow patients to pay for services rendered
 Provide or give second opinions

 Mental Health

Likely one of the most popular specialities for telemedicine, mental health practices can increase revenue,
streamline patient flow, and provide counselling sessions from anywhere. With telemedicine, patients in rural
areas can now access mobile and web apps to speak with their therapist. In addition, cancellations and no-
shows are less likely to occur. Mental health practices that implement telemedicine can also see more patients
and still provide a high level of patient care. This leads to increased profitability and effective time
management.

 Pediatric

Parents can now avoid bringing their sick child out of the house to see a doctor because of telemedicine
solutions. A Pediatrician can use HIPAA Messenger to securely share images, texts, and more to make a
diagnosis and treatment plan. Pediatrician can also provide education to parents regarding next steps just as
they would at a clinic.

 Dermatology

With telemedicine, patients can connect with their dermatologist using a smartphone, tablet, or computer.
Using high definition images and video, dermatologists can examine a patient suffering from psoriasis, eczema,
bedsores, and more. This is extremely convenient for those patients that are housebound. Using telemedicine
solutions, dermatologists can diagnose and treat skin care conditions effectively and efficiently. In addition, it
not only saves a patient from travelling to a clinic but it also helps them maintain their dignity.

 What do I need to start Telemedicine

Deciding to start a telemedicine practice is a big decision and requires a very well-thought out plan. While there
are wonderful benefits to starting a telemedicine practice, there are also some drawbacks. It is an endeavor
that requires up-to-date equipment, trained staff, and an understanding of telemedicine laws.
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  Understand the Basics

Before setting up a telemedicine practice, an organizations administration and providers should know how laws
differ when using telemedicine solutions. They should also consult with an expert to determine what
equipment they need, and have a basic understanding of why they want to offer this in the first place. In
addition, if it’s an existing practice, they should get buy-in as some physicians are not ready to make the
transition.

 Deciding On Telemedicine Solutions

After laying out the basics, an organization should decide what type of telemedicine solutions to offer. A
telemedicine expert like VSee offers a text and video collaboration app, a Virtual waiting room, and more. The
organization should be responding to their current pain points, such as overcrowded waiting rooms or difficulty
reaching patients in rural areas.

 The Equipment

VSee urges organizations to try their free app so physicians can get a feel for sharing medical documents and
streaming digital device images. In addition, organizations should ensure they have compatible microphones,
webcams, speakers, and more. A telemedicine tech should be identified within the practice to help others get
acclimated and resolve tech issues. Also, practices should be aware of their Internet connection. VSee’s video
chat is robust, but how well it works comes down to the Internet connection and computer capabilities.

 Understand Regulations and Reimbursements

Policies and regulations in the telemedicine arena can be confusing for providers, vendors, and payers.
Organizations interested in implementing telemedicine should be familiar with the laws in their state. For
example, some states require informed consent from patients, while others do not. Some payers may not pay
the same rate for telemedicine services as they do for in-person services. Practices should identify how
providers will be paid, as some organizations seek grant funding.

Consult with a telemedicine expert to determine the ins and outs as it relates to implementing telemedicine in
a practice similar to yours.

 Telemedicine in India
India is a large nation with a population of more than 121 crores of sundry people. Due to this fact, the
equitable distribution of healthcare services has proven to be a major goal in public health management time
and again. Adding to this is the recent trend of concentration of healthcare facilities to the cities and towns
(including 75% of the population of doctors), away from rural India, where 68.84% of the national population
live.

ISRO (Indian Space Research Organization) made a modest beginning in telemedicine in India with a
Telemedicine Pilot Project in 2001, linking Chennai's Apollo Hospital with the Apollo Rural Hospital at Aragonda
village in the Chittoor district of Andhra Pradesh. Initiatives taken by ISRO, Department of Information

20
Technology (DIT), Ministry of External Affairs, Ministry of Health and Family Welfare and the state governments
played a vital role in the development of telemedicine services in India.

In an attempt to coalesce the available public health data and provide easy access, the Ministry of Health in the
Government of India has taken up projects like Integrated Disease Surveillance Project (IDSP), National Cancer

Network (ONCONET), National Rural Telemedicine Network, National Medical College Network and the Digital
Medical Library Network. Setting up of standardized telemedicine practice guidelines by the Department of
Information Technology in the Government
of India, and setting up of a National
Telemedicine Task Force by the Health
Ministry, in 2005, were some of the other
positive steps by the government.
International projects like the Pan-African
eNetwork Project and the SAARC (South
Asian Association for Regional Co-operation)
Telemedicine Network Projects have also
been taken up as an initiative of the External
Affairs Ministry, strategically placing Indian
telemedicine in the global scenario.

A few noteworthy examples of the successfully established telemedicine services in India include
mammography services at Sri Ganga Ram Hospital, Delhi; oncology at Regional cancer center, Trivandrum;
surgical services at Sanjay Gandhi Postgraduate Institute of Medical Sciences, School of Telemedicine and
Biomedical Informatics, and many more.Telemedicine also finds its use in places where large populations
occasionally/periodically gather at a point of time, where provision of medical care becomes the need of the
hour; for example, the Government of Uttar Pradesh practices telemedicine during Maha Kumbhamelas.

Telemedicine is one field which was successful in invoking a keen interest in the private sector and making
them take an active part in public health management. Some of the current major Indian private sector players
in telemedicine include Narayana Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Foundation, Escorts
Heart Institute, Amrita Institute of Medical Sciences and Aravind Eye Care. They function with support from
the central and state governments and from organizations like ISRO who guide them with appropriate and
updated technology.

In the past few years, ISRO's telemedicine network has come a long way. It has expanded to connect 45 remote
and rural hospitals and 15 super specialty hospitals. The remote nodes include the islands of Andaman and
Nicobar and Lakshadweep, the hilly regions of Jammu and Kashmir, Medical College hospitals in Orissa and
some of the rural/district hospitals in other states.

 History of Telemedicine in India

The World Health Organization (WHO) defines telemedicine as,the delivery of healthcare services, where
distance is a critical factor, by all healthcare professionals using information and communication technologies
for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries,

21
research and evaluation, and for the continuing education of healthcare providers, all in the interests of
advancing the health of individuals and their communities.

The Indian Space Research Organization (ISRO) initiated telemedicine in India in 2001, starting with the
Telemedicine Pilot Project. The Health Ministry established a National Telemedicine Taskforce in 2005, sharing
jurisdiction with the Ministry of Health and Family Welfare (MoHFW). Additional national programs in India
include the Integrated Disease Surveillance Project (IDSP), the National Cancer Network (ONCONET), the
National Rural Telemedicine Network, the Digital Medical Library Network, and the National Medical College
Network that links medical colleges with the primary purpose of e-learning .

Until emergence of the COVID-19 pandemic, India had not implemented telemedicine on a large scale, and the
early attempts had not all been successful. Nor was telemedicine clearly legal before issuance of the 25 March
2020 guidelines. Several judicial orders in India impeded the practice of telemedicine. The public questioned
the usefulness of telemedicine after a top court in one of the largest states of India, Maharashtra, upheld
criminal negligence charges for a case that involved consultation over the telephone after which the patient
lost her life. Thus, a lack of clear policy or legislation and a ruling of criminal negligence left the future of
telemedicine uncertain in India until COVID-19 brought it into sharp focus.

 Scope of Telemedicine in India

In India, 68% of the population resides in a rural area where the health care services are minimal and
telemedicine can close the gap by overcoming distance barriers through joint efforts of government and private
healthcare institutions.

 Telemedicine market in India

The telemedicine market in India was approximately 450 million U.S. dollars in 2016 .

22
  Telemedicine during COVID-19 in India

As a response to the COVID-19 pandemic, the Indian government imposed a strict countrywide lockdown.
Then, out-patient departments in most government and private medical colleges either shut or curtailed
availability of services . Reports from countries affected more seriously by the pandemic prompted this
response in India. Others had learned that closed environments, particularly hospitals, facilitated secondary
transmission of the coronavirus. Hospitals plausibly functioned as sources of 'super spreading' events; to
contain the spread, hospitals closed out-patient departments and other non-emergency units . In India (and
likely in other low- and middle-income countries) physical access to healthcare was already limited along with
other dire limitations like unavailability of adequate healthcare human resource and its skewed distribution,
low affordability, massive information asymmetry and poor health awareness and thus, closure of these
services exacerbated a shortage of services .

India responded, as did many other countries worldwide, with telemedicine and other digital health
technologies. Within a week of the close of hospital out-patient departments, several healthcare facilities
commenced telemedicine services. Providers included large private hospitals as well as individual practitioners.
Union government institutions and the State-funded ones promptly offered services by electronic means . Just
after the closure of hospital units, the Ministry of Health & Family Welfare established the country’s
telemedicine policy guidelines (25 March 2020).

 Current scenario in India

WHO recommends a doctor-population ratio of 1:1000 while the current doctor population ratio in India is only
0.62:1000. Training of new physicians is time consuming and expensive, hence the doctor to patient ratio can
be expected to remain low for a long time to come.
This deficit is partly being made up by the active
telemedicine services in various parts of the
country.

Telemedicine services in the country come under

the combined jurisdiction of Ministry of Health and
Family Welfare and the Department of Information
Technology. Telemedicine division of MoHFW, GOI
has set up a National Telemedicine Portal for
implementing a green field project on e-health
establishing a National Medical College Network
(NMCN) for interlinking the Medical Colleges
across the country with the purpose of e-Education
and a National Rural Telemedicine Network for e-Healthcare delivery.

As a constituent of the e-health wing of the National Health Portal (NHP), National Digital Health Authority of
India (NDHAI)/National e-health authority (NeHA) is being set up with a vision of achieving high quality health
services for all Indians through the cost-effective and secure use of ICTs in health and health-related fields. To
ensure safe data transmission during telemedicine practices, MoHFW has developed a set of Electronic Health
Records (EHR) standards in 2013 and a revised version of the same in 2016. Telemedicine practices in India are

23
also extended to the fields of traditional medicine. The National Rural AYUSH Telemedicine Network aims to
promote the benefit of traditional methods of healing to a larger population through telemedicine.

Village Resource Center (VRC) the VRC concept has been developed by ISRO to provide a
variety of services such as tele-education, telemedicine, online-decision support, interactive farmers’ advisory
services, tele-fishery, e-governance services, weather services and water management. The VRCs not only act
as learning centers and but also provide connectivity to specialty hospitals, thus bringing the services of expert
doctors to the villages. Nearly 500 such VRCs have been established in the country.

AROGYASREE is another internet-based mobile telemedicine conglomerate that integrates multiple

hospitals, mobile medical specialists and rural mobile units/clinics. The project is an initiative of Indian Council
of Medical Research (ICMR). They have collaborated with a team of scientists from University of Karlsruhe,
Germany who are working on the design of an ECG jacket which can be used for the continuous monitoring of a
patient's ECG without hospitalization.

24
  Conclusion

The use of Telehealth technologies has the potential to make a positive impact in the healthcare lives of
patients. For example, it offers convenient health care on the patient’s time schedule therefore saving travel
time for those in rural areas.

Telemedicine cannot be the answer to all problems, but it can be very important
in addressing a vast range of problems. Services like tele-health, tele-education and tele-home healthcare are
proving to be wonders in the field of healthcare. The importance of satellite communications is emphasized in
the field of disaster management when all terrestrial modes of communication are disrupted. International
telemedicine initiatives are bringing the world closer and distance is no longer a barrier in attainment of quality
healthcare. Despite having so much potential still telemedicine has not attained the ‘boom’ which it was meant
to create. Lack of awareness and acceptance of new technology both by the public and the professionals are
holding it back. Governments are now starting to take a keen interest in developing telemedicine practices
resulting in a slow but steady rise in its utilization in public health. Hopefully in a few years, telemedicine
practices will reach their true potential.

25
 References

 https://vsee.com/what-is-telemedicine/
 https://evisit.com/resources/telemedicine-definition
 https://www.doconline.com/for-business/blog/telemedicine-india
 https://link.springer.com/article/10.1057/s41271-021-00287-w
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618173/#:~:text=Some%20of%20the%20current%20
major,and%20state%20governments%20and%20from
 https://mypages.unh.edu/telehealthtechnology
 https://mypages.unh.edu/sites/default/files/telehealthtechnology/files/telehealth_technology_picture
_front_page.jpg?m=1575163914

Thank You

26
27
  What Is Ambulance

An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as
hospitals.Typically, out-of-hospital medical care is provided to the patient during the transport.

Ambulances are used to respond to medical emergencies by emergency medical services (EMS). For this
purpose, they are generally equipped with
flashing warning lights and sirens. They can rapidly
transport paramedics and other first responders to the
scene, carry equipment for administering emergency
care and transport patients to hospital or other definitive
care. Most ambulances use a design based
on vans or pickup trucks. Others take the form
of motorcycles, buses, limousines, aircraft and boats.

Generally, vehicles count as an ambulance if they can

transport patients. However, it varies by jurisdiction as to whether a non-emergency patient transport vehicle
(also called an ambulette) is counted as an ambulance. These vehicles are not usually (although there are
exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications
than the crew of emergency ambulances. Conversely, EMS agencies may also have emergency response
vehicles that cannot transport patients. These are known by names such as no transporting EMS vehicles, fly-
cars or response vehicles.

The term ambulance comes from the Latin word "ambulare" as meaning "to walk or move about" which is a
reference to early medical care where patients were moved by lifting or wheeling. The word originally meant a
moving hospital, which follows an army in its movements. Ambulances (Ambulancias in Spanish) were first used
for emergency transport in 1487 by the Spanish forces during the siege of Málaga by the Catholic Monarchs
against the Emirate of Granada. During the American Civil War vehicles for conveying the wounded off the field
of battle were called ambulance wagons. Field hospitals were still called ambulances during the Franco-
Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as
ambulances about 1854 during the Crimean War.

 History of Ambulance

The history of the ambulance begins in ancient times, with the use of carts to transport incurable patients by
force. Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were
put into operation during the 1830s. Advances in technology throughout the 19th and 20th centuries led to the
modern self-powered ambulances.

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  Functional types of Ambulance

Ambulances can be grouped into types depending on whether or not they transport patients, and under what
conditions. In some cases, ambulances may fulfil more than one function (such as combining emergency
ambulance care with patient transport:

 Emergency ambulance – The most common type of

ambulance, which provides care to patients with an acute illness or
injury. These can be road-going vans, boats, helicopters, fixed-wing
aircraft (known as air ambulances), or even converted vehicles such
as golf carts.

 Patient transport ambulance – A vehicle, which has the job of transporting patients to,
from or between places of medical treatment, such as hospital
or dialysis center, for non-urgent care. These can be vans, buses, or
other vehicles.

 Ambulance bus – A large ambulance, usually based upon a bus

chassis, that can evacuate and transport a large number of patients.

 Charity ambulance – A special type of patient transport

ambulance is provided by a charity for the purpose of taking sick
children or adults on trips or vacations away from hospitals, hospices, or
care homes where they are in long-term care. Examples include the
United Kingdom's 'Jumbulance' project. These are usually based on a
bus.

 Bariatric ambulance – A special type of patient transport ambulance designed for extremely
obese patients equipped with the appropriate tools to move and manage these patients.

 Rapid organ recovery ambulance - Collects the bodies of people who have died
suddenly from heart attacks, accidents and other emergencies and try to preserve their organs." New
York City is launching a pilot program deploying one such ambulance with a $1.5 million, three-
year grant.

 Psychiatric ambulance – Ambulance dedicated to treat psychiatric emergencies.

"Psykebilen" ("The Psych ambo") in Bergen, Norway pioneered the idea in 2005. Other cities in Norway
and Sweden followed suit when the evidence showed that an ambulance service with personnel
specially trained in psychiatric treatment was highly effective, and reduced the use of force when
treating patients in psychiatric crises.

29
  Vehicle type of Ambulance

In North America (US and Canada), there are four types of ambulances. There are Type I, Type II, Type III, and
Type IV. Type I is based upon a heavy truck chassis-cab with a custom rear compartment that is often referred
to as a "box" or "module." Type I ambulances are primarily used for Advanced Life Support (ALS), also referred
to as Mobile Intensive Care Unit (MICU) in some jurisdictions, and rescue work. A Type II ambulance is based on
a commercial heavy-duty van with few modifications except for a raised roof and a secondary air conditioning
unit for the rear of the vehicle. These types of ambulances are primarily used for Basic Life Support (BLS) and
transfer of patients but it is not uncommon to find them used for advanced life support and rescue. Type III is a
van chassis-cab but with a custom-made rear compartment and has the same uses as Type I ambulances. Type
IV is for smaller ad hoc patient transfer that use smaller utility vehicles in which passenger vehicles and trucks
would have difficulty in traversing, such as large industrial complexes, commercial venues, and special events
with large crowds; they generally do not fall under Federal Regulations.

Ambulances can be based on many types of vehicle although emergency and disaster conditions may lead to
other vehicles serving as makeshift ambulances:

 Van or pickup truck – A typical general-purpose ambulance is based on either the chassis of a
van (vanbulance) or a light-duty truck. This chassis is then modified
to the designs and specifications of the purchaser. Vans may either
retain their original body and be upfitted inside, or may be based
on a chassis without the original body with a modular box body
fitted instead. Those based on pickup trucks almost always have
modular bodies. Those vehicles intended for especially intensive
care or require a large amount of equipment to be carried may be based on medium-duty trucks.

 Car – Used either as a fly-car for rapid response or to transport patients who can sit, these are
standard car models adapted to the requirements of the service
using them. Some cars are capable of taking a stretcher with a
recumbent patient, but this often requires the removal of the front
passenger seat, or the use of a particularly long car. This was often
the case with early ambulances, which were converted (or even
serving) hearses, as these were some of the few vehicles able to
accept a human body in a supine position. Some operators use modular-body transport ambulances
based on the chassis of a minivan and station wagon.

 Motorcycle and motor scooter – In urban areas, these may be

used for rapid response in an emergency as they can travel through heavy
traffic much faster than a car or van. Trailers or sidecars can make these
patient transporting units. See also motorcycle ambulance.

 Bicycle – Used for response, but usually in pedestrian-only areas where

large vehicles find access difficult. Like the motorcycle ambulance, a bicycle
may be connected to a trailer for patient transport, most often in the
developing world.

30
 All-terrain vehicle (ATV) – for example quad bikes; these are used for response off-
road, especially at events. ATVs can be modified to carry a stretcher, and are used for tasks such
as mountain rescue in inaccessible areas.

 Golf cart or Neighborhood Electric Vehicle – Used for rapid response at events or
on campuses. These function similarly to ATVs, with less rough terrain capability, but with less noise.

 Helicopter – Usually used for emergency care, either in places

inaccessible by road, or in areas where speed is of the essence, as they
are able to travel significantly faster than a road ambulance. Helicopter
and fixed-wing ambulances are discussed in greater detail at air
ambulance.

 Fixed-wing aircraft – These can be used for either acute

emergency care in remote areas (such as in Australia, with the 'Flying
Doctors'), for patient transport over long distances (e.g. a re-patriation
following an illness or injury in a foreign country), or transportation
between distant hospitals. Helicopter and fixed-wing ambulances are
discussed in greater detail at air ambulance.

 Boat – Boats can be used to serve as ambulances, especially in island

areas or in areas with a large number of canals, such as
the Venetian water ambulances. Some lifeboats or lifeguard vessels may
fit the description of an ambulance as they are used to transport a
casualty.

 Bus – In some cases, buses can be used for multiple casualty

transport, either for the purposes of taking patients on journeys, in
the context of major incidents, or to deal with specific problems such
as drunken patients in town centres. Ambulance buses are discussed
at greater length in their own article.

 Trailer – In some instances a trailer, which can be towed behind a self-propelled vehicle can be
used. This permits flexibility in areas with minimal access to vehicles, such as on small islands.

 Horse and cart – Especially in developing world areas, more traditional methods of transport
include transport such as horse and cart, used in much the same way as motorcycle or bicycle stretcher
units to transport to a local clinic.

31
  Fire engine – Fire services (especially in North America) often train fire-fighters to respond to
medical emergencies and most apparatuses carry at least basic medical supplies. By design, most
apparatuses cannot transport patients unless they can sit in the cab.

 Design and Construction of an Ambulance

Ambulance design must take into account local conditions and infrastructure. Maintained roads are necessary
for road-going ambulances to arrive on scene and then transport the patient to a hospital, though in rugged
areas four-wheel drive or all-terrain vehicles can be used. Fuel must be available and service facilities are
necessary to maintain the vehicle.

Methods of summoning (e.g. telephone) and dispatching ambulances usually

rely on electronic equipment, which itself often relies on an intact power grid. Similarly, modern ambulances
are equipped with two-way radios or cellular telephones to enable them to contact hospitals, either to notify
the appropriate hospital of the ambulance's pending arrival, or, in cases where physicians do not form part of
the ambulance's crew, to confer with a physician for medical oversight.
Ambulances often have two stages of manufacturing. The first is frequently the manufacture of light or medium
truck chassis-cabs or full-size vans (or in some places, cars) such as Mercedes-Benz, Nissan, Toyota, or Ford. The
second manufacturer (known as second stage manufacturer) modifies the vehicle (which is sometimes
purchased incomplete, having no body or interior behind the driver's seat) and turns it into an ambulance by
adding bodywork, emergency vehicle equipment, and interior fittings. This is done by one of two methods –
either coach building, where the modifications are started from scratch and built on to the vehicle, or using a
modular system, where a pre-built 'box' is put on to the empty chassis of the ambulance, and then finished off.
Modern ambulances are typically powered by internal combustion engines, which can be powered by any
conventional fuel, including diesel, gasoline or liquefied petroleum gas, depending on the preference of the
operator and the availability of different options. Colder regions often use gasoline-powered engines, as diesels
can be difficult to start when they are cold. Warmer regions may favor diesel engines, as they are more
efficient and more durable. Diesel power is sometimes chosen due to safety concerns, after a series of fires
involving gasoline-powered ambulances during the 1980s. These fires were ultimately attributed in part to
gasoline's higher volatility in comparison to diesel fuel. The type of engine may be determined by the
manufacturer: in the past two decades, Ford would only sell vehicles for ambulance conversion if they are
diesel-powered. Beginning in 2010, Ford will sell its ambulance chassis with a gasoline engine in order to meet
emissions requirements.

 Equipments of an Ambulance
In addition to the equipment directly used for the treatment of patients, ambulances may be fitted with a
range of additional equipment which is used in order to facilitate
patient care. This could include:

 Two-way radio – One of the most important pieces

of equipment in modern emergency medical services as it
allows for the issuing of jobs to the ambulance, and can
allow the crew to pass information back to control or to
the hospital (for example a priority ASHICE message to
alert the hospital of the impending arrival of a critical

32
patient.) More recently many services worldwide have moved from traditional analog UHF/VHF sets, which can
be monitored externally, to more secure digital systems, such as those working on a GSM system, such
as TETRA.

 Mobile data terminal – Some ambulances are fitted with mobile data terminals (or MDTs),
which are connected wirelessly to a central computer, usually at the control center. These terminals
can function instead of or alongside the two-way radio and can be used to pass details of jobs to the
crew, and can log the time the crew was mobile to a patient, arrived, and left the scene, or fulfill any
other computer-based function.

 Evidence gathering CCTV – Some ambulances are now being fitted with video cameras
used to record activity either inside or outside the vehicle. They may also be fitted with sound
recording facilities. This can be used as a form of protection from violence against ambulance crews, or
in some cases (dependent on local laws) to prove or disprove cases where a member of the crew
stands accused of malpractice.
 Tail lift or ramp – Ambulances can be fitted with a tail lift or ramp in order to facilitate loading
a patient without having to undertake any lifting. This is especially
important where the patient is obese or specialty care transports
that require large, bulky equipment such as a neonatal
incubator or hospital beds. There may also be equipment linked to
this such as winches which are designed to pull heavy patients into
the vehicle.

 Trauma lighting – In addition to normal working lighting,

ambulances can be fitted with special lighting (often blue or red)
which is used when the patient becomes photosensitive.

 Air conditioning – Ambulances are often fitted with a

separate air conditioning system to serve the working area from that which serves the cab. This helps
to maintain an appropriate temperature for any patients being treated but may also feature additional
features such as filtering against airborne pathogens.

 Data recorders – These are often placed in ambulances to record such information as speed,
braking power and time, activation of active emergency warnings such as lights and sirens, as well as
seat belt usage. These are often used in coordination with GPS units.

 When should call for an ambulance?

You should call One Hundred Two (102) and ask for an ambulance when there is an emergency, such as when
someone:

33
  is experiencing a suspected heart attack, or has unexplained chest pain or chest tightness
 suddenly has weakness, numbness or paralysis of the face, arm or leg
 is having breathing difficulties
 is unconscious
 has a seizure
 falls from a great height
 has been stabbed or shot
 has a severe burn (especially in children)
 has sudden and severe abdominal pain
 has been injured in a major vehicle accident
 has collapsed suddenly or lost consciousness
 suddenly collapses or falls
 is experiencing heavy or uncontrollable bleeding
 has one or more broken bone

 What happens when I call an ambulance?

The person who answers your One Hundred Two (102) call will ask you questions to decide whether it is an
emergency.

If they consider it is an emergency, they will send an ambulance. They might also give first aid advice on what
to do until the ambulance arrives. If so, it is important that you follow the advice.

If they consider it is not an emergency, they might transfer you to a health direct registered nurse. They will be
able to provide you phone assistance.

 What is the cost of an ambulance?

The charges, if you call an ambulance or if someone else orders an ambulance for you, vary between states.
State ambulance services may charge a call-out fee or a per kilometre fee or both. The costs can be very high in
some states.

To find out more about the fees in your state, visit:

 ACT
 New South Wales
 Northern Territory
 Queensland
 South Australia
 Tasmania
 Victoria
 Western Australia

Ambulance costs may be reduced or removed for aged pensioner concession holders, health care concession
card holders and Department of Veterans Affairs Gold Card holders in some states.

34
The cost of an ambulance ride may be paid for from several sources, and this will depend on the local situation
type of service being provided, by whom, and to whom.

 Government-funded service – The full or the majority of the cost of transport by

ambulance is borne by the local, regional, or national government (through their normal taxation).

 Privately funded service – Transport by ambulance is

paid for by the patient themselves, or through their insurance
company. This may be at the point of care (i.e. payment or
guarantee must be made before treatment or transport),
although this may be an issue with critically injured patients,
unable to provide such details, or via a system of billing later on.

 Charity-funded service – Transport by ambulance may

be provided free of charge to patients by a charity, although donations may be sought for services
received.

 Hospital-funded service – Hospitals may provide the ambulance transport free of charge,
on the condition that patients use the hospital's services (which they may have to pay for).

 Types of Ambulance

Here we see basically 6 types of ambulance

 Basic Ambulance

These types of ambulances are the basic ambulances that we

commonly see in our daily lives. Basic ambulances are handled by
an emergency medical technician (EMT) and transport patients
who require basic medical supervision under minor or uncritical
situations such as mild fractures, and sub-acute care facilities
(nursing homes). It comprises of the patient bed, pulse oximetry
and oxygen delivery devices.

 Advance Ambulance

Advance ambulances are equipped with advanced equipment

and tools to handle critically ill patients. They are also equipped
with an ECG monitor, defibrillator, intravenous and blood
drawing tools, etc. Patients who require a high level of care and
who are fighting for life need services like hospital emergency
department or critical care unit need advance ambulance

35
services. Patients suffering from serious life-threatening causalities and cardiac emergencies are transported
with advanced life support ambulances.

 Mortuary Ambulance

A mortuary ambulance is used for transportation of the dead

body from any place. It is also called as Hearse Van. Mortuary
vans carry the body of the dead person in a freezer box. Medically
trained staff make sure that all the necessary provisions are taken
while transporting the physical remains of a person. They
maintain the safety guidelines before transporting the dead
person to the desired place and preserving the body until they
receive their last rites.

 Neonatal Ambulance

Neonatal ambulance services aimed at reducing neonatal

mortality rates. Neonatal ambulances transport premature and
sick babies to specialized care hospitals which can provide the

right kind of treatment and care to infants. They are equipped with incubators for new-borns or premature
babies.

 Patient Transport Vehicle

During non-emergency situations, Medical transport vehicle

transfers patients to and from hospitals. A patient who requires to
be transferred to a facility that can give a higher or more
specialized level of care or used to transfer patients from a
specialized facility to a hospital when they no longer require this
specialized care.

 Air Ambulance

Air ambulances use air transportation by airplane or helicopter to

transport patients to and from healthcare facilities and accident
scenes. Air ambulances transport patients to specialist care, they
can also bring specialist care to the accident scene, especially for
major trauma cases. They are mainly used for international or long-distance

36
transport. Air medical services provide fast and swift transport during emergencies. They can reach wide or
hilly areas in less time, they are more accessible than land ambulances. This makes them very efficient in
sparsely populated rural regions.

 Ambulance service in India

 History

102 National Ambulance Service was started on 17 January 2014 in Uttar Pradesh. A fleet of around
2272 Ambulances is operational in all the districts of the State, to date. On an average, around 65,000 calls are
received and 25,000 trips serviced on any working day in Uttar Pradesh. Around ten million women and
newborns have benefited from this service, until now. This service is provided through a private service
provider Ganapati Venkata Krishnanreddy Emergency Management and Research Institute GVK-EMRI which
provides free ambulance services under government-run helplines in 17 states and union territories in India.

After the success of 102 Emergency Medical Ambulance Services (OEMAS) in Uttar Pradesh, many states
of Government of India also launched the 102 ambulance service for free referral transport of pregnant women
and sick infants under Janani Sishu Surakhya Karyakram (JSSK) programme. Some of the states to launch 102
service include Odisha, Madhya Pradesh, Sikkim, Jharkhand, Himachal Pradesh, West Bengal and Uttarakhand.
In Odisha alone, the maternal mortality rate has gone 81 points down from 303 in 2006 to 222 in 2013 after the
introduction of 102 ambulance service by the state government in private public partnership with Ziqitza
Healthcare under the JSSK programme.

 Operation

It consists of an Emergency Response Centre (ERC) which is a centralized call centre that receives and handles
the emergency phone calls. The call centre is staffed with Emergency Response Officers (ERO) by GVK-JSS in
Aashiana, Lucknow. They take the emergency call, determine the location and send an ambulance to the
place. That ambulance reaches the patient in 20 minutes in cities and around 30 minutes in rural places.

Similarly, other states of India have their own centralized call centres to receive 102 emergency ambulance
service calls and send the ambulances to the emergency spot. Some states use empanelled vehicles as 102
ambulance service namely Janani express in MP & Odisha, Mamta Vahan in Jharkhand, Nishchay Yan Prakalpa
in West Bengal, and Khushiyo ki Sawari in Uttarakhand. All the state ambulances supported under National
Health Mission (NHM) abide by the mandatory NAS guidelines.

 Beneficiaries

According to the GVK-EMRI's Chief Operating Officer in Uttar Pradesh, Sanjay Khosla, around one crore and fifty
seven lakh people have already been benefited from the 102 and 108 services in Uttar Pradesh since 2013. Of
these around ninety lakh women have already benefited from the 102 services alone

37
JSSK programme has helped the National Health Mission (NHM) to substantially reduce the infant and maternal
mortality rate across India. Ziqitza Healthcare alone claims to have served 17,54,019 pregnant women and
delivered over 10,000 babies.

 The First Ambulance Service in India

It is already mentioned that there is no particular time & date when ambulance services were established in
India but the first notable change occurred in Mumbai, around the mid-80s. As the same, it was spread through
other major parts of the country. An allegedly remarkable step happen in 1991 when the services started
focusing on a systematic run and got named Centralized Accident & Trauma Services (CATS). CATS continued to
be the most important aspect of the Emergency Medical Services (EMS) of India and complemented it in
dealing with emergency medical situations across the country.

In August 2005, it took a drastic change when a corporate leader Mr Ramalinga Raju intervened and introduced
dial-108 ambulance services. It brought sustainability to the services and changed the way ambulance services
were working in India. The idea behind dial-108 was to bring all the three major emergency services
connectivity through one number. There are separate numbers for police, fire, and ambulance services 100,
101 and 102 respectively but that could confuse people in times of emergency which number they should dial.
After the initiation of 108 in 2005, it is now easier for people to remember one number only that integrates all
the emergency services. It is a collaboration between the government and the private organizations that are
actively working in 18 states and 2 union territories.

It works as a mediator and connects the caller with the concerned department after collecting the needed
information. With the assistance of the government hospitals and private ambulance aggregators like
AmbiPalm Health Pvt. Ltd., the patient is transported to the nearest government hospital. The dial-108 service
has subsided the problems while calling for emergency service. Instead of looking for different numbers, one
needs to remember one number only that brings all the emergency services to one desk.

The history of ambulances lies in Europe around the 10th or 11th century which emerged as a notable part
during World War when it was used to carry injured soldiers. Later it was shifted to bullock carts, then wheels
and then now we see the most advanced ambulances around us. In India, we can say that the emergence of a
proper ambulance service was initially an inheritance of other developed countries but now it has propelled a
trustworthy system. With National Ambulance Service 102, Emergency Medical Service 108 and other
organizations like AmbiPalm Health Pvt. Ltd., the ambulance services in India are improving with time.

 Emergency Ambulance services in India

It is well known that easy & timely availability of ambulances can save a lot of lives, especially in case of
emergencies. The state of emergency medical transport i.e. ambulances is a vast issue. In this article, let’s look

38
at the number of operational ambulances across states and various studies that evaluate the functioning of
ambulance services with various parameters.

To get an understanding of the total number of operational ambulances, we take stock of the state-run
ambulances and commercial vehicles being used as ambulances. We gather data for state-run ambulances
under National Rural Health Mission (NRHM) and state-run ambulances at Health Care Centers from Quarterly
National Health Mission Report (June 2019 update). The data on commercial vehicles being used as
ambulances has been gathered from Road Transport Year Book 2016-17.

In understanding whether the operational number of ambulances across states meet established standards, we
take World Health Organisation’s (WHO) benchmark of at least one ambulance (emergency response) per 1 lakh
population in the plains and estimate the required number of ambulances based on mid-year population
projection published in National Crime Records Bureau reports. It has to be noted that this benchmark refers to
the number of ambulances in the centralized emergency response system like 108 in some states and not the
total number of ambulances available in the country, which includes private ones as well. The Emergency
Management and Research Institute (EMRI) which manages the 108 service also talks about roughly one such
ambulance for every one lakh people.

The National Health Mission website highlights that at the time of launch of NRHM in 2005, ambulance
networks were non-existent. Now 33 States/UTs have the facility where people can Dial 108 or 102 for calling
an ambulance. Dial 108 is predominantly an emergency response system, primarily designed to attend to
patients of critical care, trauma and accident victims etc. Dial 102 services essentially consist of basic patient
transport aimed to cater to the needs of pregnant women and children though other categories are also taking
benefit and are not excluded.

 Do India have enough ambulances to meet the requires

standards?

Here is a comparison of the total number of ambulances operational across states and required number of
ambulances as per WHO standards. It has to be noted the WHO standard pertains to a centralized public
emergency response system and is not about private ambulances.

On the other hand, the data on private ambulances is available only up to 2016-17 and for several states, the
data for commercial vehicles being used as ambulances was not reported in the Road Transport Yearbook. Even
the available data pertains to those commercial vehicles registered as ambulances. There could be other
vehicles used as ambulances but are not registered as ambulances. It is also surprising to note that in certain

39
  State wise Required number of ambulance as per WHO

Number of
Number of
ERS Required
Commerci
vehicle Number of Populatio number of
al Vehicles
operationa ambulances n : Mid- Ambulance
in Use as
l under operational Year s (as per
Ambulanc
NRHM(102 other than populatio WHO
States e (as per
, 104, 108 NRHM at n standards -
Primary
and PHC/CHC/SDH/D projectio public
Permit
others) (as H ( as on n in Lakh emergency
Valid as on
on 30.06.2019) (2018) response
31.03.2017
30.06.201 system)
)
9)
Andhra
0 439 0 520.3 520
Pradesh
Arunachal
14 149 121 14.9 15
Pradesh
Assam 2008 938 0 340.4 340
Bihar 1102 164 1183.3 1183
Chattisgarh 273 590 400 284.7 285
Goa 0 51 74 15.3 15
Gujarat 587 1510 673.2 673
Haryana 534 363 0 284 284
Himachal
1118 323 138 72.7 73
Pradesh
Jammu &
789 331 712 134.3 134
Kashmir
Jharkhand 11 2120 271 370.5 371
Karnataka 8251 911 627 654.5 655
Kerala 0 43 447 350 350
Maharashtr
14533 3611 3442 1213.9 1214
a
Manipur 1 43 24 30.8 31
Meghalaya 172 43 16 32 32
Mizoram 116 60 9 11.8 12
Nagaland 0 82 0 21.3 21
Orissa 0 1004 259 435.5 436
Punjab 0 242 496 297 297
Rajasthan 1353 363 765.9 766
Sikkim 155 9 31 6.6 7
Tamil Nadu 10561 936 950 754.6 755
Telangana 7 632 362 370.3 370
Tripura 278 0 72 39.6 40
Uttrakhand 320 234 160 110.6 111
Uttar
62 4008 0 2230 2230
Pradesh
West
3616 281 965 965
Bengal

40
 Andaman &
1 52 4 4
Nicobar Island
Chandigarh 0 15 0 11.7 12
Dadra & Nagar
0 15 5.3 5
Haveli
Daman & Diu 36 11 12 4 4
Delhi 234 35 195.6 196
Lakshadweep 0 0 0.7 1
Puduchery 11 53 14.8 15
Total ( All
39259 25450 11096 13233.8 13234
India)

big states, there is not a single commercial vehicle that is used as an ambulance. It could be a case a data gap
and hence the total number of ambulances across the country could be much higher.

Except for the state of Andhra Pradesh, all other states have reported a higher number of total ambulances as
compared to the required number of ambulances as per WHO standards. This means, that the number of
ambulances across states does not fall short of international standards set by WHO, at least in the reported
figures.

However, the reported number of operational ambulances do not necessarily signify their functionality, access
& qualify of infrastructure among other things. Multiple studies across different states that have evaluated
various aspects of the functionality of ambulance services have highlighted gaps in these services.

 Evaluation of ambulances services

According to a study conducted by AIIMS in 2012, summarised in the Wall Street Journal, reports that Delhi had
152 state-run ambulances. Of the city’s state-run emergency vehicles, only 21 have advanced life-support
facilities such as defibrillators, ventilators and drugs for use in critical or trauma-related cases. Ten vehicles
have basic life support systems without drugs or ventilators and the rest are basically white vans with
stretchers. It was found that 28% of the 70,768 emergency calls received between March 2009 and May
2010 in Delhi were refused because of the shortage of ambulances.A number of irregularities and issues have
surfaced around the functioning of 108 services in recent years across states. One of the most rampant issues is
that of sub-optimal response time and calls not being attended. Non-adherence to stipulated response time in
delivery of the 108 service has been observed across several states. The mean time was between 41 to 47
minutes, as per the Comptroller Auditor General (CAG) report from Madhya Pradesh (2017). Further, the CAG
report from Odisha observed that ‘during 2013-14 out of the total call received, ambulances were dispatched in
5.43% of calls’. Further, the audit report noted that ‘no details regarding calls not attended were recorded in
the database’.A more critical issue related to poor governance is that of insufficient supervision by state
governments. CAG Reports from Kerala (2015), Orissa (2015) and Madhya Pradesh (2017) highlight oversight
issues such as lack of due diligence in the tendering process, rising costs and idling of ambulances due to
procedural delays in tender procurement, fabrication, delay in payment of operating expenditure to the private
provider, inadequate performance monitoring, and forwarding commercial gains at the expense of public
interest.

An article published in Economic & Political Weekly on 23 June 2018, summarising relevant newspaper reports
and literature, argues that there are signs of complacency and compromise in the delivery of 108 services. It
41
highlights another issue related to the non-fulfilment of conditions of the memorandum of understanding
(MoU).
Conditions like
maintenance of
equipment and
vehicles,
geographic
information
system (GIS)
tracking, skill
upgradation,
networking with
government
hospitals, and
generating
awareness
among the
public about
108 services
were not
fulfilled as per
the timeline
prescribed.

While there are

ample number
of evaluation
reports and
studies, there is also a dearth of useful data in the public domain to determine the quality of ambulances
services. As the report by Health Systems Resources Center in 2009 emphasises that there needs to be
independent monitoring of appropriate response to the emergency call, the time in which patients were
reached, the quality of stabilization care that was provided during transport. Quality data on these aspects is
essential to evaluate the quality of these services.

 Ambulance Service Charges in various Indian cities

Ambulance services are one of the most utilized medical facilities offered by the healthcare sector in India.
Ambulances are not merely means of transporting an ill person to the hospital. They are mobile hospitals
equipped with basic facilities required during a medical emergency.

Most hospitals offer ambulance facility on a 24/7 basis. This service is very helpful for bed ridden patients or
those who face a medical emergency unexpectedly. Patients referred to other hospitals from Dr YS Parmar
Government Medical College at Nahan will have to shell out Rs 20 per km for using a ventilator-equipped
ambulance.

Medical Superintendent of the college Dr Shyam Kaushik said all six medical colleges of the state had been
provided an ambulance service equipped with all modern facilities. This facility can be availed at a cost of Rs 20
42
per km, though those belonging to the below poverty line strata and others covered under the Ayushman
Bharat and Himcare scheme would be provided this facility free.

These ambulances are quipped with life-saving equipment and this was part of the Chief Minister’s budgetary
speech in the current financial year.

Given below are rates charged for ambulance services across various cities in India.

City Average Price Starting Price Price upto

Agra 402.00 /- 8.00 /- 1200.00 /-
Ahmadabad 638.00 /- 8.00 /- 3000.00 /-
Aligarh 841.00 /- 30.00 /- 2500.00 /-
Allahabad 473.00 /- 15.00 /- 1000.00 /-
Aurangabad 650.00 /- 500.00 /- 800.00 /-
Bangalore 995.00 /- 12.00 /- 6500.00 /-
Bhopal 449.00 /- 11.50 /- 2000.00 /-
Bhubaneswar 687.00 /- 20.00 /- 1500.00 /-
Chennai 1332.00 /- 300.00 /- 4500.00 /-
Coimbatore 592.00 /- 7.00 /- 3500.00 /-
Cuttack 503.00 /- 10.00 /- 1500.00 /-
Ghaziabad 491.00 /- 12.00 /- 1000.00 /-
Gorakhpur 575.00 /- 400.00 /- 1000.00 /-
Guntur 378.00 /- 15.00 /- 1000.00 /-
Gurgaon 709.00 /- 20.00 /- 2000.00 /-
Guwahati 702.00 /- 30.00 /- 2000.00 /-
Gwalior 398.00 /- 15.00 /- 700.00 /-
Hyderabad 896.00 /- 50.00 /- 1600.00 /-
Indore 520.00 /- 300.00 /- 800.00 /-
Jalandhar 333.00 /- 10.00 /- 700.00 /-
Jamshedpur 500.00 /- 500.00 /- 500.00 /-
Jodhpur 600.00 /- 300.00 /- 1000.00 /-
Kanpur 378.00 /- 200.00 /- 500.00 /-
Kochi 437.00 /- 20.00 /- 600.00 /-
Kolkata 542.00 /- 12.00 /- 3500.00 /-
Kota 226.00 /- 10.00 /- 500.00 /-
Lucknow 925.00 /- 10.00 /- 6000.00 /-
Ludhiana 568.00 /- 25.00 /- 1500.00 /-
Madurai 633.00 /- 15.00 /- 1500.00 /-
Mangalore 577.00 /- 20.00 /- 1500.00 /-
Meerut 477.00 /- 10.00 /- 800.00 /-
Mumbai 667.00 /- 30.00 /- 1580.00 /-
Mysore 424.00 /- 13.00 /- 1000.00 /-
Nagpur 334.00 /- 10.00 /- 700.00 /-
Nashik 517.00 /- 250.00 /- 1000.00 /-
New Delhi 1141.00 /- 30..00 /- 6000.00 /-
Noida 519.00 /- 13.00 /- 1650.00 /-
Patna 466.00 /- 11.00 /- 1500.00 /-
Pondicherry 464.00 /- 18.00 /- 1000.00 /-
Pune 560.00 /- 9.00 /- 1850.00 /-
Raipur 383.00 /- 8.00 /- 700.00 /-
Rajkot 114.00 /- 10.00 /- 500.00 /-
Ranchi 694.00 /- 10.00 /- 3000.00 /-
43
 City Average Price Starting Price Price upto
Varanasi 598.00 /- 10.00 /- 2000.00 /-
Vijayawada 700.00 /- 350.00 /- 2000.00 /-
Vishakhapatnam 704.00 /- 210.00 /- 2500.00 /-
Warangal 515.00 /- 350.00 /- 600.00 /-
Salem 565.00 /- 350.00 /- 1000.00 /-
Siliguri 812.00 /- 22.00 /- 5000.00 /-
Solapur 274.00 /- 7.00 /- 500.00 /-
Srinagar 482.00 /- 25.00 /- 800.00 /-
Surat 321.00 /- 12.00 /- 1000.00 /-
Thiruvanantapuram 496.00 /- 13.00 /- 3000.00 /-
Vadodara 349.00 /- 10.00 /- 700.00 /-

 Some hospitals who service ambulance service

 RED Health
 Apollo Hospitals
 Amri Hospitals
 Desun Hospitals
 Forties Hospitals
 Manipal Hospitals
 MaxCure Hospital
 Ruby Hospital
 ILS Hospitals
 Ambulance Service provide by Non Government Organisation (NGO)
 Ambulance Service provide by Government

44
  Conclusion

In conclusion, ambulance services play a vital role in providing medical care and transportation to patients
during emergencies. By providing timely medical attention and transportation to hospitals, ambulance services
have helped save countless lives. It is essential that we recognize the importance of ambulance services in
society and support their efforts to provide quality healthcare services. By booking an ambulance when
needed, we can contribute to a healthier and safer society.

45
  References

 https://www.medifee.com
 https://rakkshak.com
 https://www.medifee.com
 morth.nic.in
 https://www.ambipalm.com
 factly.com.in

Thank you

46
47
  What is Waste Management
Americans alone are responsible for producing a whopping 277 million tons of waste (annually). Since this
number is far more than any other nation in the world, the US government and Environmental Associations
have devised numerous methods to deal with this burning
issue.

But what exactly is Waste Management? In the simplest

terms, it can be defined as the collection, transportation,
and disposal of garbage, sewage, and other waste products.

The process of waste management involves treating solid and

liquid waste. During the treatment, it also offers a variety of
solutions for recycling items that aren’t categorized as trash.

The entire idea thus boils down to re-using garbage as a valuable resource and given our current
environmental climate, this process is extremely vital for all households and businesses.

According to Wikipedia,

“Waste management or Waste disposal is all the activities and actions required to manage waste from its
inception to its final disposal. This includes amongst other things, collection, transport, treatment
and disposal of waste together with monitoring and regulation. It also encompasses the legal and
regulatory framework that relates to waste management encompassing guidance on recycling etc.“

You will find there are eight major groups of waste management methods, each of them divided into numerous
categories. Those groups include source reduction and reuse, animal feeding, recycling, composting,
fermentation, landfills, incineration, and land application.

You can start using many techniques right at home, like reduction and reuse, which works to reduce the
amount of disposable material used.

48
  The Benefits of Waste Management

There are multiple benefits to treating and managing waste. In this section, we will take a closer look at them.

 Better Environment

Probably the biggest advantage of managing waste is that it eventually leads to a better and fresher
environment.

Waste disposal units also contribute to the well-being of people by helping them become disease-free. The best
part: all of this happens while the unnecessary is duly disposed of in a proper and sanitary manner.

Multiple waste disposal units should be placed in tier-1 and tier-2 cities in a bid to prep up the process of waste
disposal. This will also help implement remarkable safety measures in the long run.

 Reduces Pollution

When waste is managed the right way, it doesn’t

merely eliminate the subsequent waste but also
reduces the impact and the intensity of harmful
greenhouse gases like carbon-di-oxide, carbon
mono-oxide, and methane that are often exuded
from accumulated wastes in landfills.

Managing waste reduces our reliance on landfills

while also significantly cutting down the many
factors that adversely impact our environment.

 Conserves Energy

Recycling is one of the biggest aspects of waste management, and over time, it helps conserve energy. One of
the biggest instances of this advantage can be traced to the practice of recycling paper.

All of us are probably aware that thousands of trees are cut to produce paper. When a used paper is recycled to
create new paper, the need of cutting trees is significantly minimized. This helps conserve energy while also
reducing your carbon footprints.

49
  Creates Employment

The recycling industry alone creates hundreds of jobs. As more people adopt this eco-friendly practice,
organizations creating and selling recycled products come to the forefront. This helps boost their business
while also creating hundreds of jobs.

 Helps Make a Difference

By managing waste, you are also making a difference to the society and the world in general. While none of us
can completely get rid of garbage, we can always adopt eco-friendly practices of reducing and reusing waste.
This way, you create an example for the people around you, who in turn are now motivated to embrace a
sustainable approach.

There are eight major categories of waste management, and each of them can be divided into numerous sub-
categories.

The categories include source reduction and reuse, animal feeding, recycling, composting, fermentation,
landfills, incineration, and land application. Some of these methods like reduction and reuse can be started
from the comfort of your homes.

 Identify Wastes
The University provides safe, effective, and efficient waste management services for managing nonhazardous
solid waste, recyclable waste, and hazardous waste. The University community is responsible for identifying the
type of waste produced and using the appropriate University management system.

 Evaluate Waste
The University community must evaluate their waste for its physical, chemical, and biological characteristics to
determine how it is to be properly managed.

A waste may be:

 Recyclable material (e.g., paper, soda cans)

 Compostable organic waste (e.g. food, animal bedding, biodegradable plastics)
 Non-hazardous solid waste
 Hazardous radioactive waste: containing or contaminated with a radioactive isotope
 Hazardous biological waste: containing or contaminated with an infectious or potentially infectious
agent, a biological toxin, animal carcasses, genetically modified organisms, recombinant DNA, etc.
 Hazardous chemical waste: waste chemicals, products which are chemical in nature (cleaning agents,
paint, motor oil, and pharmaceutics), products that contain chemicals (fluorescent lamps,
thermometers), or materials contaminated with chemicals (contaminated soil or rags)
 Otherwise Regulated Material: asbestos, car batteries, contaminated soil, and construction debris

50
  Manage Wastes

Once wastes have been identified and evaluated, the University community must manage it according to
applicable University of Minnesota waste management instructions. These waste management instructions
have been developed to keep the University in compliance with all applicable laws and regulations and to
promote a safe and healthy workplace.

 What is the Issue with Waste Management?

Waste management is a big problem in Kolkata. The city produces a lot of waste, and there is nowhere to put it.
The government has not provided enough resources to deal with the problem, so the people have to take
matters into their own hands.

There are a few recycling plants in Kolkata, but they are not enough to handle all the waste. Most of the waste
ends up in landfills, which are overflowing. The government has not been able to find a solution to the
problem, and the situation is getting worse.

The people of Kolkata are fed up with the government’s inaction on the issue. They have started to take
matters into their own hands and are cleaning up the city themselves. However, they cannot do it alone. They
need the government’s help to solve the problem of waste management in Kolkata.

 How Waste Management Works?

Waste management is a process that involves the collection, transportation, and disposal of waste products
and materials. In Kolkata, waste management is a major
problem due to the city’s large population and lack of
infrastructure.

The first step in waste management is a collection. Waste

collectors go door-to-door or set up drop-off points where
residents can leave their waste. Once collected, the waste is
transported to a treatment facility.

At the treatment facility, the waste is sorted and either

recycled or incinerated. Recycling involves breaking down the
waste into its component parts so that it can be used to make
new products. Incineration involves burning waste at high
temperatures so that it is destroyed.

The final step in waste management is disposal. Disposal

options include landfill, incineration, and recycling. Landfills are the most common method of disposal in
Kolkata. Waste products are buried in landfills and then covered with soil.

Incineration is another option for disposing of waste in Kolkata. Incineration involves burning waste at high
temperatures so that it is destroyed. However, incineration can release harmful pollutants into the air.

51
  Various Methods of Waste Disposal

Although there are many methods of disposing of waste, in this section let’s take a look at some of the most
commonly used methods that you should know about waste management.

 Landfills

Throwing daily waste/garbage in the landfills is the most popularly used method of waste disposal used today.
This process of waste disposal focuses attention on burying the waste in the land.

Landfills are commonly found in developing countries. There is a process used that eliminates the odors and
dangers of waste before it is placed into the ground.

While it is true this is the most popular form of waste disposal, it is certainly far from the only procedure and
one that may also bring with it an assortment of space.

This method is becoming less these days although, thanks to the lack of space available and the strong
presence of methane and other landfill gases, both of which can cause numerous contamination problems.

Landfills give rise to air and water pollution which severely affects the environment and can prove fatal to
the lives of humans and animals. Many areas are reconsidering the use of landfills.

 Incineration/Combustion

Incineration or combustion is a type disposal method in which municipal solid wastes are burned at high
temperatures. The process eventually converts them into
residues and gaseous products.

The biggest advantage of this type of method is that it

can reduce the volume of solid waste to 20 to 30 percent
of the original volume. Additionally, it also decreases the
space they take up while also reducing the stress
on landfills.

Incinerators are primarily used in thermal treatment

where solid waste materials are converted to heat, gas,
steam, and ash. Incineration is also widely popular in
countries where landfill space is no longer available, such as the US and Japan.

 Recovery and Recycling

Resource recovery is the process of taking useful discarded items for a specific next use. These discarded items
are then processed to extract or recover materials and resources or convert them to energy in the form of
useable heat, electricity or fuel.

52
Recycling is the process of converting waste products into new products to prevent energy usage and
consumption of fresh raw materials. Recycling is the third component of Reduce, Reuse and Recycle waste
hierarchy.

The idea behind recycling is to reduce energy usage, reduce the volume of landfills, reduce air and water
pollution, reduce greenhouse gas emissions, and preserve natural resources for future use.

 Plasma gasification

Plasma gasification is another form of waste management. Plasma is primarily an electrically charged or highly
ionized gas. Lighting is one type of plasma that produces temperatures that exceed 12,600 °F.

With this method of waste disposal, a vessel uses characteristic plasma torches operating at +10,000 °F which is
creating a gasification zone till 3,000 °F for the conversion of solid or liquid wastes into a syngas.

During the treatment of solid waste by plasma gasification, the waste’s molecular bonds are broken down as a
result of the intense heat in the vessels and the elemental components.

Thanks to this process, the destruction of waste and dangerous materials are found. This form of waste
disposal provides renewable energy and an assortment of other fantastic benefits.

 Composting

Composting is an easy and natural bio-degradation process that takes organic wastes i.e. remains of plants
and garden and kitchen waste and turns into nutrient-rich food for your plants.

Composting, normally used for organic farming, occurs

by allowing organic materials to sit in one place for
months until microbes decompose it.

Note that composting is often deemed to be one of the

best methods of waste disposal as it can turn unsafe
organic products into safe compost. The process,
however, has its downsides. Some people have found it
to be slow, while others have observed that it takes a lot
of space.

But regardless of these issues, many people are still embracing home composting approaches to manage and
reduce waste.

53
  Waste to Energy (Recover Energy)

Waste-to-Energy, also widely recognized by its acronym WtE is the generation of energy in the form of heat or
electricity from waste.

Waste to energy(WtE) process involves the conversion of non-recyclable waste items into useable heat,
electricity, or fuel through a variety of processes. This type of so energy is a renewable energy source as non-
recyclable waste can be used over and over again to create it.

WtE can also help reduce carbon emissions by offsetting the need for energy from fossil sources. Over time,
this reduces global warming and makes our environment better.

 Special Waste Disposal

There are certain waste types that are considered hazardous and cannot be disposed of without special
handling which will prevent contamination from occurring.

Biomedical waste is one example of such a waste disposal method. It is primarily practiced in health care
facilities and similar institutions. The special waste disposal system effectively disposes of hazardous
biomedical waste.

 Avoidance/Waste Minimization

The most easier method of waste management is to reduce the creation of waste materials thereby reducing
the amount of waste going to landfills.

Waste reduction can be done through recycling old materials like jar, bags, repairing broken items instead of
buying a new one, avoiding the use of disposable products like plastic bags, reusing second-hand items, and
buying items that use less designing.

 Biogas Generation
Biodegradable waste, such as food items, animal waste or
organic industrial waste from food packaging industries are
sent to bio-degradation plants. In bio-degradation plants,
they are converted to biogas by degradation with the help
of bacteria, fungi, or other microbes. Here, the organic
matter serves as food for the micro-organisms. The
degradation can happen aerobically (with oxygen) or
anaerobically (without oxygen). Biogas is generated as a
result of this process, which is used as fuel, and the residue
is used as manure.

54
  Vermicomposting

Vermicomposting is the process of using worms for the degradation of organic matter into nutrient-rich
manure. Worms consume and digest the organic matter. The by-products of digestion which are excreted out
by the worms make the soil nutrient-rich, thus enhancing the growth of bacteria and fungi. It is also far more
effective than traditional composting.

 The Best Methods of Waste Management

Recycling and composting are a couple of the best methods of waste management. Composting is so far only
possible on a small scale, either by private individuals or in areas where waste can be mixed with farming soil or
used for landscaping purposes.

Recycling, on the other hand, can be widely used around the world, with plastic, paper, and metal leading the
list of the most recyclable items. Most material recycled is reused for its original purpose. In some instances,
they may also be sold for generating profits.

 Bottom Line

As you can see there are plenty of important things that you should know about waste management and
disposal in order to ensure that you and the environment around you are safe.

While it may not be apparent, it is your choice that paves the way towards a better world and a healthier
environment. That is why always be sustainable and make actionable efforts to manage and treat waste.Since
we have listed multiple waste management methods, explore your options, before making a final choice.

 Waste Disposal Methods

There are multiple waste management strategies and methods available. These strategies can be combined or
rearranged to form a waste management system that fits an organization. Modern waste management
strategies are geared towards sustainability. Other alternatives for waste disposal is to reduce, reuse, and
recycle waste.

 Recycling – also known as physical reprocessing, recycling is ideal for the disposal of inorganic
waste such as plastic, glass, and metals. Though organic waste such as paper and food can also be
recycled, composting would be a better waste disposal method as it converts organic waste into
nutrient-rich fertilizer.

 Waste-to-Energy – or WtE on the other hand, is the conversion of non-recyclable waste into
heat, electricity, or fuel using renewable energy sources such as anaerobic digestion and plasma
gasification.

55
  Anaerobic digestion – the biological reprocessing of animal manure and human excreta into
methane-rich biogas. Plasma gasification uses a plasma-filled vessel operating at high temperatures
and low levels of oxygen to transform hazardous waste into syngas. Another option for disposing of
hazardous waste is bioremediation, the treatment of contaminants, toxins, and pollutants through
micro-organisms.

 Approaches and Best Practices

A waste audit is an assessment of an organization’s waste management system. It analyzes the movement of
waste from generation to disposal. Common approaches for conducting waste audits are records examination,
facility walk-throughs, and waste sorting.

 First approach – involves looking at waste hauling and disposal records as well as contracts with
recycling facilities.

 Second approach – requires a team of internal auditors to identify waste-generating activities

through observation and interviews with employees.

 Third approach – is the physical collection, sorting, and weighing of a sample of the
organization’s waste. This sample can be a day’s worth of waste or a collection of waste from each
department.

Best practices for conducting a waste audit are to refrain from releasing the audit date to the entire
organization, prepare personal protective equipment and a venue for sorting beforehand, and commit to acting
on the waste audit result. This can be achieved by creating corrective action plans for each possible result.

For example, if the organization scored low on a certain area, then the following steps should be done. For this
to work, it is essential for the organization to set the criteria before conducting the waste audit. Another tip is
to use digital waste audit checklists for easy documentation and a more comprehensive data analysis.

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  How to Create a Waste Management Plan

Before forming a waste management plan, get input and buy in from various stakeholders. Ask for suggestions
on how to be more eco-friendly. Next, assess the strength of the current system by conducting waste audits.
After reviewing the waste audit results, identify development needs including budget, estimated waste
composition, current waste reduction, and waste generation.

To ensure that the implementation of the waste management plan is feasible, maintain a realistic perspective
when establishing goals. Once goals for the waste management plan have been finalized, perform the following
steps:

 Determine the needed resources (containers, vehicles, etc.)

 Assign a point person and clarify their responsibilities

 Prepare a timeline for implementation

During implementation, remember to document everything and involve everyone in the organization. Aside
from keeping all waste audit results, document the day-to-day waste disposal and resource use of the
organization. Additionally, give everyone the tools they need to participate effectively in waste management.
These tools can include training, induction, toolbox talks, and even digital checklists.

 Some Waste Management System

 Food Waste Management System

A food waste audit analyzes the components of a restaurant’s waste. It helps restaurants identify the
inefficiencies in their processes and provides them with the data they need to effectively address their food

waste. As part of the Target-Measure-Act approach recommended

by the World Resources Institute, food waste audits enable
restaurants to set reduction targets, measure and report food loss,
and be bold in taking action to combat food waste.

 Hospital Waste Management System

Independent auditors perform clinical waste audits to assess a

healthcare facility’s compliance with government regulations. In the
UK, it is legally required to sort, code, and manage clinical waste,
which is defined by the Controlled Waste Regulations as any waste
which consists of:

 human or animal tissue, blood or other body fluids,

excretions
 drugs or other pharmaceutical products, swabs or dressings,
57
  syringes, needles or other sharp instruments
 any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice

 Hazardous Waste Management System

Hazardous waste management was a key factor in the formation of the Resource Conservation and Recovery Act
(RCRA). Hazardous waste is defined by the EPA as waste that is potentially harmful to human health or the
environment. However, hazardous waste is only subject to RCRA
Subtitle C regulation if it is:

 a solid waste
 not excluded from the definition of solid waste
 not excluded from the definition of hazardous waste
 specifically listed as a known hazardous waste; OR
 meets the characteristics of a hazardous waste; and
 not delisted

 Medical Waste

Medical waste is a subset of wastes generated at health care facilities, such as hospitals, physicians' offices,
dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and
laboratories. Generally, medical waste is healthcare waste that that may be contaminated by blood, body fluids
or other potentially infectious materials and is often referred to as regulated medical waste.

Hospital medical waste disposal is one of the most important functions of any medical facility. Failure to
properly handle and dispose of medical waste can cause environmental hazards and even widespread illness.

Hospital medical waste is any refuse generated through the course of normal hospital operations. While the
waste generated from a clothing retailer or a restaurant (for example) can be handled through normal
municipal waste collection channels, hospital medical waste must be handled and disposed of in a very
regulated manner to ensure clinicians, hospital staff and downstream service staff aren't exposed to potentially
hazardous contaminants.

 History of Medical Waste

Concern for the potential health hazards of medical wastes grew in the 1980s after medical wastes were
washing up on several east coast beaches. This prompted Congress to enact The MWTA of 1988. The MWTA
was a two-year federal program in which EPA was required to promulgate regulations on management of
medical waste. The Agency did so on March 24, 1989. The regulations for this two year program went into
effect on June 24, 1989 in four states - New York, New Jersey, Connecticut, and Rhode Island and Puerto Rico.
The regulations expired on June 21, 1991.

EPA concluded from the information gathered during this period that the disease-causing potential of medical
waste is greatest at the point of generation and naturally tapers off after that point. Thus, risk to the general
public of disease caused by exposure to medical waste is likely to be much lower than risk for the healthcare
workers.

58
After the MWTA expired in 1991, states largely took on the role of regulating medical waste under the guidance
developed from the two year program.

Most states have since further developed their own programs resulting in each state program

differing significantly from each other.

 Who Regulates Medical Waste?

Since the 1988 Medical Waste Tracking Act Expired in 1991

Medical waste is primarily regulated by state environmental and health departments. EPA has not had
authority, specifically for medical waste, since the Medical Waste Tracking Act (MWTA) of 1988 expired in
1991. It is important to contact your state environmental program first when disposing of medical waste.
Contact your state environmental protection agency and your state health agency for more information
regarding your state's regulations on medical waste.

Other federal agencies have regulations regarding medical waste. These agencies include Centers for Disease
Control (CDC), Occupational Safety and Health Administration (OSHA), U.S. Food and Drug Administration
(FDA), and potentially others.

 Biomedical waste

Biomedical waste or hospital waste is any kind of waste containing infectious (or potentially infectious)
materials generated during the treatment of humans or animals as well as during research involving biologics.

It may also include waste associated with the generation of biomedical waste that visually appears to be of
medical or laboratory origin (e.g. packaging, unused bandages, infusion kits etc.), as well research laboratory
waste containing biomolecules or organisms that are mainly restricted from environmental release.Biomedical
waste may be solid or liquid. Examples of infectious waste include discarded blood, sharps,
unwanted microbiological cultures and stocks, identifiable body parts (including those as a result
of amputation), other human or animal tissue, used bandages and dressings, discarded gloves, other medical
supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the
characteristics described above. Waste sharps include potentially contaminated used (and unused discarded)
needles, scalpels, lancets and other devices capable of penetrating skin.

Biomedical waste is generated from biological and medical sources and activities, such as the diagnosis,
prevention, or treatment of diseases. Common generators (or producers) of biomedical waste
include hospitals, health clinics, nursing homes, emergency medical services, medical research laboratories,
offices of physicians, dentists, veterinarians, home health care and morgues or funeral homes. In healthcare
facilities (i.e. hospitals, clinics, doctor's offices, veterinary hospitals and clinical laboratories), waste with these
characteristics may alternatively be called medical or clinical waste.

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Biomedical waste is distinct from normal trash or general waste, and differs from other types of hazardous
waste, such as chemical, radioactive, universal or industrial waste. Medical facilities generate waste
hazardous chemicals and radioactive materials. While such wastes are normally not infectious, they require
proper disposal. Some wastes are considered multihazardous, such as tissue samples preserved in formalin.

 Categories of Hospital Waste

There are important sub-categories as well. Because hospitals offer a diverse scope of medical processes,
testing, and -- in some cases -- pharmaceutical compounding, there are multiple classifications of medical
waste that require different handling, transportation, and disposal methods. Here are four hospital medical
waste classifications that demand specific disposal protocols.

 Infectious Waste

This category is also commonly known as biohazardous materials. This is waste

that could potentially cause the spread of infection, and includes anything that
has been exposed to bodily fluids and tissue, either human or animal. This
includes blood, cells, bandages, sample flasks and containers, swabs, and all
non-reusable items that have been contaminated by potentially infectious
material. Infectious waste poses a threat of the spread of pathogens, requiring
scrupulous care in its disposal.

 Hazardous Waste

Hazardous waste is waste that poses a threat of harm either through

pollution, poisoning, or injury, and is therefore considered dangerous. This
includes pharmaceuticals, chemical solvents, and old surgical and examination
tools. Though this category of waste does not include materials that could
cause harm via infection, it does have the potential to cause significant harm
to people and the environment. In hospitals, the majority of hazardous
substances fall under the categorization RCRA Hazardous.

 Radioactive Waste

Numerous diseases are diagnosed and treated using radiology. Cancer

therapies use radioactive treatments, and even basic diagnostic technologies
like x-rays, mammography, positron emission tomography (PET), and
fluoroscopy use radiation. The byproducts that have been exposed to nuclear
isotopes are classified as radioactive waste. This waste, if handled and disposed
of improperly, could pose widespread health risks.

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  General Waste

Medical settings produce general waste, which is similar to typical household

or office waste. However, because of its proximity to hazardous, biohazardous,
and radioactive waste, it must be handled very carefully, as contamination can
occur. This category of waste includes paper products, disposable plastics, and
food waste.

 Why Understanding Hospital Medical Waste is an Essential Part

of Responsible Medical Practices ?

While medical settings have clear-cut biohazardous medical refuse like used needles, blood, and cell matter
that require careful disposal, it might still be mistakenly handled improperly during busy periods. It is critically
important to follow rigorous waste management protocols so that general waste that could have been
contaminated by infectious or radioactive waste materials doesn't end up in landfills.

To learn how Daniels Health can partner with your hospital to ensure safe, responsible, sustainable, and
effective hospital medical waste handling and disposal solutions, visit our hospital page here to learn how
Daniels' clinically-differentiated approach transforms the waste segregation and environmentally responsible
management of all hospital-generated waste streams. Understanding the downstream impact of correct waste
segregation and the risk poor internal practices pose to healthcare workers; our approach to hospital waste
disposal is predicated on five distinct pillars:

 Safety | Protection of Healthcare staff

 Sustainability | Protection of the Environment
 Efficiency | Minimizing patient interruptions and burden on hospital staff
 Compliance | Minimizing risk by upholding regulatory governance
 Education | Empowering hospital staff to understand waste segregation

If you're curious why hospitals like Stanford Health, Rush University, Henry Ford and Advent Health choose
Daniels for full management of all healthcare waste streams across their hospital sites and clinics, learn more
about our unique approach and its transformative impact on hospital waste management.

 Types of Medical Waste

Waste and by-products cover a diverse range of materials, as the following list illustrates:

 Infectious waste: waste contaminated with blood and other bodily fluids (e.g. from discarded
diagnostic samples), cultures and stocks of infectious agents from laboratory work (e.g. waste from
autopsies and infected animals from laboratories), or waste from patients with infections (e.g. swabs,
bandages and disposable medical devices);

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 Pathological waste: human tissues, organs or fluids, body parts and contaminated animal
carcasses;

 Sharps waste: syringes, needles, disposable scalpels and blades, etc.

 Chemical waste: for example solvents and reagents used for laboratory preparations,
disinfectants, sterilants and heavy metals contained in medical devices (e.g. mercury in broken
thermometers) and batteries;

 Pharmaceutical waste: expired, unused and contaminated drugs and vaccines;

 Cytotoxic waste: waste containing substances with genotoxic properties (i.e. highly hazardous
substances that are, mutagenic, teratogenic or carcinogenic), such as cytotoxic drugs used in cancer
treatment and their metabolites;

 Radioactive waste: such as products contaminated by radionuclides including radioactive

diagnostic material or radiotherapeutic materials; and







 Non-hazardous or general waste: waste that does not pose any particular biological,
chemical, radioactive or physical hazard.

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  The major sources of health-care waste

 hospitals and other health facilities

 laboratories and research centres
 mortuary and autopsy centres
 animal research and testing laboratories
 blood banks and collection services
 nursing homes for the elderly

High-income countries
generate on average up to
0.5 kg of hazardous waste
per hospital bed per day;
while low-income countries
generate on average 0.2 kg.
However, health-care waste
is often not separated into
hazardous or non-
hazardous wastes in low-
income countries making the real quantity of hazardous waste much higher.

 Hospitals Waste disposal management

Hospital waste management, also called medical waste management, is a system that handles the segregation,
containment, and disposal of hazardous, hospital-generated, infectious waste. Efficient waste management is
critical for healthcare institutions because medical waste can be pathogenic and environmentally hazardous.
Non-compliance with proper hospital waste management can lead to serious health risks, fines, and damage to
a healthcare institution’s reputation.

 How hospitals dispose of medical waste

It is important to differentiate the types of hospital waste so that hospitals and other medical or laboratory
facilities are able to dispose of their waste correctly and safely. This is to protect healthcare workers, refuse
workers and the general public.

The Health and Safety Executive and the Department of Health offer guidance and support on how
healthcare waste can be managed safely. Hospitals and other establishments dealing with similar waste have
a colour system to help waste handlers identify how to dispose of hospital waste correctly.

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 Colour Waste
Waste that needs to be incinerated. This must be
Yellow
done in a permitted facility.
Waste that should be treated before disposal to
Orange
render it safe. This waste can also be incinerated.
Waste that contains cytotoxic or cytostatic
Purple substances and must be treated and/or
incinerated.
Waste that is offensive or hygiene waste. This can
Yellow & Black
be placed in landfill or incinerated.
Red Anatomical waste that must be incinerated.
Municipal waste. This waste can go to landfill or
Black be incinerated in the same way as usual domestic
waste.
Blue Medicinal waste which must be incinerated.
This waste is for amalgam (such as is used in
White
dental fillings). It can be recycled.

As is clear, most hospital waste requires incineration with some waste requiring specialist medical incinerators.
This is to ensure that all traces of pathogens or infection are destroyed completely.

 How to manage hospital waste

Hospital waste management is something that must be taken extremely seriously. As outlined, disposing of
hospital waste correctly reduces the risks to both people and the environment. It requires diligence and
proactivity to prevent adverse risks to health that are often associated with the poor management of waste,
including exposure to toxic substances and infectious materials.

According to the HSE, health providers must consider infection control and health and safety legislation,
environmental and waste legislation and transport legislation when managing healthcare waste. Particular
focus should be on ensuring that hospitals are compliant in how they manage waste by classifying, storing and
transporting their waste appropriately as outlined in the Health Technical Memorandum 07-01.

 How hospital waste management could be improved

To improve hospital waste management, organisations should promote practices that not only reduce the
amount of waste that they generate but also ensure that waste is segregated appropriately. Hospitals must
develop systems that meet all standards, both nationally and internationally.

 Alternatives to incineration

The World Health Organization recommends that, where possible, hazardous waste should be treated by
methods other than incineration to reduce the risks to the environment and indirect exposure to hazardous

64
substances. These methods can include microwaving, autoclaving, chemical treatments and steaming
treatments.

 Create a system

Hospitals should ensure that they have the organisation required to dispose of waste correctly. This means that
there should be a hierarchy of those responsible at each step in the process when it comes to clinical waste
disposal. This system may take time to embed as all staff within a hospital or other care setting must be trained
in its proper implementation and use for it to work effectively.

 Training

Those responsible for handling healthcare waste must also be made aware of the hazards and risks associated
with their role. Full training should be given to all workers in hospitals and other clinical environments to
ensure that safe practices are maintained at all times.

This training applies equally to volunteers, hospital café workers and cleaners all the way up to consultants and
managers. Those handling substances that are hazardous to health should receive full COSHH training.

 Introducing environmentally friendly practices

As mentioned, hospital waste is largely non-recyclable. However, even recyclable waste is often thrown away
with municipal waste. For hospitals to manage their waste effectively and become sustainable in a world where
climate change is an increasing concern, opting for environmentally friendly practices is paramount. Hospital
leaders should investigate potential waste management options that are more sustainable and reduce
environmental hazards.

 Country-wise regulation and management

 United Kingdom

In the UK, clinical waste and the way it is to be handled is closely regulated. Applicable legislation includes
the Environmental Protection Act 1990 (Part II), Waste Management Licensing Regulations 1994, and
the Hazardous Waste Regulations (England & Wales) 2005, as well as the Special Waste Regulations in
Scotland. A scandal erupted in October 2018 when it emerged that Healthcare Environment Services, which
had contracts for managing clinical waste produced by the NHS in Scotland and England, was in breach of the
environmental permits at four of its six sites by having more waste on site than their permit allows and storing
waste inappropriately. Seventeen NHS trusts in Yorkshire terminated their contracts immediately. The
company sued for compensation. Amputated limbs were said to be among 350 tonnes of clinical waste
stockpiled instead of incinerated in Normanton. The company maintains that the problem was caused by a
reduction in incineration capacity, and the re-classification of clinical waste as "offensive", which meant more
needed incineration. The government's contingency plans included installing temporary storage units at
hospitals, but the company say that this is more dangerous than allowing them to exceed their permitted

65
allowances. The company still has contracts with 30 other trusts in England, and a waste disposal contract with
NHS England for primary care and pharmacy.

 United States

In the United States, biomedical waste is usually regulated as medical waste. In 1988 the U.S. federal
government passed the Medical Waste Tracking Act which allowed the EPA to establish rules for
management of medical waste in some parts of the country. After the Act expired in 1991, responsibility to
regulate and pass laws concerning the disposal of medical waste returned to the individual states. The states
vary in their regulations from none to very strict.

In addition to on-site treatment or pickup by a biomedical waste disposal firm for off-site treatment, a mail-
back disposal option allows generators of waste to return it to the manufacturer. For instance, waste medicines
and equipment can be returned. The waste is shipped through the U.S. postal service. While available in all 50
U.S. states, mail-back medical waste disposal is limited by very strict postal regulations (i.e., collection
containers must comply with requirements set out by the Food and Drug Administration, while shipping
containers must be approved by the postal service for use).

 India

The Bio-medical Waste (Management and Handling) Rules, 1998 and further amendments were passed for the
regulation of bio-medical waste management. On 28 March 2016 Biomedical Waste Management Rules (BMW
2016) were also notified by Central Govt. Each state's Pollution Control Board or Pollution control Committee
will be responsible for implementing the new legislation. New regulations affect the distribution of medical
waste by medical professionals into their proper receptacles.

In India, though there are a number of different disposal methods, the situation is desultory and most are
harmful rather than helpful. If body fluids are present, the material needs to be incinerated or put into an
autoclave. Although this is the proper method, most medical facilities fail to follow the regulations. It is often
found that biomedical waste is dumped into the ocean, where it eventually washes up on shore, or in landfills
due to improper sorting or negligence when in the medical facility. Improper disposal can lead to many
diseases in animals as well as humans. For example, animals, such as cows in Pondicherry, India, are consuming
the infected waste and eventually, these infections can be transported to humans who consume their meat or
milk. Large number of unregistered clinics and institutions also generate bio-medical waste which is not
controlled.

Due to the competition to improve quality and so as to get accreditation from agencies like ISO, NABH, JCI,
many private organizations have initiated proper biomedical waste disposal but still the gap is huge.

Many studies took place in Gujarat, India regarding the knowledge of workers in facilities such as hospitals,
nursing homes, or home health. It was found that 26% of doctors and 43% of paramedical staff were unaware
of the risks related to biomedical wastes. After extensively looking at the different facilities, many were
undeveloped in the area regarding biomedical waste. The rules and regulations in India work with The Bio-

66
medical Waste (Management and Handling) Rules from 1998, yet a large number of health care facilities were
found to be sorting the waste incorrectly.Update around 26 March 2020. The National Green Tribunal (NGT)
has been stringent on the application of the BMW 2016 over the past 12 months. There are now over 200
licensed Common Bio Medical Waste Treatment and Disposal Facilities (CBWTDF) or Common Treatment
Facility (CTF) in the country. The rules have been updated over the years. The training of Health Care Facility
staff and the awareness of the Hazards of Bio Medical waste is still a challenge in most of the country. The
compliance is being enforced through penalties and via awareness. The CTF are operational in most Tier 1 cities
and Tier 2 cities of India and compliance is high today because of NGT. But lack of awareness lead to issues of
improper segregation. In Tier 2 and 3 cities the general waste is also mixed with biomedical waste.

 The best method is to perform medical waste shredding and

steam sterilization within one vessel

With the Integrated Sterilizer and Shredder (ISS), the shredding and the sterilization is done within one single
vessel. The importance of this is essential during maintenance procedures, as it provides a safe working
environment for both operators and technicians. The processed waste is rendered non-infectious, non-
hazardous, and non-reusable; it is defined as non-regulated waste and can be discarded as normal municipal
waste. This process takes place in one vessel to preclude the possibility of any cross-contamination.

67
  Conclusion

Hospital waste management and clinical waste disposal pose hazards to people and the environment. And, with
almost 600,000 tonnes produced each year, it must be disposed of correctly. Having strong management and
systems is the key to handling hospital waste correctly.

With strategies in place and forward-thinking from leaders, hospitals should be able to reduce their waste and
find some environmentally friendly alternative to its disposal, at least in part.

The hospitals produce considerable amount of waste which contain infectious as well as non infectious waste.
Hospital waste should not be stored or dumped without Proper processing. Hospitals must be aware and follow
Biomedical Waste (Management and Handling) Rules to manage there waste. If the problem of hospital waste
can be managed we can save ourselves from future pathogenic disasters.

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 References

 https://www.icontrolpollution.com
 https://safetyculture.com
 https://cpdonline.co.uk
 https://celitron.com
 en.wikipedia.org
 www.danielshealth.com

 APHA, 1995. Standard Methods for the Examination of Water & Waste Water. Edited by Andrew D.
Eaton, Lenore S. clesceri, Arnold E. Greenberg 19th edition.

 Biomedical Waste (Management and Handling) Rules, 1998 vide S.O.630 (E) Ministry of Environment
and Forests Notification, dated 20th July, 1998, published in the Gazette of India.

Thank You

69
70
  What is a Hospital

A hospital is a healthcare facility that provides specialized medical and nursing care as well as medical supplies
to patients. The most well-known form of the hospital is the general hospital, which usually carries an
emergency department to handle urgent health issues such as fire and accident victims, as well as medical
emergencies.

According to the hospital definition, a district

hospital is usually the region's primary
healthcare facility, with a large number of
intensive-care beds and extra beds for patients
who need long-term care. Trauma centers,
children's hospitals, rehabilitation hospitals,
hospitals, and seniors' (geriatric) hospitals for
coping with particular medical conditions such
as psychiatric care are also examples of
specialized hospitals and several other disease categories. When opposed to general hospitals, specialized
hospitals can help save money on health care. Based on the source of revenue, hospitals are categorized as
general, specialized, or government.

A teaching hospital integrates patient care with medical students as well as nurse education. A clinic is a care
facility that is smaller than that of a hospital. A hospital's departments (such as surgery and urgent care) and
specialty units (such as cardiology) are diverse. Outpatient departments and chronic care centers are available
at certain hospitals. Pathology, pharmacy, and radiology are examples of common support units.

 Function of Hospital

Below mentioned are some of the functions of hospital/hospital use:-

 Medical hospital - medical hospital includes the treatment and management of patients by a team of
doctors.

 Patient Support provides nursing, nutritional diagnostic, counseling, pharmacy, and medical supplies,
all of which are directly related to patient care.

 Administrative responsibilities include carrying out

the hospital's guidelines and directives regulating
the release of support services in the areas of
finance, staff, housekeeping, materials and property,
laundry, protection, transportation, engineering,
and board as well as several other maintenance.

 The hospital's financial activities must be planned,

guided, and coordinated for

 Patients in a hospital as well as the employees

working there.

71
  Prepare a job and financial plan for services and initiatives, as well as funding projections.

 To keep track of cash receipts and disbursements.

 To manage personnel development plans, procedures, and standards; to provide guidance on policy,
implementation, and administration of laws, rules, and regulations.

 The quality, efficacy, and outcomes of health services for various groups and populations are shaped by
the structure and dynamics of healthcare organizations; the policy repercussions for future health care
reform initiatives and patients in the hospital.

 Hospital operation is another major benefit of hospitals.

 History of hospitals

 Early Ages

In early India, Fa Xian, a Chinese Buddhist monk who travelled across India c. AD 400, recorded examples of
healing institutions. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the
sixth century AD, King Pandukabhaya of Sri Lanka (r. 437–367 BC) had lying-in-homes and hospitals
(Sivikasotthi-Sala). A hospital and medical training
centre also existed at Gundeshapur, a major city in
southwest of the Sassanid Persian Empire founded
in AD 271 by Shapur I. In ancient Greece, temples
dedicated to the healer-god Asclepius, known
as Asclepeion functioned as centres of medical
advice, prognosis, and healing. The Asclepeia spread
to the Roman Empire. While public healthcare was
non-existent in the Roman Empire, military hospitals
called valetudinaria did exist stationed in military
barracks and would serve the soldiers and slaves
within the fort. Evidence exists that some civilian
hospitals, while unavailable to the Roman population,
were occasionally privately built in extremely wealthy Roman households located in the countryside for that
family, although this practice seems to have ended in 80 AD.

The first hospital in North America (Hospital de Jesús Nazareno) was built in Mexico City in 1524 by Spanish
conquistador Hernán Cortés; the structure still stands. The French established a hospital in Canada in 1639 at
Quebec city, the Hôtel-Dieu du Précieux Sang, which is still in operation (as the Hôtel-Dieu de Québec),
although not at its original location. In 1644 Jeanne Mance, a French noblewoman, built a hospital of ax-hewn
logs on the island of Montreal; this was the beginning of the Hôtel-Dieu de St. Joseph, out of which grew the
order of the Sisters of St. Joseph, now considered to be the oldest nursing group organized in North America.
The first hospital in the territory of the present-day United States is said to have been a hospital for soldiers
on Manhattan Island, established in 1663.

The early hospitals were primarily almshouses, one of the first of which was established by English Quaker
leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in America was
the Pennsylvania Hospital, in Philadelphia, which obtained a charter from the crown in 1751.

72
  Middle Ages

The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision
of care. Following the First Council of Nicaea in
AD 325 construction of a hospital in every
cathedral town was begun, including among the
earliest hospitals by Saint
Sampson in Constantinople and by Basil, bishop
of Caesarea in modern-day Turkey. By the twelfth
century, Constantinople had two well-organised
hospitals, staffed by doctors who were both male
and female. Facilities included systematic
treatment procedures and specialised wards for
various diseases.

The earliest general hospital in the Islamic world was built in 805 in Baghdad by Harun Al-Rashid. By the 10th
century, Baghdad had five more hospitals, while Damascus had six hospitals by the 15th century,
and Córdoba alone had 50 major hospitals, many exclusively for the military. The Islamic bimaristan served as a
center of medical treatment, as well nursing home and lunatic asylum. It typically treated the poor, as the rich
would have been treated in their own homes. Hospitals in this era were the first to require medical diplomas to
license doctors, and compensation for negligence could be made. Hospitals were forbidden by law to turn away
patients who were unable to pay. These hospitals were financially supported by waqfs, as well as state funds.

 Early modern and Enlightenment Europe

In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a
secular one. In England, after the dissolution of the monasteries in 1540 by King Henry VIII, the church abruptly
ceased to be the supporter of hospitals, and only by direct petition from the citizens of London, were the
hospitals St Bartholomew's, St Thomas's and St Mary
of Bethlehem's (Bedlam) endowed directly by the
crown; this was the first instance of secular support
being provided for medical institutions.

In 1682, Charles II founded the Royal Hospital

Chelsea as a retirement home for old soldiers known
as Chelsea Pensioners, an instance of the use of the
word "hospital" to mean an almshouse. Ten years
later, Mary II founded the Royal Hospital for Seamen,
Greenwich, with the same purpose.

Other hospitals sprang up in London and other British cities over the century, many paid for by private
subscriptions. St Bartholomew's in London was rebuilt from 1730 to 1759, and the London Hospital,
Whitechapel, opened in 1752.

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The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of hospital design in having "pavilions" to
minimize the spread of infection. John Wesley visited in 1785, and commented "I never saw anything of the
kind so complete; every part is so convenient, and so admirably neat. But there is nothing superfluous, and
nothing purely ornamented, either within or without." This revolutionary design was made more widely known
by John Howard, the philanthropist. In 1787 the French government sent two scholar
administrators, Coulomb and Tenon, who had visited most of the hospitals in Europe. They were impressed and
the "pavilion" design was copied in France and throughout Europe.

 19th century

English physician Thomas Percival (1740–1804) wrote a comprehensive system of medical conduct, Medical
Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and
Surgeons (1803) that set the standard for many textbooks. In the mid-19th century, hospitals and the medical
profession became more professionalised, with a reorganisation of hospital management along more
bureaucratic and administrative lines. The Apothecaries Act 1815 made it compulsory for medical students to
practise for at least half a year at a hospital as part of
their training.

Florence Nightingale pioneered the modern

profession of nursing during the Crimean War when
she set an example of compassion, commitment to
patient care and diligent and thoughtful hospital
administration. The first official nurses' training
programme, the Nightingale School for Nurses, was
opened in 1860, with the mission of training nurses to
work in hospitals, to work with the poor and to teach.
Nightingale was instrumental in reforming the nature
of the hospital, by improving sanitation standards and changing the image of the hospital from a place the sick
would go to die, to an institution devoted to recuperation and healing. She also emphasised the importance
of statistical measurement for determining the success rate of a given intervention and pushed
for administrative reform at hospitals.

By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a variety of
public and private hospital systems. By the 1870s, hospitals had more than trebled their original average intake
of 3,000 patients. In continental Europe the new hospitals generally were built and run from public funds.
The National Health Service, the principal provider of health care in the United Kingdom, was founded in 1948.
During the nineteenth century, the Second Viennese Medical School emerged with the contributions of
physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp
Semmelweis. Basic medical science expanded and specialisation advanced. Furthermore, the first dermatology,
eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth
of specialised medicine.

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  20th century and beyond

By the late 19th and early 20th centuries, medical advancements such as anesthesia and sterile techniques that
could make surgery less risky, and the availability of more advanced diagnostic devices such as X-rays,
continued to make hospitals a more attractive option for treatment.

Modern hospitals measure various efficiency metrics such as occupancy rates, the average length of stay, time
to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate,
and case mix index.

In the United States, the number of hospitalizations continued to grow and reached its peak in 1981 with 171
admissions per 1,000 Americans and 6,933 hospitals.

This trend subsequently reversed, with the rate of

hospitalization falling by more than 10% and the
number of US hospitals shrinking from 6,933 in 1981 to
5,534 in 2016. Occupancy rates also dropped from 77%
in 1980 to 60% in 2013.

Among the reasons for this are the increasing

availability of more complex care elsewhere such as at
home or the physicians' offices and also the less
therapeutic and more life-threatening image of the
hospitals in the eyes of the public.

In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not
formally admitted. In the US, inpatient stays are covered under Medicare Part A, but a hospital might keep a
patient under observation which is only covered under Medicare Part B, and subjects the patient to additional
coinsurance costs. In 2013, the Center for Medicare and Medicaid Services (CMS) introduced a "two-midnight"
rule for inpatient admissions, intended to reduce an increasing number of long-term "observation" stays being
used for reimbursement. This rule was later dropped in 2018. In 2016 and 2017, healthcare reform and a
continued decline in admissions resulted in US hospital-based healthcare systems performing poorly financially.
Microhospitals, with bed capacities of between eight and fifty, are expanding in the United States. Similarly,
freestanding emergency rooms, which transfer patients that require inpatient care to hospitals, were
popularised in the 1970s and have since expanded rapidly across the United States.

 Quality and safety:

As the quality of health care has become more of a concern around the world, hospitals have had to pay more
attention to this issue. One of the most powerful ways to analyze this component of health care is through
independent external quality assessment, and hospital accreditation is one way to do so. Accreditation is
sourced from other countries in many parts of the world, a phenomenon known as international healthcare
accreditation.

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  Hospital Services

Hospital Services refers to the clinical services provided by the Hospital, as well as the operational activities that
support those clinical services, which are funded in whole or in part by the LHIN, and includes the type, volume,
frequency, and availability of Hospital Services; HSAA Indicator Technical Specifications refers to the document
titled "HSAA Indicator Technical Specifications," as amended or replaced from time to time.Hospital services
are the foundation of a hospital's services. They are frequently influenced by the demands or wishes of the
hospital's key users, with the goal of making the hospital a one-stop or core institution of the local community
or medical network. Hospitals are facilities with basic services and personnel—usually medicine and surgical
departments—that provide clinical and other services for specific diseases and ailments, as well as emergency
care. Hospital services include everything from basic health care to training and research for major medical
school centres, as well as services created by a network of industry-owned institutions such as health
maintenance organisations.

Below mentioned are some of the hospital services:-

 Emergency room services

 Short-term hospitalization

 X-ray/radiology services

 General and specialty surgical services

 Blood services

 Laboratory services

Health maintenance organization hospitals supplement the basic list with a variety of specialized and auxiliary
services, such as:

 Pediatric specialty care

 Prescription services

 Good access to surgical specialists

 Rehabilitation services and physical therapy

 Home nursing services

 Mental health care

 Nutritional counseling

 Genetic testing and counseling

 Family support services

 Financial services

 Case management or social work services

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  Types of Bed in Hospital With Name

Making a bed is a skill. It is a method of preparing a suitable bed based on the patient's condition and using
scientific nursing concepts. The patient would feel more comfortable if the bed is made with care. Nurses must
be able to prepare hospital beds in a variety of ways depending on the situation. In most cases, beds are made
after a client requires specific treatment and when there are no other people in the room.

 Types of beds in hospitals with names are:

 Simple Beds

 Special Beds

 Simple Beds:

 Closed Bed

 Open Bed

 Occupied Bed

Special Beds:

 Operation Bed

 Cardiac Bed

 Blanket Bed

 Amputation Bed

 Fracture Bed

 Fundings of the Hospitals

 Support for modern hospitals comes from several

places. They may be paid for by public funds,
charitable contributions, or private funds and
health insurance. The National Health Service in
the United Kingdom provides state-funded health
services to legal citizens "completely free of
delivery," as well as emergency care to everyone,
regardless of nationality or status.

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  Due to the requirement for hospitals to prioritize their available resources, there is a propensity for
'waiting lists' for non-essential treatment in countries with such programs, then those who can access it
can opt for private medical insurance to receive treatment quite rapidly and efficiently.

 Hospitals and clinics in the United States are generally privately owned and operated, with certain for-
profit hospitals including HCA Healthcare. A chargemaster is used to charge a database of procedures
and their costs; nevertheless, these prices could be lower for healthcare services provided across
healthcare networks.

 Hospitals are required by law to treat patients in life-threatening emergencies regardless of their
financial capacity to pay. Privately operated hospitals that accept people without insurance in
emergency cases, including the aftermath of Hurricane Katrina, suffer significant revenue damage.

 Departments or Wards

A hospital contains one or more wards that house hospital beds for inpatients. It may also have acute services
such as an emergency department, operating theatre, and intensive care unit, as well as a range of medical
specialty departments. A well-equipped
hospital may be classified as a trauma center.
They may also have other services such as
a hospital pharmacy, radiology, pathology,
and medical laboratories. Some hospitals
have outpatient departments such
as behavioral health services, dentistry,
and rehabilitation services.

A hospital may also have a department of

nursing, headed by a chief nursing
officer or director of nursing. This
department is responsible for the administration of professional nursing practice, research, and policy for the
hospital.

Many units have both a nursing and a medical director that serve as administrators for their respective
disciplines within that unit. For example, within an intensive care nursery, a medical director is responsible for
physicians and medical care, while the nursing manager is responsible for all the nurses and nursing care.

Support units may include a medical records department, release of information department, technical
support, clinical engineering, facilities management, plant operations, dining services, and security
departments.

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  Remote monitoring

The COVID-19 pandemic stimulated the development of virtual wards across the British NHS. Patients are
managed at home, monitoring their own oxygen levels using an oxygen saturation probe if necessary and
supported by telephone. West Hertfordshire Hospitals NHS Trust managed around 1200 patients at home
between March and June 2020 and planned to continue the system after COVID-19, initially for respiratory
patients. Mersey Care NHS Foundation Trust started a COVID Oximetry@Home service in April 2020. This
enables them to monitor more than
5000 patients a day in their own
homes. The technology
allows nurses, carers, or
patients to record and
monitor vital signs such as
blood oxygen levels.

 Various Kind of Hospitals

Some patients go to a hospital just for diagnosis,

treatment, or therapy and then leave ("outpatients")
without staying overnight; while others are "admitted"
and stay overnight or for several days or weeks or
months ("inpatients"). Hospitals are usually
distinguished from other types of medical facilities by
their ability to admit and care for inpatients whilst the
others, which are smaller, are often described
as clinics.

 General and acute care

The best-known type of hospital is the general hospital, also known as an acute-care hospital. These facilities
handle many kinds of disease and injury, and normally have an emergency department (sometimes known as
"accident & emergency") or trauma center to deal with immediate and urgent threats to health. Larger cities
may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and
Canada, have their own ambulance service.

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  District

A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive
care, critical care, and long-term care.
In California, "district hospital" refers specifically to a
class of healthcare facility created shortly after World
War II to address a shortage of hospital beds in many
local communities. Even today, district hospitals are the
sole public hospitals in 19 of California's counties, and
are the sole locally accessible hospital within nine
additional counties in which one or more other hospitals
are present at a substantial distance from a local
community. Twenty-eight of California's rural hospitals
and 20 of its critical-access hospitals are district hospitals.
They are formed by local municipalities, have boards that
are individually elected by their local communities, and
exist to serve local needs. They are a particularly important provider of healthcare to uninsured patients and
patients with Medi-Cal (which is California's Medicaid program, serving low-income persons, some senior
citizens, persons with disabilities, children in foster care, and pregnant women). In 2012, district hospitals
provided $54 million in uncompensated care in California.

 Specialized

A specialty hospital is primarily and exclusively dedicated to one or a few related medical specialties. Subtypes
include rehabilitation hospitals, children's hospitals, seniors'
(geriatric) hospitals, long-term acute care facilities, and hospitals
for dealing with specific medical needs such as psychiatric problems
(see psychiatric hospital), cancer treatment, certain disease
categories such as cardiac, oncology, or orthopedic problems, and
so forth.

In Germany specialised hospitals are called Fachkrankenhaus; an

example is Fachkrankenhaus Coswig (thoracic surgery). In India,
specialty hospitals are known as super-specialty hospitals and are
distinguished from multispecialty hospitals which are composed of
several specialties.

Specialised hospitals can help reduce health care costs compared to

general hospitals. For example, Narayana Health's cardiac unit
in Bangalore specialises in cardiac surgery and allows for a
significantly greater number of patients. It has 3,000 beds and
performs 3,000 in paediatric cardiac operations annually, the largest number in the world for such a facility.

Surgeons are paid on a fixed salary instead of per operation, thus when the number of procedures increases,
the hospital is able to take advantage of economies of scale and reduce its cost per procedure.

Each specialist may also become more efficient by working on one procedure like a production line.

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  Teaching

A teaching hospital delivers healthcare to patients as well

as training to prospective Medical Professionals such
as medical students and student nurses. It may be linked to
a medical school or nursing school, and may be involved
in medical research. Students may also observe clinical
work in the hospital.

 Clinics

Clinics generally provide only outpatient services, but some may have a few inpatient beds and a limited range
of services that may otherwise be found in typical hospitals.

 Different Departments in Hospital (Various Departments in

Hospital)

Below given are the details of different departments in the hospital:-

 Outpatient department (OPD), Surgical department, Inpatient service (IP), Nursing

department, Physical medicine, Paramedical
department, and Rehabilitation department,
Dietary department, Pharmacy department,
Operation theater complex (OT), Radiology
department (X-ray), and Non-professional
services are some of the departments located in
hospitals.

 A nursing department, led by a director

of nursing or a chief nursing officer, might exist in
a hospital. Such a department has the

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  responsibility of overseeing the hospital's clinical nursing practice, research, and regulation.

 Numerous units also have nursing as well as a medical director who also acts as a supervisor for their
subject areas. A medical director, for instance, is in charge of doctors and medical treatment in an
intensive care nursery, whereas the nursing manager is in charge of both nurses and nursing
healthcare.

 Health records, technical support, disclosure of information, facilities management, clinical

engineering, dining services, and plant operations, are examples of support units.

 Types of Hospitals

Hospitals are typically subsidized by the government, for-profit or nonprofit health agencies, health insurance
providers, or charities, such as direct charitable donations. Depending on the funding, hospitals can be
classified into one of three groups.

Below mentioned are the types of the hospital:

 Publicly owned hospital

 Nonprofit hospitals

 For-profit hospitals

Hospitals may be further graded depending on the type of care they provide (indicative) or the services they
provide, such as:

 Specialty Hospitals

 General Medical & Surgical Hospitals

 Clinics

 Teaching Hospitals

 Psychiatric Hospitals

 Clinics for Family Planning and Abortion

 Hospices & Palliative Care Centers

 Centers for Emergency and Other Outpatient Care

 Clinics for Sleep Disorders

 Blood & Organ Banks

 Dental Laboratories

 What is speciality Hospital

A typical community hospital provides a broad range of services

to accommodate the needs of the public it serves. Specialty
hospitals offer focused services to treat medical conditions that

82
require a particular subset of skills and technology. Specialty hospitals provide care for a specific specialty and
tailor their care and facilities to fit the chosen type of condition, patient, or procedure on which they focus.
Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors'
(geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see
psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopaedic problems, and so
forth.

 What is the Specialty Hospitals Industry ?

The industry includes companies that provide diagnostic and medical treatment to inpatients with a specific
type of disease or medical condition. Specialty hospitals have existed in various forms for many years as
children’s hospitals, psychiatric hospitals, rehabilitation hospitals, eye and ear hospitals, arthritis hospitals, and
they are also focusing on cardiovascular surgery, orthopedic surgery, general surgery, and women’s health.
Specialty hospitals include hospitals that primarily provide long-term care for the chronically ill and those that
offer rehabilitation, restorative and adjunctive services to physically challenged or disabled people. The
industry does not include specialty units within general hospitals or psychiatric or substance abuse hospitals.

 Specialty Hospitals Industry Products

 Long-term acute care hospitals

 Inpatient rehabilitation facilities
 Children's specialty hospitals
 Cardiac facilities
 Orthopedic facilities
 Women's facilities
 Rehabilitation facilities
 Eye and ear facilities
 Arthritis treatment facilities
 Cancer hospitals
 Geriatric hospitals
 Chronic disease hospitals
 Nose and throat hospitals

 Specialty Hospitals Industry Activities

 Inpatient care
 Outpatient care
 Diagnostic x-rays
 Clinical laboratory services
 Operating room services
 Physical therapy
 Educational and vocational services
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  Psychological and social work services
 Food services

 Specialty Hospitals V/s General Hospitals:

Specialty hospitals are specialized centers which concentrate their effort on a single field providing their
physicians with the necessary resources to remain at the cutting edge for the treatment in the area of their
specialization. Due to greater volumes, they can deliver better care at a lower price. Physicians who work at
specialty hospitals are masters of their area and have greater input; autonomy and independence in the
operation of the facility hence have an added advantage of direct participation in the governance of their
facility and can quickly make decisions that allow them to more easily influence quality and efficiency. Specialty
hospitals by allowing physicians to share in the efficiency gains through ownership create incentives to achieve
cost and quality improvements. Competition from specialty hospitals prompts positive changes in community
hospitals’ in-patient services, such as extending patient hours, improving scheduling, and upgrading equipment.
As specialty hospitals focus on a small number of medical procedures, they are able to execute that
responsibility well in comparison to general hospitals.

 Specialty Hospitals Industry Analysis & Industry Trends

Specialty hospitals are gaining traction for future expansion and development and continued healthcare
reforms will further benefit this trend. There is a focus on improving medical outcomes and as specialty
hospitals adopt to pay for performance systems, they are likely to continue growing. Specialty hospitals will be
well-positioned to benefit from value-based purchasing and other pay for performance programs. Specialty
hospitals are ranking well in key metrics like length of stay, discharge rates, and quality care measures.

 Key Drivers for Specialty Hospitals Industry

 High entry barriers to open specialty hospitals

 Establish referral relationships with doctors, insurers, and others
 Awareness and reach among the local community
 The aging population influencing increased demand
 Impact of new technologies on specialized treatments
 Medicare reimbursement rates
 Shortage of skilled healthcare personnel
 Consumer demand
 Procedural Operating Margins
 Clinical efficiencies
 Procedural economies of scale
 Economies (and diseconomies) of scope
 Competencies and learning

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  What is Speciality Hospital

A single super speciality hospital is defined as a hospital that is primarily and exclusively engaged in the care
and treatment of the patients suffering from a specific illness. They offer specialized services to their patients.

There is a growing trend now a days in India towards the single super speciality hospitals. The single speciality
hospitals are more focussed on a specific disease. In multi super speciality hospitals the loss of nimbleness
related to large size, loss of professional autonomy, potential risk of sharing fee with other specialities and
administrative complexities are there, which is not seen in the single super speciality hospitals.

 What comes under super speciality

 Cardio Thoracic Surgery. ...

 Endocrine Surgery. ...
 Neuro Surgery. ...
 Paediatric Surgery. ...
 Plastic and Reconstructive Surgery. ...
 Surgical Gastroenterology. ...
 Urology. ...
 Vascular Surgery.

 Benefits of choosing a Super Specialty Hospital

Because super specialty hospitals put together a custom team of physicians, therapists and caregivers, every
patients plan is designed with unprecedented expertise.

 High-quality staff with focused experience

 Peer support from patients with similar injuries
 Specialized patient and family education and resources
 More options to participate in research studies
 Access to services not found in most rehabilitation centers
 Specialized long-term support

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  Overview of a super speciality
Hospitals

 Hospital Name - Parkview Super Speciality Hospital

 Address - HB Block, Sector III, Salt Lake Kolkata

 Introduction

Parkview Hospital Pioneering in Health. Medical science has witnessed an unprecedented development these
days. The amazing advancement in the arena has really worked wonders. What appears to be an impossible
proposition even a few years back is now well within our reach. Life expectancy of average human being has
gone up distinctly. Today human life has a clear edge over age.

This has given birth to new challenges in the healthcare sector. The
problem of obesity has now become more acute than ever before. It is
also inviting other related problems. Cancer is about to become a
household name. Within a few decades, it is about to spread its
tentacles in every family.

We are geared up for such challenges. Our whole-hearted aim is to

provide quality health care service. Our team of experienced doctors
and paramedical staff and state-of-the-art infrastructural facilities
work non-stop to treat any medical or surgical emergency. Our only
aim is to try our level best to provide you best healthcare and
treatment. We earnestly believe that you deserve the best treatment
and care.

Parkview Super Specialty hospital is nothing less than a family and

everyone associated is a member of the family.

We fervently believe Parkview Super Specialty Hospital will carve a niche for itself very soon with its infallible
commitment and utmost dedication.

 Mission Of Parkview Hospital

Parkview Hospital mission is to provide compassionate, accessible, high-quality, and cost-effective healthcare
to the community; promote health; educate health professionals; and participate in appropriate clinical
research.

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 Departments

 Bariatric Surgery
 Cardiology
 CARDIOLOGY - INTERVENTIONAL
 C A RDI OLOG Y P AC EMAKER C LI NIC
 D ERM ATOLOG Y
 DIABETOLOGY AND ENDOCRINOLOGIST
 DIABETOLOGY, OBESITY & METABOLIC DISORDERS
 E. N. T
 ENDOCRINOLOGY
 G A S TROENTEROLOG Y
 G ENERAL & MI NIM AL I N VASI VE
S URG ERY
 G ENERAL M EDIC I NE
 GYNAECOLOGY
 G YNA EC OLOG Y & OBSTETRIC S
 GYNAECOLOGY - ONCOLOGY
 HA EM ATOLOG Y - ONC OLOG Y
 IVF & INFERTILITY
 MEDICINE ONCOLOGY
 NEP HROLOG Y
 NEUROLOGY (STROKE CLINIC)
 ORAL MAXILLO FACIAL SURGERY
 ORTHOP AEDI CS
 P A EDI A TRIC S
 PAIN MANAGEMENT
 PLASTIC SURGERY
 RES P I RATORY M EDI CI NE
 SURGICAL ONCOLOGY
 UROLOG Y
 UROLOGY ONCOLOGY

 Facilities Provided
 Day care
 Same day report
 Special clinic’s
 Physiotherapy

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 Online payment
 TPA desk
 Advance bookings (No waiting)
 Outdoor medicine shop
 Cafeteria

 Newsletter

88
 Our Visiting Photo to Parkview Hospital

89
  Conclusion

Patients and staff satisfaction is an important component of the health care industry in this competitive
modern era. In the hospital, the Outpatient Department is often called "Shop Window". Patients' satisfaction
leads to drift in both new and old patients, which hinders the sustainability of any hospital in long run. This
study was conducted to know the satisfaction level of patients and also get a feedback about the services
provided in the outpatient departments. The patients were randomly selected and a questionnaire was
developed to evaluate patient satisfaction about the outpatient department services, logistic arrangement in
the outpatient departments, waiting time, facilities, perception about the performance of staff, appointment
system, behaviour of staff, support service and any other suggestions of patients. Out of 200 patients
surveyed, 90-95% of patients were satisfied with the service offered in the hospital.

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 References

 wikipedia.org
 www.britannica.com
 www.vedantu.com
 www.ncspecialty.com
 www.technofunc.com
 healthcare.siliconindia.com
 craighospital.org
 www.researchgate.net
 www.parkviewhospital.in

Thank You

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