Final Trauma Aiims Jammu-Update

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Contents
1.0 About Jammu & Kashmir...........................................................................................................4
1.1..............................................................Health System & Status Of Jammu & Kashmir
........................................................................................................................................................................5
......................................................................................................................................................................13
2.0 About Aiims..........................................................................................................................................14
3.0 Centre Of Excellence............................................................................................................................16
4 . 0 S w o t A n a l y s i s (Strength, Weakness, Opportunity, And Threats Analysis)..................20
......................................................................................................................................................................22
5.0 Pestle (Political, Economic, Social, Technological, Legal & Environmental) Analysis......................23
......................................................................................................................................................................18
6.0 Risk & Mitigation...................................................................................................................................19
6.1 Project Level Risk..................................................................................................................................28
6.2 Possible Future Consequences Score.....................................................................................33
......................................................................................................................................................................34
7.0 Proposal Statement...............................................................................................................................35
......................................................................................................................................................................36
8 .0 Statement Of Need...............................................................................................................................37
......................................................................................................................................................................43
9.0 Scope......................................................................................................................................................44
......................................................................................................................................................................49
10.0 Objectives......................................................................................................................................50
......................................................................................................................................................................51
11.0 Detailed Justification Of The Proposal............................................................................52
12.0 Timeline For The Project Completion..............................................................................56
13.0 Resource Requirements..........................................................................................................58
13.1 Manpower...........................................................................................................................................58
13.2 Hardware & Software Required...........................................................................................63
14.0 Equipment Requirement........................................................................................................65
......................................................................................................................................................................70
15.0 Infrastructure Requirement Including Area Requirement:....................................71
15.2 Design Philosophy............................................................................................................................91
15.3 Basic Planning Aspects...........................................................................................................95
15.4 Design Considerations...........................................................................................................98
15.5 Area Requirement............................................................................................................................101
15.6 Floor Plan..........................................................................................................................................104
Design Concept & Planning.....................................................................................................................108
....................................................................................................................................................................110
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16.0 Statutory Requirements.......................................................................................................111
17.0 Cost Implications....................................................................................................................113
17.1 Capital Cost................................................................................................................................113
17.2 Operational Cost......................................................................................................................115
....................................................................................................................................................................116
18.0 Project Summary.....................................................................................................................117
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1.0 About Jammu & Kashmir
Jammu & Kashmir is a newly created Union Territory in India consisting of two
divisions: Jammu Division & Kashmir Division, both of which are administered by
the Central Government of India. It is located to the north of Himachal Pradesh &
Punjab and to the west of Ladakh. Jammu is known as the City of Temples &
offers plentiful sightseeing opportunities with its gardens, palaces, forts &
religious attractions, the most famous of which is Mata Vaishno Devi in Katra.
Kashmir Valley is famous for its meadows, lakes, high altitude passes, hill
stations, Mughal Gardens, Dal Lake, Shikara Ride & ancient religious sites.
The population of jammu as of 2020 is 13.6 million. There are 10 districts in

Jammu Region. These are Kathua, Jammu, Samba, Udhampur, Reasi, Rajouri,
Poonch, Doda, Ramban & Kishtwar.
Districts in Kashmir Region: Kashmir Valley Region consists of 10 districts, which

are Anantnag, Kulgam, Pulwama, Shopian, Budgam, Srinagar, Ganderbal,
Bandipora, Baramulla & Kupwara.
At present the state has 3400 health institutions, over 5800 doctors, 12855
hospital beds in the government institutions and private aided institutions,
including 4 Medical Colleges, 22 District Hospitals, 2 Ayurvedic hospitals, 273
Ayurvedic dispensaries, 2 Unani hospitals, 235 Unani dispensaries.
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On an average one medical institution has to serve 3127 persons. 111 hospital
beds and 48 number of doctors/vaids/hakims put together are available per lakh
population.
The climate of Jammu and Kashmir varies with altitude and across regions.
Southern and southwestern areas have a sub tropical climate, with hot summers
and cool winters. This region receives most of its rainfall during
the monsoon season. In the east and north, summers are usually pleasant. The
effect of the monsoon diminishes in areas lying to the leeward side of the Pir
Panjal, such as the Kashmir valley, and much of the rainfall happens in the spring
season due to western disturbances. Winters are cold, with temperatures reaching
sub-zero levels. Snowfall is common in the valley and the mountain areas.
1.1 Health System & Status of Jammu & Kashmir
Health is an essential input for the development of humans. The health status of
the population reflects a crucial aspect of human development i.e. physical and
mental capacity which combined with appropriate skill and competence, forms
valuable human capital of a nation. Human being, the essence of all development
strategies, health constitutes an integral and essential component of the overall
social and economic development strategy.
In Jammu and Kashmir State, “Health Care Services” is important not only for
human resource development, but also for restoring the faith of the people in the
institutions of governance. The main thrust of these services includes; delivery in
the areas of preventive, promotive and rehabilitative health care services at
primary, secondary and tertiary level. Primitive health care system inherited from
the independence period has undergone enormous changes in establishing
advanced network of health delivery system of the State.
Human capital, as characterized by good education and good health is an

important determinant of economic growth. Health finds a predominant place in
three of the eight goals, eight of the sixteen targets and eighteen of the forty-eight
indicators of the “Millennium Development Goals of the United Nation”. Health is
the most important social service sector having direct correlation with the welfare
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of the human being. This sector assumes focus for reaping the demographic
dividend having healthy productive workforce and general welfare of a State. The
State of Jammu and Kashmir has performed relatively well in providing health and
medical facilities to the people, but the level is still beneath the satisfaction. The
progress of health infrastructure in the State can be judged by the health
infrastructure i.e., the availability of hospitals, dispensaries and doctors.
The social infrastructure falls behind most of the developed states in India. The
social indicators here are literacy rate, infant mortality rate, death rate, birth rate,
status of children and women and level of poverty and rural development.
The Total Fertility Rate is 2.3, the Infant Mortality Rate is 51 [All India 55], Crude
Birth Rate is 19.0 [All India average: 23.1]; Crude Death Rate: 5.8 [All India: 7.4];
and the Sex Ratio is 892 (All India: 933). Estimated Death Rate 5.8 ((All India:
7.4), and Life expectancy at birth 65 (All India: 65.8). [SRS 2008] Health
Infrastructure
In J&K, Government institutions are overloaded: 91% in-patients load is on the

Public sector against 41.7 % at national level. State needs 1666 Sub centres (1907
in position), 271 PHCs (375 in position), 67 CHCs (85 in position), 238 Allopathic
Dispensaries, 2282 Multipurpose Workers (existing 1794), 1907 Male Health
Workers at Sub centres, 375 Female Health Assistants (in position 27), 375 Male
Health Assistants (in position 89), 85 Gynecologists (28 in position), 85 Physician
Specialists (44 in position), 65 Pediatricians (17 in position), 340 total specialists
(135 in position), 85 Radiographers (59 in position), 460 Lab Technicians (396 in
position) and 970 Nurses (403 in position).
Moreover adequate number of Anesthesiologists has to be posted at District and

Sub-District Hospitals. Blood Banks have to be made fully functional and
responsive to the needs of population. Appropriate Laboratory facility including
trained manpower is a necessity.
At present the state has 3400 health institutions, over 5800 doctors, 12855
hospital beds in the government institutions and private aided institutions,
including 4 Medical Colleges, 22 District Hospitals, 2 Ayurvedic hospitals,
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273 Ayurvedic dispensaries, 2 Unani hospitals, 235 Unani dispensaries.. On
an average one medical institution has to serve 3127 persons. 111 hospital
beds and 48 number of doctors/vaids/hakims put together are available per
lakh population.
Community Health Centre (CHC) is a 30 bedded hospital/Referral Unit of 4 PHCs

with specialised services. Primary Health Centre (PHC): A referral unit for 6 sub-
centres, 4-6 bedded manned with a Medical Officer in-charge and 14 subordinate
paramedical, Sub Centre: Most peripheral contact point between Primary Health
Care System and community manned with one MPW(F)/ANM and one PMW (M)/or
Pharmacist.
Health Institutions Average Rural Area (sq.Km) covered by a Health Intuitions

Average Radial Distance ( Kms) covered by a Health Institutions. J&K All India
Sub Centre 117.21 21.47 6.11 1 2.61 Primary Health Centre 591.67 139.40 13.72
6.66 Community Health Centre 2766.07 770.90 29.67 15.66 Average Rural Area &
Average Radial Distance Covered By Primary Health Institutions. Impediments to
Growth: Low density population, difficult terrain (problem of accessibility), poor
road connectivity, limited presence of private sector/NGOs and private sector
largely owned/operated by in-service doctors. The slow growth of the state can be
attributed to various factors. The civil unrest in Kashmir during the past two
decades has been a major factor. Low productivity in agriculture and allied sectors
has impeded employment and income generation. Poor industrial infrastructure
along with the poor investment climate has left the industrial sector in its infant
stage. There has not been a suitable strategy for the potential sectors to achieve
higher economic growth. Lack of sound fiscal management has also been
responsible for the poor economic growth of the state. Challenges and
opportunities
As a state with unique features and a strategic location, the speedy

development needs an integrated approach. Sound policy and good governance
can lead the state to a faster development path. District and Sub-district hospitals
must be strengthened. The infrastructure of the hospitals: buildings, space,
technology, latest biomedical equipment (like CT scan machines, ultrasound
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machines, X-ray equipment, Auto analysers, etc) has to be upgraded. The problem
of shortage of manpower should be addressed. A scientific human resource
development program must be a top priority. Qualification and experience need
due consideration while recruiting technicians, nurses and other staff. Patients
should be looked after by appropriately qualified nurses and paramedics and not
by unskilled persons. Facilities need to be provided to the district and Sub-District
hospitals so that they remain functional 24x7. Emergency Medical Services are
essential part of healthcare delivery. Functional Emergency Department (Casualty
wards) should be set up at all the district hospitals.
There is a need to streamline the functioning of the Out Patient Department’s.

Residential facilities to doctors should be provided at the district hospitals so that
they remain available 24x7.
The bed strength of the District hospitals has to be increased. Mental Health has
been neglected for far too long. It needs our urgent attention. Birthing Centres at
strategic locations must be provided to take care of mother and child. Doctors
working in far flung areas should be given incentives like rural service allowances.
Government must invest reasonably in imparting hands-on training to doctors
and paramedics by arranging regular aggressive Continuous Medical Education
Programmes both at district and state levels which will help them to enhance their
knowledge and skills. Competencies of Health Professionals have to be
continuously enhanced. Only proficient staff can provide quality care. Special
attention must be given to the training of doctors and nurses in Critical care
including Trauma management.
All training programs (Symposia, Conferences, Workshops, Seminars) must fetch

Credit Points to those who attend it. Earning of credit points should be made
essential for professional growth of doctors. District Hospitals should be made a
hub of health care activities and designated as teaching centres for doctors and
nurses so far Internship and Residency programmes are concerned. These
hospitals should be managed by professionally qualified Hospital Administrators.
Quacks that are playing havoc with the lives of poor and vulnerable populations
must be brought to book. Drugs should be dispensed by the chemists against a
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proper prescription by a qualified doctor. Deviations by the chemists need to be
dealt under rules.
A proper Referral System must be in place to treat the Right patient at the Right
Place at the Right Time. The system needs regular monitoring by higher
authorities. Referring institutions/doctors must be made accountable for it and
performance determined with proper feedback from referral centres to the referring
doctors (two-way).
Arrangements can be made to make CHCs functional round-the-clock and PHCs

can work in two shifts. Quality Assurance must be at the heart of all health
facilities. Mechanisms have to be in place to measure the outcome of interventions
in accordance with principles of Evidence Based Medicine. Clinical Audit is a
necessity for improvising patient care. A robust Health Information System
including Electronic Medical Records is an inescapable necessity for planning,
policy making and continuity of care. Networking of healthcare facilities by
combining all the three levels of care through Telemedicine is required.
The impact of service standards rests to a great extent on how staff work and how
they are facilitated in what they do. A changing workplace: Healthcare
professionals expect the organisations they work for to provide high-quality care.
They want healthy and efficient workplaces that enhance the well-being of patients
as well as themselves, allowing convenient and rapid access to medical expertise.
Innovation in delivery: While acute hospitals offer increasingly sophisticated and
effective treatments, there is also a policy drive to shift less demanding care closer
to the home, and to integrate it with other community services. Improving staff
recruitment, retention and effectiveness: the impact of workplace design is
significant enough to affect productivity, attachment to the workplace and levels of
staff retention. Research into the therapeutic effect of environments shows how
their design can affect health outcomes for patients and improve the performance
of staff.
Following Table I narrates the position of health care infrastructure in

Jammu and Kashmir State.
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Facility Health Population Beds Beds Doctors Doctors
indicators Institutions covered available available Available per
per Per lakh of lakh of
institution population population
2009-10 3690 3125 12932 113 5573 48
2010-11 3972 3024 14165 115 5573 48
2011-12 3850 3080 13578 108 6255 49
2012-13 3856 3080 14545 116 6278 50
2013-14 3858 3080 15536 124 7992 60
2014-15 4433 3546 12965 104 6674 53
Besides that, considerable achievements have been made to improve health

standards such as life expectancy, child mortality, infant mortality and maternal
mortality. The selected health indicators of Jammu and Kashmir and its adjoining
States are shown in Table II.
Life Crude Crude Total Infant Couple Institu Full

S. State/ expectancy Birth Death Fertility Mortality Protection tional Immunization
No. UT’s at Birth Rate Rate Rate Rate Rate Births (%) (%)
(years) (CBR)* (CDR)* (TFR) (IMR)* (CPR) %
1 2 3 4 5 6 7 8 9 10
1 All India 66.1 17.0 5.4 2.3 34 46.6 78.9 62
2 J&K 70.1 11.9 4.4 1.7 24 15.9 85.7 75.1
3 Delhi 71.0 15.6 4.0 1.6 18 24.9 85.4 66.4
4 Punjab 69.3 14.1 5.1 1.7 21 56.5 90.5 89.1
5 Himachal 70 10.5 7.0 1.7 25 50.5 76.4 69.9
6 Haryana 67 18.3 5.1 2.3 33 43.3 85.5 62.2
7 U.P 62.7 22.8 5.5 1.9 43 36.0 67.8 51.1
In comparison to its adjoining States, Jammu and Kashmir fairs poorly with Delhi
in all health parameters whereas it is at a better position as compared to Uttar
Pradesh and Haryana. Punjab and Himachal Pradesh are also comparatively
better than Jammu and Kashmir. Couple Protection Rate (CPR) in Jammu and
Kashmir State is very low as compared to National level and its other adjoining
states. The main reason of the low Couple Protection Rate is that the traditional
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attitudes against Family Planning are still a big barrier against the universal or
large scale use of birth control devices.
J&K identified 12 high delivery load Facilities, six each in Srinagar and Jammu
division from 9 districts (one aspirational and 8 non-aspirational) which includes 4
Medical colleges, 3 District hospitals, 2 sub-district hospitals and 3 CHCs
considering that it will give over all status of the UT of J&K for designing
appropriate strategy. NIPI team conducted assessments from 4-8 January 2021.
The assessments were successfully completed in 6 facilities of Jammu division
(MGS hospital Jammu, SDH Akhnoor, CHC Katra, DH Udhampur, SDH
Sunderbani and DH Rajori).
1.2 Changing face of Healthcare in Jammu and Kashmir
In 2018, India launched Ayushman Bharat – one of the most ambitious health
missions ever to expand Universal Health Coverage, especially in rural and
vulnerable populations. This initiative has been designed to meet Sustainable
Development Goals (SDGs) and its underlying commitment, which is to “leave no
one behind.”
The aim is to provide essential health services throughout the country, through
the four pillars of this programme:
 Health and Wellness Centres (HWCs)

 Pradhan Mantri Jan Arogya Yojana (PM-JAY)
 Ayushman Bharat Digital Mission
 Pradhan Mantri - Ayushman Bharat Health Infrastructure Mission
As a part of this process, the Government of India has been working towards
transforming the landscape of healthcare in Jammu & Kashmir as well. There are
several new initiatives being launched in J&K, which have helped in improving the
infrastructure, and overall healthcare facilities. Through health schemes and new
development projects, the healthcare sector in Jammu and Kashmir has made
great strides, and several milestones have been achieved over the past few years in
the state.
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Other contributing factors contributing to the healthcare factors are
NUTRITIONAL STATUS
Food is very important factor that has an impact on woman’s health. A healthy
mother can give birth to a healthy child. A woman who eats balanced diet does not
suffer from severe anaemia. Anaemia is a major health problem in State, especially
among women and children. More than half of women in Jammu and Kashmir (52
percent) have anaemia, including 37 percent with mild anaemia, 13 percent with
moderate anaemia, and 2 percent with severe anaemia.
Children’s nutritional status in Jammu & Kashmir has improved since NFHS-3 by
all the three measures. Stunting decreased from 35 percent to 27 percent in the
10 years between NFHS-3 and NFHS-4, and the percentage of children who are
underweight decreased from 26 percent to 17 percent.
SANITATION
Sanitation coverage, which ought to be a way of life to safeguard health, is

inadequate in Jammu and Kashmir State. Access to sanitation facilities is still a
challenge- almost 50 percent of households have no toilets. Furthermore, the
practice of open defection in Jammu and Kashmir State remains a major
challenge.
In India, only 50 per cent of households had access to sanitation facilities. In

Jammu and Kashmir State 50 per cent of households were without toilets, and
thus there was a greater possibility of open defection in the state. The proportion
of households with toilet facilities was significantly higher in urban areas (85.5
percent) than rural areas. It should be noted that in rural India as many as 61.5
per cent of households were without toilets. Thus, it is not surprising that in the
rural areas the population has many health problems.
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2.0 About AIIMS
The All India Institutes of Medical Sciences (AIIMS) is a group of autonomous

government public medical universities of higher education under
the jurisdiction of Ministry of Health and Family Welfare , Government of India.
The first AIIMS was established in 1956 under the All India Institute of Medical
Sciences Act, 1956.Originally proposed by the then Prime Minister of
India Jawaharlal Nehru for establishment in Calcutta, it was established in New
Delhi following the refusal of Chief Minister of West Bengal Bidhan Chandra Roy.
[
These institutes have been declared by an Act of Parliament as Institutes of
National Importance. AIIMS New Delhi, the forerunner institute, was established
in 1956. Since then, 24 more institutes were announced. As of January 2022,
nineteen institutes are operating and five more are expected to become operational
until 2025.
All India Institute of Medical Sciences, Vijaypur is a public institute of national

importance. public medical school the medical school and hospital based in
Vijaypur, Samba district, Jammu and Kashmir India, and one of the All India
Institutes of Medical Sciences. The cabinet of Government of India approved the
proposal for establishment of AIIMS Jammu under Pradhan Mantri Swasthya
Suraksha Yojana (PMSSY) in January 2019. The foundation stone for AIIMS
Jammu project was laid by Shri Narendra Modi, Hon’ble Prime Minister on
03.02.2019.
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3.0 CENTRE OF EXCELLENCE
A Centre of Excellence is an area of health care specialization in a medical

centre that is recognized by the medical community as providing the most expert
and highest level of care. A clinical service is designated as a Centre of
Excellence when it meets these criteria:
• A comprehensive clinical continuum of care

• Quality differentiation of services and technology
• Commitment to education and research
• Clinical and administrative leadership
• Community impact and market prominence
A Centre of Excellence means more focused care in a critical medical field. It

means access to a full range of treatment options and quality care. The doctors
who treat are so qualified in their specialty that they are entrusted with training
future doctors in the field. And it means that every patient can be assured that
we are focused on improving treatment protocols, programs and outcomes for
every patient.
It is a program within a healthcare institution which is assembled to supply an

exceptionally high concentration of expertise and related resources cantered on a
particular area of medicine, delivering associated care in a comprehensive,
interdisciplinary fashion to afford the best patient out-comes possible.
Specialized programs within healthcare institutions which supply exceptionally

high concentrations of expertise and related resources Centred on particular
medical areas and delivered in a comprehensive, interdisciplinary fashion—afford
many advantages for healthcare providers and the populations they serve.
1. Organization Design- In a centre of excellence, work responsibilities and

resources associated with addressing a particular medical condition are
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centralized into a functional organizational subunit with responsibilities for
delivering the full continuum of care, often within a single medical building.
2. Service space Design- Upgraded materials, design, and workmanship

characterize the services capes of properly assembled centres of excellence,
carrying the excellence theme across all features of the environment. While
these sorts of upgrades are common in most any quality healthcare
establishment, centres of excellence take a critical additional step, customizing
entire services capes to serve patients experiencing the particular medical
conditions addressed by the given centres.
3. Personnel- The most notable features of centres of excellence pertains to the

depth and breadth of qualifications possessed by their personnel. Indeed,
extensive reservoirs of skill and experience reside within centres of excellence
and, in keeping with the specialization characterizing this delivery model, the
skills possessed by staff members specifically pertain to the medical conditions
addressed by the given centres. These experts are assembled via carefully
planned organizational structures into collaborative, interdisciplinary teams
and directed in a manner to deliver exceptional care, something facilitated by
open communication, including formal opportunities to share experiences
4. Medical Care- Possessing a deep understanding of its patient populations,

Well-equipped services capes and expert workforces converge via effective
organization designs to permit a level of medical care that is difficult to match
outside of the centre of excellence delivery model. These various elements are
carefully woven together to form synergies which yield an integrated,
comprehensive continuum of care designed to support patients from their
initial presentation through to completion of service delivery.
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Seven Pillars of Excellence in healthcare
 Safety pertains to overall care quality, patient outcomes, and team

commitment to quality improvement.
 Satisfaction relates to patient’s perception of excellent care, department

reputation, and efforts to advance stature.
 Solvency addresses current opportunities for fiscal improvement through

optimal coding, test utilization and lean processes.
 Space represents the functionality of the facility and equipment from both the
clinical team and patient perspective.
 Staff incorporates physicians and nurse credentials, team staffing levels and
retention, and professional satisfaction.
 Support involves relationships with administration and medical staff, adequacy

of on-call coverage, and involvement in emergency department-wide
committees.
 Systems refer to work flow processes, care pathways, and technological

advances, especially in computerization .
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4.0 SWOT ANALYSIS (Strength, Weakness, Opportunity,
and Threats Analysis)
Strength
 Brand Name “AIIMS”
 Supported by the Government
 High volume of patients neighbouring states
 Highly qualified and skilled staff
 Vast Infrastructure
 Training, Development, and research
 Good leadership and management
Impact
 Large Patient base
 Various partnerships and collaborations
 Accessibility
 Quality specialized care
 Innovations, policy formulation and quality healthcare
Weakness
 Inadequate asset management
 Unconducive work environment
 Shortage of some specialized skills
Impact
 Inefficiency
 Haphazard acquisition
 Poor clinical outcomes
 Lack of improvements in quality of care
Opportunity
 Best in Providing Clinical Services
 Potential for expansion of services
 Potential for research & high skilled Personnel’s
 Existence of professional networks
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 Support by development partners
 Demand for specialized training
Impact
 Establishment of centres of excellence
 Improved service delivery
 Influence health policies
 Capacity building
 Exchange of skills and knowledge
Threats
 Changes in government policies
 High poverty levels
 Increase in accidents and disasters
 Emerging and re-emerging diseases
 Weak referral system
Impact
 Reduced funding
 Resource diversion
 High Mortality and Morbidity rate
 Increased intervention costs
 High demand on resources
 Negative public image
 Poor quality of service
 Additional Capacity building costs
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5.0 PESTLE (Political, Economic, Social, Technological, Legal &
Environmental) Analysis
Political Factors
FACTORS STRATEGIC IMPACT
Power politics  Resource misapplication
 Lack of innovativeness
 Promotion of negative culture
 Multiple reporting lines
 High turnover of Directors
 Fragmentation of services
 Compromised leadership
Political unrest (Riots and  Strain on resources
violence)  Uncertainty of donor funding
 Delays in project implementation
Political interference  Interference with hospital mandate
 Compromised leadership
Political goodwill  Creates conducive legal framework
 Improved funding both local and
international
Terrorism  Insecurity  Strain on resources
Environmental Factors
Poor waste management  Increase demand for health services
 Increased cost of waste management
Global warming  Increase in disease burden
 Changing pattern of disease
Water shortage  Poor service delivery
 Increase in hospital acquired infections
 Increase in communicable disease
Air and water pollution  Increase in disease burden
 Increase in hospital acquired infections
 Increase in communicable disease
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Social Factors
Unhealthy lifestyle  Increase in lifestyle diseases
 Need for more investments
Attitudes, culture, and beliefs  Non-compliance to treatment
 Poor health outcomes
High illiteracy levels  Poor health outcomes
 High cost of treatment
Increase in substance abuse Increase in mental health disorders
 Poor clinical outcomes
Use of alternative medicine  Delayed interventions
 High cost of managing complications
Increased life expectancy Increase in old-age related diseases
Technology Factors
Technological changes  Improved service delivery
 Frequent replacement of equipment
 Budgetary constraints
 Need for skilled personnel
New energy sources  Cost reduction
 Reduced demand for health services
Legal Factors
Change in Labor laws  Improved employee satisfaction
 Increased healthcare costs
 Need for increased budget allocations
 Increased industrial action
 Increased workman compensation
Inadequate legal framework for  Constraints in decision making and policy
Centre of Excellence implementation
 Impediment to resource mobilization
Statutory and Regulatory  Improved work environment
framework  Increased litigation
 Increased environmental management costs
 Increased budgetary allocations
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Economic Factors
High interest rates and  Delayed and high costs of equipment
inflation replacement
 High operational costs
 Low purchasing power
 Disruption of procurement plans
Inadequate National Health Poor health service delivery
budget allocation  Low investment in capital acquisition
High poverty levels Increase in disease burden
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6.0 Risk & Mitigation
Risk Category Phase of Risk Risk Mitigation Plan

Predominan Identification /
ce Description
Delays in Project During the Arranging finance during the
Project Development development project
Development phase, the
critical activities development phase to
that may be ensure timely availability of
identified are: funds to meet development
- Finalization of Employing consultants with

project correct management skills
structure
(Both “hard” and “soft”).
- Availability of
Employing lawyers with the
requisite
requisite expertise soon
approvals &
after the project is
clearances
conceptualized.
- Achievement of
Sensitizing government to
Financial Close
the number, type, and
- Delay in Project timing of government
commissioning approvals much in advance
of the requirement for the
approvals.
Incorporating the concerns

of lenders and potential
equity investors in project
structure and legal
documentation prior to
approaching the market for
funds.
Project Construction The project This risk should be

Completion Period completion risk mitigated through a
Risk or the Provision under Concession
contractor’s risk Contract
refers to the
possibility of (CC). CC with EPC
non-Completion Contractor to design
of the project &construction contract with
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within the payments made on
designated reaching certain
period from the milestones.
Notice to
Proceed. Any Contractor to pay
delays in the Liquidated Damages for
construction delays during construction.
may be expected
to result in Independent Engineer
increased should review and monitor
construction progress.
costs.
Project Cost Construction If the EPC The detailed Project Report

Risk/Cost Period Contract is a should be made specifying in
Overruns unit rate detail, the cost estimates for
contract rather various sub- components of
than a fixed the project on the basis of
price contract, which the EPC bids should
there is a be invited.
possibility of an
increase in the Additionally, adequate
project cost as contingency provision and
compared to the insurance cost for
current unforeseen circumstances
estimates. should be built into the
project.
c. Strict construction
monitoring by the
Independent Engineer.
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Technology Construction This pertains to The project to be designed
Risk /Operations the risk that the after a comprehensive
Period project may be analysis of the local
either physically conditions
inappropriate to
handle the The construction supervision
projected should be carried out with
demand strict penalties for non-
or compliance of the technical
is appropriately design by the Contractor.
designed to meet
local socio- The cost of rectifying such
economic needs non- compliance would also
(i.e., increased be borne by the Contractor.
requirements)
and hence The Contractor should
rectification of provide a performance bond
these design with a validity of eighteen
defaults could months (defects liability
escalate the period) after project
O&M costs commissioning to take care
during the of any construction lacunae
operations that may be detected
period. during the initial phase of
project operations.
Regulatory & Operations During the Debt Service Reserve:

Administrative Period operations Maintenance of cash
Risk phase, the reserves aggregating to one
delays and year’s debt service reserve
costs associated requirement for the next
with complying year to ensure that any
with the temporary shortfall of
regulatory revenues due to non-
requirements of increase of tariffs does not
the government, adversely impact debt
lenders and servicing in the short run.
multilateral
institutions can Extension of Concession
adversely Period: In the event of
impact the chronic delays in tariff
financial review adversely affecting
viability of the the achievement of the
21
project. In designated return on the
particular, project, the Concession
delays in toll Agreement should provide
notification will for extension of the
adversely affect concession period till the
cash flows, designated return is
weakening the achieved.
project debt
service capability
(especially in the
critical initial
years) and
investor
returns.
Commercial Operations This category The demand estimates

Risk Period comprises of should be conservative
various risks since, actualization of
that are demand in line with estimates
associated with is a key economic risk that
the underlying the project participants
economic would bear.
rationale for the
project. E.g., The Concession Agreement
project viability should also provide for an
is critically extension in periods of two
dependent upon years each, till
realization of designated returns
demand as are achieved.
projected and
hence any
significant
adverse
variation from
the estimates
would
impair the debt
servicing
capability of the
project.
22
Operations & Operations In the event of The selection of O&M
Maintenance Period O&M costs operator will be on the basis
Risk exceeding the of competitive bidding. The
estimates used selection criteria should
for the consider of its past record,
establishment of fiduciary responsibility
financial exhibited in other
viability, the assignments, financial
residual cash strength etc.
flows for
debt/equity The O&M contract should
servicing would provide for a fixed & a
be lower than variable fee which could be
anticipated based upon the O&M
thereby requirements set forth in the
affecting project Concession Agreement.
returns
O&M Contract is a fixed
price contract, with the risk
of cost overruns to be
borne by the O&M
Contractor.
8. FINANCIAL
RISKS
a. Interest Rate Operations Determination The project should be

Risk Period of project financed on an optimal mix
viability is of fixed rate and floating rate
predicated on instruments, to hedge the
the existing interest rate movement risk.
interest rate
scenario
prevailing in the
country. A
drastic increase
in the interest
rate scenario
may affect the
debt servicing
23
capability
through project
cash flows and
significantly
depress
shareholder
returns, even
though the
project may still
achieve the
designated
return
b. Foreign Operations In the absence Tariff adjustments

Exchange Period of any natural permitted under the
Exposure hedge of export concession agreement.
Rate revenues, the
project cash Forex debt should be kept to
flows would be the minimum and to be
exposed to the swapped for Rupee debt to
currency the extent possible
devaluation risk
c. Inflation Risk Operations The tariff rates Tariffs to be adjusted for

Period being inflation inflation during operations
indexed, the as per formulae given in the
project revenues concession agreement.
&consequently
the achievement
of the
designated rate
of return would
be adversely
affected in case
the inflation rate
is lower than
what has been,
assumed in the
financial model
9. Termination Operations The risk Compensation package

Risk Period pertains to the should be structured in
24
possibility of case of Termination of the
unilateral Concession
termination of
the concession Agreement with in-built
agreement prior disincentives for any
to the contracting party to seek
achievement of termination on frivolous
the designated grounds
rate of return on
frivolous
grounds
10. Force Throughout This risk Comprehensive Insurance

Majeure Project Cycle category deals Coverage
Terminatio with non-
n Risk political events In Force Majeure risks of
of force majeure types which are not
considered as insurable, the investors
‘Acts of God’ should get a yield of certain
such as percentage on equity on the
epidemics, date of termination
natural
disasters,
earthquakes,
floods during
construction
phase affecting
construction and
such other
events. The
impact of these
risks on
construction
and/or the
project
operations could
range from
minor to severe,
say in case of an
earthquake,
where the
damage maybe
severe enough
25
to render the
facilities
irreparable
11. POLITICAL & SOCIAL RISKS
A. Events & War Throughout In the event of The probability of such a risk
Project Cycle war or is verylow. Though the
widespread civil insurance companies do not
disobedience, have a package available for
the project’s the operating company, risk
commercial coverage is available to
viability may international lenders from
be adversely various financial
Affected institutions.
The Concession Agreement
could also provide for a
relief to each affected party
from its respective
obligations including
payment of Liquidated
Damages.
B. Throughout The political The Concession Agreement

Nationalization Project Cycle risk pertains to should provide for
or Revocation relegation of Termination in case of
contract terms certain politically motivated
and/or events affecting the project.
nationalization In such a scenario, the
of infrastructure compensation payable by the
services being government for transfer of
provided. project assets should at least
be equal to the outstanding
dues to the project lenders,
therebyfully protecting the
lenders.
C. Social Risk Throughout This is the risk Appropriate insurance

Project Cycle that civil/ political package for the project
problems may should be designed that
surface as a result provides adequate cover
of the project, against such risks.
26
manifesting in
boycotts, sabotage
etc. Such distur-
bances may arise
from a number of
Different concerns,
public objection to
imposition of
tariffs, public
discontent with
the environmental
impact of civil
works or with
other features of
the project. An
event similar to
any of the above
could impair the
ability of the
Concessionaire to
collect revenue,
thereby affecting
the project
viability.
12.Lack of Throughout Lack of business Based on the source of

Business Project Cycle is a funding, risk mitigation plan
multifactorial will be formulated.
risk.
6.1 Project Level Risk
Control-
Risks Control-1 Control -2 Control- 3 Control -5
4
Legislative Risks
27
Failure of Provide checklists of Obtain a copy Project
compliance to all laws, rules, of all licenses &Monitoring Cell
law of land regulations & certificates as to ensure
statutory required & update &
requirements to keep records of revision of
establish &operate a the same at QA licenses &
healthcare facility Cell certificates
within from time to
time
Inability of Conduct proper Project Project
contractor/ assessment on the Monitoring Cell Monitoring Cell
partner to shortlisted to lay down to ensure
meet partners' complete follow up on
contractual performance & guidelines on performance &
agreement functioning within how to meet all functioning in
the norms of contractual given
legislation as agreements context and
applicable on remaining suggest
healthcare within ambit of corrective
organizations legislative norms actions as
deemed fit
Planning Risks
Services Conduct feasibility Study disease Project Policy Project
planned are study onto trends at Monitoring Cell Guidelin Moni-
not correct developing the existing public to study case es on toring
service distribution health facilities & volume mix change Cell to
matrix for said facility to decide to suggest in take note
priorities of resource service On
sponsors Allocation matrix Changing
logically changes to to be Load
ensure framed patterns
improved by &
utilization rates mutual Priorities
consent Of
Stakehold
ers to
make
Amendme
nts to
Service
Matrix
Failure of the Functional Plan Functional plan

functional Guidelines to be for all units/
plan drafted with mutual departments
consent should be
prepared before
commissioning
& approved by
sponsors
28
required
Resources Resource Allocation Resource Project

planned are Guidelines to be allocation plan Monitoring Cell
not adequate drafted by mutual for all units/ to ensure
consent departments timely audits
should be on Resource
prepared before Allocation Plans
commissioning & to suggest
approved by improvement/c
sponsors h anges if
required
Demand Risks
Usage of Forecast Strategy for Marketing Project
services assumptions to be load generation strategy Monitorig
varies from formulated based on by for achieving Cell to
the forecast actual/ near actual establishing the defined study
market demand & referral systems targets be service
consumption in public framed by the consum-
patterns healthcare partner & ption
facilities be notified to patterns
framed by Project vis-à- vis
mutual consent Monitoring Cell load
gene-
ration &
market
strategies
and
suggest
changes
in mix &
Approach
if required
New demands Partner to keep note Project Policy

evolve with on changing market Monitoring Cell Guidelines on
time trends, disease to keep note on Expansion of
loads and changing Services to
healthcare needs & market trends, meet Changed
notify same to disease loads demands be
Project Monitoring and healthcare formulated
Cell from time to needs through with mutual
time inputs from consent
partner & also
from its own
independent
sources &
incorporate
same in the
annual report
29
Design Risks
Design Risk assessment Functional Project Re-
adopted do of impact of design performance Monitoring Cell design/
not work on functional indicators to ensure all re-
satisfactorily performance be should technical structuring
conducted & risk accommodate inputs from be decided
scores be specified the inherent concerned by mutual
as actual risk on this specialists for consent
context minimizing
risks by re-
structuring/
re- design
within
permissible &
practical limits
Designs (in Design Guide International Project

future) do Principles be framed Architectural Monitoring Cell
not work by mutual consent or Guidelines be to ensure all
satisfactorily National Guidelines considered in technical
(if any evolves) be designing all inputs from
adopted future concerned
expansions on specialists for
the facility all such future
expansions
Operating Risks
Required Performance Indicators for Resource Project Project
standards for Monitoring Policy Performance Allocation & Monitorin Monitori
performance be framed Monitoring be Functional g Cell to n g Cell
& availability defined & Plans to be ensure to ensure
not met enlisted (in scale based on availability all
up fashion) performance & usage of technical
standards all tools inputs
agreed upon required from
for concerne
implement d
ing specialist
performan s for
ce audit & capacity
improvem building
ent plan of
partner
on
improvin
g
performa
n ce.
30
Transaction Risks
Partner Variables on Variables Project Project Agree-
selected is choosing partner be chosen are Monitoring Cell Monitorin ment to
not right specified and all allocated to ensure all g Cell be Signed
choice applicants be weightage and technical should With
compared on the scores in inputs from maintain Partner
same defined range be concerned detail Should
decided on specialists for option Have
chosen scale? enabling analysis Specific
Weightage chosen partner on all clause on
Scores should fit the required shortlisted discontin
be the deciding bill of activities applicants u ation of
criteria on short & performance , their the same
listing the willingnes stating
applicants s, the
capability liabilities
& interest on the
in the said issue of
project accounta
bi lity
Transaction is Transaction plan bDetail PERT Day wise Project

delayed framed e on the whole checklist of Monitorin
transaction activities be g Cell to
process be framed & used ensure
framed by for monitoring availabilit
Transaction purpose & be y of the
advisors with approved by resources
mutual Project for
consent after Monitoring Cell smooth &
final selection timely
transactio
n
Likelihood of Incidence Recurrence Score
Level Descriptor Description
Not expected to occur, except for exceptional

1 Rare
circumstances, given existing controls.
2 Unlikely Not expected to occur given existing controls.
3 Possible Could occur, given existing controls.
4 Likely Will occur, given existing controls.
31
5 Certain Will occur frequently, given existing controls.
6.2 Possible Future Consequences Score
Level Injury/ Harm Service Delivery Financial Reputation
1. Short-term No service <10k No publicity

Insignificant injury <1 disruption
month. 3 days to
1month absence
for staff.
32
2.Minor Semi- Service Disruption. 10k - 50K <3 days local Media
permanent harm publicity
(1 month-1 year)
>1month absence
for staff.
3.Moderate Semi- Failure services of 50k – 5Lac >3 days local Media
permanent harm Support publicity
(1month –1 year).
4.Major Single death Intermittent 5-10 Lac Adverse National

/multiple serious failures of a Publicity/
injuries /major critical client or reputation
permanent support service. reparably
harm/retire- Including fire, theft damaged/ middle
ment on health or Damage to managers
grounds. property. resign or removal
5. Multiple deaths Complete Losses; International

Catastrophic / substantial breakdown of claims adverse publicity
number Service delivery. /damages; /reputation
injuredor Including fire, overspendi irreparably
affected (E.g., theft, or damage ng; damaged / top
screening to property. commissi managers resign
error) onin g or Removal
shortfall:>
10 Lac
33
34
7.0 Proposal Statement
The Establishment of centre of Excellence in Trauma Sciences and Institute of

Traumatology being proposed in the AIIMS Jammu Campus. This Proposal has
been prepared in keeping the considerations of planning of centre of excellence
and its need in the region. The Proposed Centre of Excellence of Trauma sciences
have been prepared in accordance with the needs of the community.
This Proposal presents the outlined view for Establishment of centre of Excellence
in Trauma Sciences and institute of Traumatology. It gives a brief idea about the
need of the hospital, Services to be provided by the hospital, resource requirement
including manpower, hardware & software, Equipment requirement,
Infrastructure requirement with space plan for the various service gone to be
being provided by the hospital and other cost implications including capital and
operational costs of the Centre.
This will make a platform for the commencement of project with a proper
understanding and strategic approach which shall lead to the foundation of
health care specialization providing the most expert and highest level of care. A
Centre of Excellence shall consist of comprehensive clinical continuum of care,
Commitment to education and research Clinical and administrative leadership,
Community impact and market prominence leading to an excellence in the field
of healthcare.
35
36
8 .0 Statement of Need
The Proposed Centre of Excellence of Trauma sciences will provide a platform to

the health workers and the community leading to a world class centre of
treatment. Emergencies and accidents are common place in all parts of India.
Every day, India faces the dual challenges posed by emergencies related to
infections and communicable diseases and those related to chronic diseases and
trauma.
The majority of "emergency care" is typically given in rooms known as Casualty or

Accident rooms in hospitals in India. For those working in emergency care, formal
education and specialised training are neither required nor available.
In India, there are hardly any specialised trauma centres or professional trauma
surgeons. Clinical decisions are frequently delayed as a result of the lack of clearly
defined duties among specialists. Patients with multi-system injuries are more at
danger. The majority of "emergency care" is typically given in rooms known as
Casualty or Accident rooms in hospitals in India. For those working in emergency
care, formal education and specialised training are neither required nor available.
The doctors work in the Causality/Accident rooms and don't have any specialised
training in emergency care. The process to designate emergency medicine as a
separate medical specialty has just lately been started.
Pre-hospital care is being provided by the state government regulated ambulances

in many states by Emergency Management and Research Institute with a common
toll-free number 108.
The provision of emergency services is enshrined in India’s Constitution. As per

the Article 21 of India’s Constitution “right to life”, if any hospital fails to provide
timely medical treatment to a person result’s in the violation of person’s “right to
life”. India always had a disproportionately small health budget because of its
37
ambitious growth aspiration and fastest growing population, with one doctor for
every 1,700 people and 21% of the world’s burden of disease. In India almost 23%
of all trauma is transportation-related, with 13,74 accidents and 400 deaths every
day on roads. The rest of the 77.2% of trauma is related to other events such as
falls, drowning, agriculture related, burns, etc. According to World Health
Organization, India has the highest snakebite mortality in the world estimates it at
30,000 every year.
Definitive care for victims with emergencies is offered by government hospitals,

corporate hospitals and a large number of small clinics. Government hospitals
generally offer free care, but the quality of that care differs between centres. Most
university hospitals provide a reasonable level of emergency care. District
hospitals often lack trained staff, adequate infrastructure, and supply of
consumables.
There are no dedicated trauma surgeons and very few designated trauma centres
in India. Orthopedic surgeons lead the trauma response in 50% of facilities. In the
remainder; the responsibility is not clearly defined. In the absence of defined roles
amongst specialists, clinical decisions are often delayed. Multi-system injury
patients are at the greatest risk. Typically, most of the “emergency care” in the
hospitals in India is provided in areas known as Casualty or Accident rooms.
Formal education and specialty training in emergency care are neither available
nor mandatory for personnel involved in emergency care. These Causality/
Accident room physicians lack any specific training in emergency medicine.
Proceedings have only recently been initiated to recognize Emergency medicine as
a distinct medical discipline.
Residents posted in these ‘rooms’ often rotate from various specialties such as
surgery, orthopaedics, and medicine and have little commitment towards patient
management. These physicians are often waiting to retake the All India Entrance
38
Examination in the hope of securing postgraduate position in established fields
recognized by the MCI.
In some hospitals, emergency rooms (ERs) are traditionally divided into separately
run medical and surgical teams. With this division it becomes very difficult to
deliver quality, cost-effective care. In many hospitals, physicians staffing the
emergency rooms lack the resources and knowledge to manage the wide variety of
emergencies. They therefore function as ‘postal carriers’ who ‘deliver ‘victims to
the respective specialties. The most junior and inexperienced staff frequently treat
the most seriously injured patients.
Percentage contribution of disease categories to total deaths 2016
Year 2016
Populations ( Thousands) 1324200
GHE 2012 CAUSE CATEGORY Total (%)
All Causes 100
Communicable , Maternal, perinatal and
1 27.5
nutritional conditions
2 Non – Communicable diseases 61.8
1. Cardiovascular diseases 28.1
2. Respiratory diseases 10.9
3. Malignant Neoplasms 8.3
4. Diabetes Mellitus 6.5
3 Injuries 10.7
Data are % ( 95% uncertainity interval).
Total Number of Road Accidents in Jammu & Kashmir

2016 5,501
2017 5,624
2018 5,978
39
2019 5,796
2020 4,860
Emergency due to Terrorism
Incident Terrorists/
Civilian Security Not
Year s of Insurgents/ Total
s Forces Specified
Killing Extremists
2014 91 28 47 114 0 189
2015 86 19 41 115 0 175
2016 112 14 88 165 0 267
2017 163 54 83 220 0 357
2018 206 86 95 271 0 452
2019 135 42 78 163 0 283
2020 140 33 56 232 0 321
2021 153 36 45 193 0 274
2022 119 24 28 152 0 204
Total
1205 336 516 1625 0 2522
**
40
According to Govt of India Guidelines for Trauma Center Level 1, Level 2,
Level 3 have been kept in considerations while making the proposal.
Moreover, to fit in the stature of AIIMS, this proposal has been made in
accordance with govt. guidelines with certain Modifications. The
Guidelines on trauma Centre are as:
The trauma care network has been so envisaged that no trauma victim has to be
transported for more than 50 kilometers and a designated trauma care facility is
available at every 100 Km. A Trauma Care Facility often referred to as ͚Trauma
Centre is a healthcare institution that has the resources and capabilities
necessary to provide trauma services at a particular level to injured patients.
Trauma center designation criteria set strict requirements for staffing, specialist
availability, response times, training, quality improvement and community
education. This facility verification and designation is an important foundation for
the success of an inclusive trauma system. Under this scheme, Trauma Care
Facilities have been categorized into four levels:
Level III Trauma Care Facility
Provides initial evaluation and stabilization (surgically if appropriate) to the

trauma patient. Comprehensive medical and surgical inpatient services would be
made available to those patients who can be maintained in a stable or improving
condition without specialized care. Emergency doctors and nurses are available
round the clock. Physicians, surgeons, Orthopaedic surgeon and Anaesthetist
would be available round the clock to assess, resuscitate, stabilize and initiate
transfer as necessary to a higher-level Trauma Care Service. Such hospitals will
have limited intensive care facility, diagnostic capability, blood bank and other
supportive services. The district/ tehsil hospitals with a bed capacity of 100 to
200 beds would be selected for level III care.
41
Level II Trauma Care Facility
Provides definitive care for severe trauma patients. Emergency physicians,

surgeons, Orthopaedicians and Anaesthetists are in-house and available to the
trauma patients immediately on arrival. It would also have on-call facility for
neurosurgeons, paediatricians. If neurosurgeons are not available, general
surgeons trained in neuro surgery for a period of 6 months in eminent institutions
would be made available 24*7. The centre should be equipped with emergency
department, intensive care unit, blood bank, rehabilitation services, broad range
of comprehensive diagnostic capabilities, and supportive services. The existing
medical college hospitals or hospitals with bed strength of 300 to 500 should be
identified as Level II Trauma Centre.
Level I Trauma Care
Facility will provide the highest level of definitive and comprehensive care for
patient with complex injuries. Emergency physicians, nurses and surgeons would
be in-house and available to the trauma patient immediately on their arrival. The
services of all major super specialties associated with trauma care would be
available 24*7. Due to high levels of skill, specialists and infrastructure required,
Level I Trauma Centres should be only in medical college hospitals.
42
43
9.0 Scope
Trauma Centre offers its services to patients whose medical needs can be met within
the capability of the Hospital’s staff and facilities. scope of services includes inpatient
and outpatient diagnosis and treatment as well as provide emergency service. All
departments collaborate to provide the best care possible for our patients, to improve
outcomes, and achieve our mission, vision and goals.
Each individual area of the hospital will have a defined scope of services which
includes the types and ages of patients served, the hours of operation, staffing, the
types of services provided, and the goals or plans to improve quality of service.
Patients can expect appropriate procedures, treatments, interventions and care will be
provided according to established policies, procedures, protocols and order sets that
have been developed to ensure patient safety and positive outcomes. Appropriateness
of procedures, treatments, interventions, and care will be based upon patient
assessments, re-assessments, and desired outcomes.
Trauma center is fully licensed and accredited as an emergency acute care hospital
and is licensed for 400 beds. The hospital offers primary, specialty as well as provide
emergency services. These professional services are offered in a caring and
compassionate manner.
44
 General Surgery
 Burn Ward
 Neuro Surgery
 Orthopedics
 Reconstructive Surgery
 Dialysis
 Transplant Program
 Eye and ENT
 Obs and Gyn
 Pediatrics
 General Medicine
 Intensive Care Unit
 Disaster management area and disaster wards
Other Services
 Blood Bank
 Radiology
 Laboratory
 Telemedicine/ command center/help line
Clinical services
1. Anaesthesia & Critical Care
2. Emergency Medicine
3. Department of Forensic Medicine
4. Hospital administration
5. Laboratory and transfusion Medicine
6. Neurosurgery
45
7. Orthopaedics
8. Radiology
9. Trauma Surgery and Critical Care
10. Information Technology
11. Plastic, Reconstructive and Burn Surgery
12. Physiotherapy and Rehabilitation
13. Transfusion medicine
14. Microbiology
15. Lab medicine
17. Nursing
18. Medical Record Section
19. Trauma Skill lab
DEPARTMENTS
 Trauma Surgery and Critical Care
 Emergency Medicine
 Department of Forensic Medicine
 Hospital administration
 Neurosurgery
 Orthopaedics
 Radiology
46
 Anaesthesia & Critical Care
 Burn, Plastic and Reconstructive Surgery
 Physiotherapy and Rehabilitation
 Transfusion medicine & Blood Bank
 Microbiology
 Lab medicine (Pathology, Biochemistry)
 Medical Record Section
 Information Technology
 Nursing
 Organ Facility Center
 Skill Center
47
BEDS STATUS
Total - 400 Beds
Total ED Beds – 100
• Red - 20
• Yellow - 40
• Green -40
Ward Beds – 150
 Trauma Sx - 50
 Neuro Sx- 40
 Ortho- 40
 Plastic Sx – 10
 Pediatrics - 10
ICU - 80
 Trauma Sx – 30
 Neuro Sx – 30
 Ortho - 10
 Plastic Sx - 10
HDU - 40
 Trauma Sx 15
 Neuro Sx - 15
 Ortho -5
 Burn Unit -5
 Disaster/ Observation - 30
48
49
10.0 Objectives
 To act as a knowledge Centre on diverse aspects related to Healthcare.
 Ensure definitive treatment for the injured within the Golden Hour.
 Appropriate skill training to various Human Resources viz. Doctors, Nurses,

Paramedics.
 Be committed to providing the highest level of care to every patient, every time.
 To conduct research that translates into improved treatment options and

patient outcomes & facilitates integration of innovation & research in the
healthcare.
 Demonstrate quality differentiation of their services, equipment and

technologies & enact a culture of continuous improvement.
 Have a strong reputation in the medical community and the area it serves.
 To provide concentrated expertise and resources to develop best practices, and

the most effective treatments available.
 To provide access to world-class doctors, nurses and other professionals

across many specialties —working together to bring you the highest-quality,
most comprehensive and specialized care possible. Each member of center of
excellence team specially trained and certified on your specific condition and
will be entrusted to train our next generation of doctors.
 COE offers a full range of services tailored to meet patients’ needs, from
wellness services and screenings to the most advanced care for the most
severe cases.
50
51
52
11.0 Detailed Justification of the Proposal
This Proposal presents the rationale and justification for Establishment of centre
of Excellence in Trauma Sciences and institute of Traumatology. It gives a brief
idea about the need of the hospital, Services to be provided by the hospital,
resource requirement including manpower, hardware & software, Equipment
requirement, Infrastructure requirement with space plan for the various service
gone to be being provided by the hospital and other cost implications including
capital and operational costs of the Centre.
The Proposal is about the establishment of Centre of Excellence in the Jammu.

This Proposal will make a platform for the commencement of project with a
proper understanding and strategic approach which shall lead to the foundation
of health care specialization providing the most expert and highest level of care.
A Centre of Excellence shall consist of comprehensive clinical continuum of
care, Commitment to education and research Clinical and administrative
leadership, Community impact and market prominence leading to an excellence
in the field of healthcare.
Centre of Excellence will be more focused care in a critical medical field. Will
lead to access to a full range of treatment options and quality care. Qualified
doctors in their specialty will be entrusted in training of future doctors in the
field, assuring the improving treatment protocols, programs and outcomes for
every patient.
The Proposal provides all relevant detail to enable to make necessary decisions
regarding the project. The Proposal contains the information regarding the
stipulated time required for the completion of the project with cost implications for
capital as well as operationalising the centre of excellence.
The Trauma Centre will help to access to an international, expert faculty and
53
innovative, technology-enhanced learning. We can take part in interactive
discussion forums and one-to-one tutor sessions. Medical Workforce will have a
practical knowledge and experience of decision-making so you can deliver safe,
professional core clinical functions in the management of seriously injured
patients.
It offers a module for the knowledge on patients with burns injuries. It will allow
to develop a more critical and evaluative approach to the care of burns patients,
through a complete overview of assessment, stabilization and management in
respect to the most recent literature.
This facility will provide a background into both military and civilian austere
events. It will cover triage, pre-hospital care, mass casualty management and
surge capacity, chemical and biological trauma. The latest techniques will be
proposed and critically evaluated.
It is supported by all medical and surgical subspecialty services. It is equipped

with the latest state-of-the-art technology and equipment, including 'intelligent
ventilators", neuro-monitoring devices, ultrasound, and point-of-care testing and
video airway devices.
Centre of Excellence, linked to the Education department, with presence of

fellows, and residents. Residents (from general surgery, general medicine, Eye,
ENT, Pediatric, Obs. & Gyn, orthopedics, Transplant Program, Reconstructive
surgery and neurosurgery, Burn unit) are actively part of the clinical team.
The patients gone to be admitted will be mainly polytrauma patients with varying
degrees and combinations of head, chest, abdominal, pelvic, spine, and orthopedic
injuries, or isolated-TBI.
The main processes that are involved in the trauma in as part of this network are:
patient flow, clinical practice guidelines, evaluation and procurement of
54
technologies, and in general, taking part in any process that pertains to critical
care.
A multidisciplinary team of physicians, nurses, and allied health professionals
participate in these projects, and meet for review of project. It is well staffed with
highly trained and qualified personnel, and utilizes the latest in technology and
state-of-the-art equipment. It performs very well, when compared to other similar
units in the world, and achieves a comparable, or even lower mortality rate. With
continued great support from the hospital, corporation administration, and
Ministry of Public Health, the future goals of the project will be to maintain and
improve upon the high standards of clinical care it provides, as well as perform a
high quality and quantity of research, quality improvement initiatives, and
educational work, in order for it to be amongst the best trauma critical care units
in the world.
55
56
57
12.0 Timeline for the Project Completion
Timeline for the completion of the project
Design Phase 3 Months

Tendering & Award Phase 3 Months
Construction Phase 24 Months
Equipmentation 4 Months
Manpower Recruitment
3 Months
Commissioning Phase
Total Months 37 Months
3 3
4 3
Timeline for the completion of

the project
Design Phase
Tendering & Award Phase
Construction Phase
Equipmentation
Manpower Recruitment
Commissioning Phase
24
58
59
13.0 Resource Requirements
13.1 Manpower
The Manpower requirements for the operationalising the Centre of Excellence is
briefed below:
TRAUMA CENTRE OF EXCELLENCE (AIIMS, JAMMU)
Department Designation Number Salary/Month Total

/Person Salary
Medical 1 300000 300000
Superintendent
Deputy Medical 1 250000 250000
Superintendent
Orthopedics
Professor 2 300,000 600000
Associate Professor 2 250,000 500000
Assistant Professor 4 190,000 760000
Senior Residents 18 130,000 2340000
Junior Residents 22 100,000 2200000
Post graduate 2 100,000 200000
Nursing Staff 88 70,000 6160000
Technicians 20 50000 1000000
Store Keeper 5 30000 150000
Data operator 6 25000 150000
Office attendant 34 15000 510000
E.N.T
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
Technicians 10 50000 500000
Ophthalmology
Professor 2 300,000 600000
60
Nursing Staff 40 70,000 2800000
Obs. & Gynae
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
Radio-diagnosis
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
Anesthesia
Professor 2 300000 600000
Associate Professor 2 250000 500000
Additional Professor 2 275000 550000
Assistant Professor 8 190000 1520000
Senior Residents 46 130000 5980000
Junior Resident 50 100000 5000000
( Academic)
Trauma Fellows 4 100000 400000
Nursing Staff 250 70000 17500000
Technicians 30 50000 1500000
61
(OT/ICU/ED)
MEDICAL SUPER SPECIALTY

Gastroenterology
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
Neurology
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
Nephrology
Professor 2 300,000 600000
Nursing Staff 40 70,000 2800000
SURGICAL SUPER-SPECIALITY
Cardio-thoracic & Vascular Surgery

Professor 2 300,000 600000
62
Nursing Staff 88 70,000 6160000
Neuro-Surgery
Professor 2 300,000 600000
Nursing Staff 88 70,000 6160000
EMERGENCY
DEPARTMENT
Professor 2 300,000 600000
Nursing Staff 88 70,000 6160000
HOSPITAL STAFF
S.No. Designation Number Salary/Month

/Person
63
Nursing Staff
Nursing 1 150000 150000
Superintendent
Deputy Nursing 2 92000 184000
Superintendent
Pharmacist 16 30000 480000
Other Staff
Front office 25 18000 450000
Billing 20 18000 360000
Accounts 15 18000 270000
Kitchen staff 15 15000 225000
Laundry staff 18 15000 270000
Maintenance staff 15 15000 225000
Drivers 20 15000 300000
TOTAL 151424000
13.2 Hardware & Software Required
1. Hardware
64
• Computers & Peripherals
2. Software
• HIS – Hospital Information System
• PACS - Picture Archiving and Communication System
• Access Control
• RFID - Radio Frequency Identification (RFID) Devices
• iBMS - Integrated Building Management System
65
66
14.0 Equipment Requirement
EQUIPMENT
PLAN
OPERATING
THEATRES
OT TABLE 12 2000000 24000000
Ceiling mounted Lights (shadowless) 12 1000000 12000000
Anaesthesia Work station 12 900000 10800000
Electrocautery 24 600000 14400000
Syringe infusion pump 24 60,000.00 1440000
Suction Machines 12 12,000.00 144000
Monitor 12 400,000.00 4800000
Defibrillator/monitor/recorder 12 300,000.00 3600000
C Arm with IITB 4 1,800,000.00 7200000
Flash Autoclave 2 300,000.00 600000
Portable emergency light 6 100,000.00 600000
Operating microscope 2 8,000,000.00 16000000
Laparoscope 2 2,000,000.00 4000000
Cystoscope 2 1,200,000.00 2400000
Bronchosope Fiberoptic 2 700,000.00 1400000
Cell saver 1 1200000 1200000
Portable usg doppler 1 400000 400000
Blood and fluid warmer 3 60000 180000
Crash Cart 12 50000 600000
C-MAC 2 1200000 2400000
ABG Machine 1 275000 275000
Transport ventilator 5 120000 600000
Patient warming system 3 90000 270000
MRI 1 40000000 40000000
HEART LUNG MACHINE 2 8,000,000.00 16000000
INTENSIVE PICU-20 Beds and MICU -30,SICU-30 Beds
CARE UNITS
(80 beds)
SICU - 30
ICU bed 30 250,000.00 7500000
Bedside Monitors (multiparamater) 30 400,000.00 12000000
Central Station 2 900,000.00 1800000
Syringe Infusion Pump 90 60,000.00 5400000
Defibrillator 2 300,000.00 600000
Ventilator 30 900,000.00 27000000
Nebulizer 10 15,000.00 150000
Crash cart 2 50,000.00 100000
ECG machine 2 200,000.00 400000
67
Portable Suction Machine 6 20,000.00 120000
Patient warming system 3 90000 270000
ABG Machine 1 275000 275000
Surgical ICU-
30
ICU bed 30 250,000.00 7500000
Bedside Monitors (multipramater) 30 400,000.00 12000000
Central Station 2 900,000.00 1800000
Defibrillator 7 300,000.00 2100000
Ventilator 30 900,000.00 27000000
Nebulizer 10 5,000.00 50000
Crash cart 2 50,000.00 100000
ECG machine 2 200,000.00 400000
IABP 2 1,000,000.00 2000000
ABG Machine 1 275000 275000
Ortho Plastic
surgery and
Burn ICU- 20
ICU bed 20 250,000.00 5000000
Central Station 2 900,000.00 1800000
Defibrillator 4 300,000.00 1200000
Ventilator 20 900,000.00 18000000
Nebulizer 4 5,000.00 20000
Crash cart 2 50,000.00 100000
ECG machine 2 200,000.00 400000
Fiberoptic bronchoscope 1 200000 200000
Endoscope 1 120000 120000
HDU - 40
ICU bed 40 250,000.00 10000000
Central Station 2 900,000.00 1800000
Defibrillator 4 300,000.00 1200000
Ventilator 20 900,000.00 18000000
Nebulizer 8 15,000.00 120000
Crash cart 2 50,000.00 100000
ECG machine 2 200,000.00 400000
68
ABG machine 1 90000 90000
INTERVENTIONAL Radiology
DSA Room
Monitor 1 50000 50000
Cardiac Catheterization machine 2 40000000 80000000
ventilator 1 900,000.00 900000
Pressure Injector (with Anglo system) 2 54000 108000
Heamoximeter 2 23000 46000
Defibrillator with crash cart 2 350000 700000
Pulse Oximeter 2 22000 44000
Sequential Pacemaker 2 40000 80000
Digital camera 2 35000 70000
RADIOLOGY
Digital X-ray 1000 MA 1 1,900,000.00 1900000
Digital X-ray 500 MA 1 1,000,000.00 1000000
Portable X-ray 60mA 3 75,000.00 225000
Ultrasound with color doppler 4-D 6 1,050,000.00 6300000
OPG 1 1,600,000.00 1600000
Xray Viewer (8 film panel) 10 9,000.00 90000
CT scan( 128 SLICE ) 2 20,000,000.0 40000000
0
MRI scan( 3 tesla) 1 50,000,000.0 50000000
0
Computerized stress Test 2 500,000.00 1000000
fluoroscopy 1 80,000.00 80000
LABORATOR
Y
Automatic Clinical Analyzer 1 4,500,000.00 4500000
Fully automated Analyzer 2 3,000,000.00 6000000
Cell counter 1 650,000.00 650000
Blood Gas Analyzer 2 450,000.00 900000
Electrolyte analyzer 1 400,000.00 400000
Binocular Microscope 2 120,000.00 240000
Microscope 2 40,000.00 80000
Elisa Reader with Washer 1 450,000.00 450000
Incubator and hot air oven 2 50,000.00 100000
Centrifuge machine 2 10,000.00 20000
VDRL rotator 2 5,000.00 10000
Flame Photometer 2 30,000.00 60000
Single Top Balance 2 3,000.00 6000
Lab autoclave 1 50,000.00 50000
69
Refrigerator 4 20,000.00 80000
Microtome 1 20,000.00 20000
Blood Bank Refrigerator 2 1,000,000.00 2000000
Freezer (100 bags) 2 100000 200000
RIA lab 1 3,000,000.00 3000000
Distilled Water and Equipment and water bath 2 20,000.00 40000
Urine analyser 1 70,000.00 70000
ESR 1 80,000.00 80000
Blood Bank
Cryoprecipitate Bath 2 80000 160000
Blood Bank Refrigerator (215 Litres for 200 Blood 2 90000 180000
Bags) With Stabilizer – 4 Kva
Elisa Plate Rotator 2 135000 270000
Plasma Separator 2 2000000 4000000
Syringe Needle Destroyer 2 5000 10000
Platelet Incubator (120 Ltrs), Capacity: – 36 Bags 2 140000 280000
Platelet Rotator 2 186000 372000
Platelet Agitator 2 150000 300000
Tube Sealer 2 130000 260000
Blood Collection Monitor 2 80000 160000
Medical Refrigerator Of 300 Ltrs 2 10000 20000
Ultra-Low Temperature Research Cabinet Of 400 Ltrs. 2 80000 160000
With Horizontal Mode
Microscope 4 40000 160000
Total
DIALYSIS Dialysis unit 4 900,000.00 3600000
UNIT
EMERGENCY
Monitor 45 400000 18000000
Ventillator 50 900000 45000000
ECG Machine 6 200,000.00 1200000
Defibrillator 8 300,000.00 2400000
Ambulance Services- BLS 3 2,400,000.00 7200000
ALS 2 4,000,000.00 8000000
CSSD
Auto Clave (Horizontal Cylindrical)(500*1200mm)of 1 250,000.00 250000
digital temp. controller with timer & automatic water
feed system
Auto Clave (Horizontal Cylindrical)(400mm*600mm) 1 200,000.00 200000
of digital temp. controller with timer & automatic
water feed system
ETO (450*450*1200mm.) 1 250,000.00 250000
Heat Sealing Machine 1 200,000.00 200000
70
Hot Air Oven 1 100,000.00 100000
Ultra-sonic Cleaner of 30 lit 1 120,000.00 120000
Sterile Washer Disinfector 1 150,000.00 150000
Sterile Table Top Portable Autoclave with 1 200,000.00 200000
Microprocessor Control & Vacuum Pulsing (Chamber
Capacity - 19 Lt. Size: 210 Día X 550 Mm D
Cssd Rack (1200 (W) X 500 (D) X 1800 (H) Mm) 1 50,000.00 50000
Washing Station (2400 X 650 X 900 Mm (L X H X H) 1 30,000.00 30000
Hyperbic 1 60,000,000.0 60000000

Oxygen 0
MEDICAL Gas 1 50,000,000.0 50000000
Pipeline system 0
Total 771530000
71
72
15.0 Infrastructure Requirement including area
Requirement:
15.1 TRAUMA CARE FACILITY: PLANNING CONSIDERATIONS
A Trauma Care Facility can be a specialized area within a hospital building, a

separate building adjunct to an existing hospital or a standalone facility self-
sufficient in all aspects. The core areas in all these three types remain consistently
the same as detailed below, the difference being primarily in the scope of support
facilities that needs to be planned for.
CORE AREAS IN A TRAUMA CARE FACILITY
Patient access
 Ambulance entrance
 Walking entrance
Patient care areas
 Triage & Reception area

 Resuscitation area
 Treatment area
 Ambulatory care area
 Waiting Area
 Observation Ward
 Isolation rooms
Clinical Support Services
 Lab Services
 Radiology
 Blood Bank
 Pharmacy
 Communications
 CSSD
 Manifold
 Security Facilities for patient’s relatives
 Waiting Area
 Communication Room
 Toilets
73
 Refreshment Area
Staff facilities
 Staff changing rooms

 Staff shower and toilets
 Staff dining area
Office accommodation:
 Administrative support
 Staff offices
GUIDING PRINCIPLES
Patient care in a Trauma Care Facility is uniquely time-dependent. The length of

time spent by patients waiting for, or receiving care, the number of patients
attending and the scope of services offered influences the design requirements for
each component of the facility. As form follows function, it is important to
understand that the reception/triage, the trauma bay, the OR, the postoperative
care unit, the intensive care unit (ICU), and the surgery ward form an
interdependent system through which the trauma patient will transit during their
stay at the hospital.
It is important to note that when a Trauma Centre is built within an existing

hospital premises, it should preferably be located adjacent to the existing
emergency department with common entry, registration point and triage areas.
This will allow patients whose needs are best met in an area other than the
Trauma Care Facility to be redirected, depending on their clinical condition and
local operational policies. Conjoint triage ensures that patients who require
resuscitation have the quickest route to the care they need, rather than being
subsequently redirected from another access point or clinical area. This also
enables provision of two key connectivity between the two facilities; namely the
sterile connectivity and diagnostic connectivity.
Sterile Connectivity: It is a sterile corridor between the Operating Rooms situated
74
on the same floor in the two buildings. This helps the operating rooms staff and
surgeons to travel between both O‘͛s seamlessly.
Diagnostic Connectivity: This represents a corridor between two buildings at the

level of laboratory and radiological services; which helps in sharing the diagnostic
facilities between both facilities thereby enabling optimal utilization of the
resources.
ENTRANCE AREA
The Trauma Care Facility should be preferably accessible by two separate

entrances: one for ambulance patients and the other for ambulant patients. These
entrances must be at grade-level, well-marked, illuminated, and covered. There
should be Direct Access from public roads for ambulance and vehicle traffic, with
the entrance and driveway clearly marked and paved. Temporary parking should
be provided close to the entrance. In an existing hospital, these entrances must be
common with the hospital’s emergencyentrances or close to the
emergencyentrances to ensure a single point of arrival for a patient in acute
distress. In case the entrance to the Trauma Care Facility isnecessarily separated
flow the hospitalsemergencyentrance due tolimitations of space, patient load, etc.,
it must be ensured that there are appropriate internal logistics and access to rush
trauma patients mistakenly arriving at hospital emergency entrance and non-
trauma patients at trauma center entrance to their respective areas of definitive
care. If this cannot be achieved due to certain constrains, then adequate provision
must be made to stabilize such kind of patients at the inappropriate facility as
well before shifting them to the respective areas for definitive care. However, in no
case should a patient in acute distress be refused or left to fend for himself after
entering the hospital premises.
75
WAITING AREA
The Waiting Area should provide sufficient space for waiting patients as well as
relatives / escorts. It should be preferably open and nearer to the Triage and
Reception areas. Seating should be comfortable and adequate. Space should be
allowed for wheelchairs, walking aids and patients being assisted. Waiting Areas
shall be negatively pressured vis a vis the other areas of the Trauma Care Facility.
TRIAGE & RECEPTION AREA
Triage is the sorting of patients for prioritisation according to clinical acuity.

Triage may occur before or instantaneously upon patient arrival, within minutes
of arrival, at the bed-side or in a designated area. The Triage/ Assessment area
may include a designated area for ambulance patients and an area for ambulant
patients. The Reception / Triage and Staff Station shall be located where staff can
observe and control access to treatment areas, pedestrian and ambulance
entrances, and waiting areas. Patient movement between Triage and the following
areas should be given special consideration: Reception, Waiting area,
Resuscitation, Treatment & Ambulatory Care, patient toilets and Diagnostic
Imaging. Each Triage/Assessment space should be of not less than 16m2in size
and should be trolley and wheelchair accessible. It should at least have an
examination light, equipment for physiological measurement& examination,
wound dressings, documentation desk, etc. The minimum combined Reception
and Triage area must be 1.8 m2/1000 patient attendances per annum and there
should be a minimum allocation of one triage/assessment cubicle per 10,000
annual attendances. It is important to note that triage / assessment spaces may
not be necessarily physically divided by fixed infrastructure but instead maybe
even dynamically demarcated in a specified area or divided by removable
partitions / curtains. In certain cases, an appropriate space in a facility being
demarcated as Triage / assessment area is adequate till the objective of immediate
assessment and sorting of patients by acuity is being met. It must be understood
is that the purpose of Triage is not to delay the treatment any further but to
76
ensure that the patients are provided resources commensurate with their clinical
condition and also to ensure that the most precious resources are not being
wasted on those whodon’trequire it the most. Hence, separateprocessesfor pre-
triaged & pre-notified patients being bought in by the ambulance service should
be put in place to ensure that such patients are directly rushed to the
resuscitation / treatment area as the case maybe. Also, care should be taken to
ensure that no patient spends an unduly long time being triaged and at all costs,
over / under triage needs to be avoided in an acute care setting and more so in a
Trauma Care Facility.
TRAUMA RESUSCITATION AREA (RED AREA)
The resuscitation area is the specific area where most of the critical and lifesaving
interventions are done after reaching hospital. The size and number of the
resuscitation area largely depends on the level of centers and the frequency of
resuscitation done. Resuscitation area should not be too far from the entrance
(Triage area). At a minimum, two nurses per shift shall be there to perform
primary assignment for the resuscitation area. There shall be 360-degree
circumferential access to the patient, monitoring equipment and defibrillator,
suction, oxygen and washbasin. If more than one resuscitation beds are used,
there should be enough work space between the two resuscitation beds.
Resuscitation equipment, ventilator, infusion device, cannulation, etc. must be
checked and kept ready for all the time. Unnecessary attendant shall not be
entertained in resuscitation area.
Treatment Room (Yellow Area)
The treatment room shall provide a private and controlled environment for patient
consultations, examinations, treatments and minor procedures. Treatment room
is also called acute medical care room. At a minimum, 1:2 beds per nurse ratio
per shift shall be there at all times. The number of treatment beds may depend
upon the level of centres and frequency of number of emergency and trauma
77
patients. All the beds must be equipped. With monitoring devices and other
necessary facilities such as suction, oxygen, infusion device, infection control
bins, hand rub, wash basin, screen, etc. Only up to one attendant per patient may
be allowed if required in treatment area.
Operating Room
The trauma centre shall have at least one adequately staffed operating room
immediately available for trauma patients and post-anaesthesia recovery (the
surgical intensive care unit is acceptable). The operating team shall consist
minimally one scrub nurse or technician, one circulating staff nurse, one
anaesthesiologist immediately available. Ideally, the operating room should be
located near or adjacent to the resuscitation area to minimize transportation time
for an unstable emergency and trauma patients. There shall be enough space in
operating room to accommodate most surgical procedures required in emergency
and trauma care with portable operating light, portable imaging equipment and
others. Room shall be clean with separate bins for biohazard waste and others as
per the standard. The walls and ceiling should be free of fissures, open joints and
cracks.
Observation Room (green area)
It is the room for the continued treatment and evaluation process for patients
prior to leaving the ER or admitted to the ward. Observation room shall be
equipped with all the basic medical and non-medical equipment required in
functional mode. The number of observation beds may depend on the level of
centre and frequency of patients. Each bed shall have enough space (at least 1.5
meters) for the smooth and comfortable working environment for staff.
ISOLATION ROOM
EMTC shall have one designated room to keep trauma patients those whoare
78
diagnosed with highly contagious disease such as tuberculosis, measles, or
chickenpox that need isolation from other patients and staff in the hospital. It
should be maintained under negative room pressure technique used in hospitals
and medical centers to prevent crosscontaminations from room to room. It
includes a ventilation system that generates negative pressure to allow air to flow
into the isolation room but not escape from the room, as air will naturally flow
from areas with higher pressure to areas with lower pressure, thereby
preventingcontaminated air from escaping the room. This technique is used to
isolate patients with airborne contagious diseases.
INTENSIVE CARE UNIT (ICU)
The critically ill trauma patient requires continuous and intensive

multidisciplinary assessment and intervention to restore stability,prevent
complications, and achieve and maintain optimal outcomes. The trauma
centre(level I) shall provide ICU care for the patients as long as the patient
remains critically ill. A minimum of 1:2 beds per nurses ratio shall be there at all
time and may increase above this as dictated by patient acuity.
Level II and III trauma centre may not have a separate standard ICU but there
shall have trauma ward with enough bed capacity for the care ofcritically ill
trauma patients.
Disaster Management Department:
India is one of the disaster prone countries of south Asia .There has been frequent
incidents in J&K and Ladakh region that has been afflicted not only by multiple
natural disasters such as floods, earthquakes, avalanches, and landslides but also
by the terrorism and violence, which has caused unparalleled death and
destruction. These natural and man-made disasters have adversely affected most
aspects of life and development in the region. To mitigate the risks, effective
disaster risk reduction and management systems, early warning systems and
79
infrastructure need to be strengthened.
The government of India (GOI), Ministry of Home Affairs (MHA) and United Nations
Development program (UNDP) signed an agreement in August 2002 for the
development of “Disaster Risk Management” Program to reduce the vulnerability of
the communities to natural disaster, in identified multi disaster prone areas.
Disaster management Area and Ward:
The disaster management wards are equipped to handle Mass Casualty Incidents
which can generate more patients at one time than locally available resources can
manage using routine procedures.
The Disaster wards require exceptional emergency arrangements and additional or

extra ordinary assistance. It is very vital that hospital preparedness of personnel
identification of vulnerable people, structure and services in the trauma center
can make the communities more resilient.
With coordinated hospital disaster management the hospital can be more

responsive with trained staff in supporting the disaster care.
The “Golden hour “ concept of trauma care that is developed by Dr. Adams Cowley
that refers to the amount of time from injury to definitive care that should be
allocated to maximize survival from traumatic injuries can be achieved by having
a well trained and equipped establishment like AIIMS Trauma center state of the
art facility.
Organ Donation Facility:
Organ transplantation is one such advancement by the medical system and has a
remarkable success in helping people with chronic disorders who are combating
80
life-threatening ailments.
Aiims Jammu trauma center can be the center of excellence for multi organ
transplant procedures and be claimed as one of India's most comprehensive solid
multi organ transplant facilities. The state of the art infrastructure and high end
equipment to perform living donor surgery and cadaveric surgeries by
experienced consultants like Transplant Surgeons, Nephrologists,
Gastroenterologists, Pediatric Gastroenterologists, Pediatric Surgeons,
Anesthetists, Intensivists and physicians with integrated team approach can yield
superior outcomes and ensure greatest likelihood of superior results and highest
standards of care .
The organ donation process is prioritized upon the effects of Cold Ischemic Time
(CIT). Once the organ is removed from the donor, blood no longer perfuse through
the vessels and begins to starve the cells of oxygen (ischemia). Each organ has a
capacity to tolerate different ischemic times. Hearts and lungs need to be
transplanted within 4–6 hours from recovery, liver about 8–10 hours and
pancreas about 15 hours; kidneys are the most resilient to ischemia. •
A kidney transplant unit facility with excellent resources can efficiently

streamline the process of retrieval and packaging on ice successfully till
transplanted within 24–36 hours after recovery. Developments in kidney
preservation have yielded a device that pumps cold preservation solution through
the kidneys vessels to prevent Delayed Graft Function (DGF) due to ischemia.
Research and development can be undertaken underway for heart and lung
preservation devices, in an effort to increase distances procurement teams may
travel to recover an organ.
There is a wide gap between patients who need transplants and the organs that
are available in India. As a known fact there are many challenges like lacking of
efficient infrastructure ,lack of awareness of the concept of brain stem death
among stakeholders, lack of organized systems for organ procurement from the
81
deceased donor and maintenance of standards in transplantation ,retrieval and
tissue banking .Esteemed organization like AIIMS trauma centers can address
these challenges efficiently and can save and provide a life for thousands of people
who are in need for organ donation for survival.
With the coordination and guidelines of the National Network division of NOTTO
that function as the apex center for all India activities of coordination and
networking for procurement and distribution of organs and tissues and registry of
Organs and Tissues Donation and Transplantation in the country. The organ
donation activities would be undertaken to facilitate Organ Transplantation in the
safest way in the shortest possible time and to collect data and develop and
publish National registry in an efficient way. Organizations like State organ and
tissue transplant organization (SOTTO) of J&K have been organizing
several camps at different regions of Jammu to fill in the gaps and create
awareness.
AIIMSs trauma center with alien Objectives of National Organ Transplant

Programme looks forward to implement and improvise the process:
 Organ and Tissue procurement & distribution for transplantation.
 To promote deceased organ and Tissue donation.
 To train required manpower.
 To protect vulnerable poor from organ trafficking.
 To monitor organ and tissue transplant services and bring about policy and
programme corrections/ changes whenever needed.
SKILL CENTER
Skill center means an educational institution which specifically provides skills training
or education in the commercial, technical, and vocational or language field.
82
Skill center has taken a differentiated approach by adopting innovative teaching
methodologies to make healthcare education more practically relevant and impart
job specific skills that will make the Indian healthcare professional a part of the much
sought after global work force.
• physical examination skills
• practical skills
• communication skills
• treatment skills
• clinical reasoning/diagnostic skill
ROLE OF SKILL CENTRE IN TRAUMA CARE
Considerable improvements have occurred in the care of injured patients since the
times of World War I and II. This has been brought about not only by technological
advances but also due to improved training of doctors and nurses in providing
trauma care. Important elements of combat trauma training are realism, human-
specific injuries and treatments, volume of trauma exposure, and team building. In
all modern armies training is imparted using human simulators and mannequins,
human cadavers, occasionally live animals but more often using animal tissues.
Worldwide trauma training courses are mandatory for both paramedics and medical
officers. There is a need to set up an organized system of trauma training in India and
we, in the Armed Forces have to capitalize on the wealth of combat and non-combat
trauma experience, in setting up such courses.
Trauma Training
Trauma care is a subject neglected by the medical curriculum planners. A number of
studies recently have addressed this issue and worldwide steps are being taken to
impart training to medical students prior to internship through courses like the
Emergency Trauma Training Course (ETTC).
Trauma training aims at providing the essential information and skills that the doctor
may then apply to identify and treat life threatening or potentially life threatening
injuries. The ABCDE approach of Advanced Trauma Life Support (ATLS) course clearly
emphasizes that injury kills in reproducible time frames. Loss of airway kills quicker
than difficulty in breathing. Loss of circulating volume kills earlier than an expanding
intracranial hematoma.
83
The American College of Surgeons recognizing that trauma is a surgical disease
adopted the Advanced Trauma Life support course. ATLS today is accepted as a
standard of first hour trauma care the world over. ATLS aims to prepare doctors and
paramedics so trained to exercise a quantum of basic knowledge and skills to save
lives, reduce morbidity and avoid unnecessary harm. The overriding principle
is premium non noncore that is first do no harm. Implementation of ATLS protocols
and training of doctors worldwide has led to a significant decrease in mortality and
morbidity. The use of regionalized trauma centers too has been shown to decrease in
trauma-related morbidity and mortality.
ARTIFICIAL INTELLIGENCE TRAINING
Artificial intelligence has also been proven useful in the development of regional
trauma systems as a tool to determine the optimal location of a new trauma center
based on trauma-patient geospatial injury data and to minimize response times
across the trauma network. Although the utility of artificial intelligence is apparent
and proven in small pilot studies, its operationalization across the broader trauma
system and trauma surgery space has been slow because of cost, stakeholder buy-in,
and lack of expertise or knowledge of its utility. Nevertheless, as new trauma centers
or systems are developed, or existing centers are retooled, machine learning and
sophisticated analytics are likely to be important components to help facilitate
decision-making in a wide range of areas, from determining bedside nursing and
provider ratios to determining where to locate new trauma centers or emergency
medical services teams.
Training Methodology
 Animal based training

 Human Simulator Training
 Human Cadaver –based trauma training
 Hybrid Model Trauma Training
 Combat Trauma Training.
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OTHER TRAINING
 primary survey
 secondary survey
 airway management
 chest trauma
 shock and circulation evaluation
 skill practices on moulaged patient for airway and cervical spine management, in
line neck immobilization
 log roll
 physical exam of trauma patient and chest tube placement on goat chest
 Trauma management of abdomen head , spine, pediatric trauma, pregnant
trauma patient, burns; with a practice on moulaged patient, neurological physical
exam, trauma radiology, analgesia and patient transport. At the end of each day,
they had case scenario practice based on the delivered lectures and skills stations.
TRAINING FOR
• Doctors
• Medical students
• Nurses
• Police personals
• School children
• Asha Workers
• Drives
• House makers
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SKILL DEVELOPMENT PROGRAMMES / TRAINING
• BLS (Basic life Support)
• ACLS (Advanced Cardiac Life Support)

• ATLS (Advanced Trauma Life Support)
Simulation education
Simulation education is a bridge between classroom learning and real-life clinical

experience. Novices – and patients - may learn how to do injections by practicing on
an orange with a real needle and syringe. Much more complex simulation exercises –
similar to aviation curricula that provided the basis for healthcare – may rely on
computerized mannequins that perform dozens of human functions realistically in a
healthcare setting such as an operating room or critical care unit that is
indistinguishable from the real thing. Whether training in a “full mission
environment” or working with a desk top virtual reality machine that copies the
features of a risky procedure, training simulations do not put actual patients at risk.
Healthcare workers are subject to unique risks in real settings too, from such things as
infected needles, knife blades and other sharps as well as electrical equipment, and
they are also protected during simulations that allow them to perfect their craft.
Simulation-based assessment refers to both “low stakes” learning for improvement,
and “high stakes” testing to determine competency. Multiple choice tests and oral
exams have been traditional methods to assess knowledge and ability for generations.
Common sense dictates, however, that once technology advances to the point that real
tasks can be accurately simulated, truly demonstrating competence becomes an
indispensable part of effective evaluation. Directions in credentialing indicate that it
will eventually be more meaningful to actually demonstrate competency than to
provide a surrogate for competency – namely, a certain number
The goals of simulation-based research differ from training and evaluation.
Researchers may be trying to understand why a particular event happened, and so
simulate the event with the same and/or other clinicians. Just as with an airplane
engine or wing in a wind tunnel, medical devices may be tested under a range of
simulated conditions before the final device is marketed and used on actual patients.
New procedures for giving dangerous drugs or using advanced resuscitation methods
may be studied under simulated conditions. Entire populations, tests, and costs may be
represented by patterns of data in a computer and multiple simulations run to find
optimal solutions for attaining the best health of a community. Different types of
simulations – live, virtual reality, and computer-based – may be combined to attack a
question from different angles. The ultimate goal of increasing knowledge and
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understanding to improve training, evaluation, and design of systems is the same.
Necessary research may also address two fundamental areas of need. One may ask, “Is
the tool of simulation valid?”. A second question to be answered by necessary
research is, “Is the tool of simulation useful?”. Answers to these fundamental
questions will continue to be increasingly addressed within the research arena.
Systems integration refers to the integration of simulation into institutional
healthcare training and delivery systems. Simulation-based processes may include
quality assessment mechanisms, thereby facilitating patient safety. Simulation may
also raise the bar for objectivity and hence fairness in evaluation, substituting visible,
accepted metrics for performance for anecdotes and opinions. Simulation-based
approaches can be effectively used to help evaluate organizational processes as well as
individuals and team performance. Examples include disaster response or testing a
new procedure before it is put into practice.
ADVANTAGES OF SIMULATION LEARNING

A range of easily accessible learning opportunities: Learning in healthcare is too
frequently in an apprenticeship model. In many disciplines, as opportunities to learn
and practice come along, it is hoped that learners encounter enough situations to
insure that they become competent. This is ultimately a haphazard way to learn, and
puts learners and patients at a disadvantage. Simulation offers scheduled, valuable
learning experiences that are difficult to obtain in real life. Learners address hands-on
and thinking skills, including knowledge-in-action, procedures, decision-making, and
effective communication. Critical teamwork behaviors such as managing high
workload, trapping errors, and coordinating under stress can be taught and practiced.
Training runs the gamut from preventive care to invasive surgery. Because any
clinical situation can be portrayed at will, these learning opportunities can be
scheduled at convenient times and locations and repeated as often as necessary.
The freedom to make mistakes and to learn from them: Working in a simulated
environment allows learners to make mistakes without the need for intervention by
experts to stop patient harm. By seeing the outcome of their mistakes, learners gain
powerful insight into the consequences of their actions and the need to “get it right”.
The learning experience can be customized: Simulation can accommodate a range

of learners from novices to experts. Beginners can gain confidence and “muscle
memory” for tasks that then allow them to focus on the more demanding parts of care.
Experts can better master the continuously growing array of new technologies from
minimally invasive surgery and catheter-based therapies to robotics without putting
the first groups of patients at undue risk. Some complex procedures and rare diseases
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simply do not present enough opportunities for practice, even to established clinicians.
Examples include treating a severe allergic reaction or heart attack in an outpatient
clinic setting, or handling a case of malignant hyperthermia in the operating room.
This is a gap that simulation training methods can help fill.
Detailed feedback and evaluation: Real events and the pace of actual healthcare
operations do not allow for the best review and learning about why things took place,
or how to improve performance. Controlled simulations can be immediately followed
by videotape-supported debriefings or after-action reviews that richly detail what
happened. Advanced surgical and task simulators gather much data about what the
learner is actually doing. These performance maps and logs provide a solid and
necessary feedback mechanism to learners and help instructors target necessary
improvements.
Healthcare simulation is coming of age, and has begun to share much with
established methods in aviation, spaceflight, nuclear power, shipping and the military.
The rapid advance of computer science, bioengineering, and design has met demands
from all stakeholders for safer, more effective and efficient ethical healthcare. When
the stakes are high and real settings do not lend themselves to artificial handling for
other purposes, simulation methods will find applications.
TELEMEDICINE
Advances in telemedicine have been shaped by increasing demands for meeting global
health needs, as well as market-driven forces. Trauma and emergency medicine face
significant barriers with regard to accessibility of care, expertise, and technology.
Telemedicine serves to bridge these gaps on both a global and loco regional scale,
making available the highest level of expertise and care to the most remote settings.
Telehealth has served to advance patient care, surgical education, and inter-
institutional collaboration through the use of modern technology.
The evolution of telemedicine in trauma and emergency management in the recent
times showcases examples of advances in technology and applications that can be
used by a wide audience of health care providers to meet the needs of patients
requiring trauma and emergency medical care.
As Injury represents a significant burden to the healthcare system worldwide, with
approximately 10 % of worldwide deaths attributed to trauma. Additionally, the
impact upon public health measures such as disability, physical impairment, loss of
work force, and quality of life remains significant. While certain mechanisms of injury
such as vehicular accidents have declined in incidence significantly over the last two
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decades in developed nations, the opposite trend has occurred in lower to middle
income countries. The disparity in outcomes between socioeconomic classes is present
not only on an international level but also on a loco regional level. The vast majority
of specialized trauma centers and traumatologists are centered in urban settings. In the
INDIA patients in rural settings are at significantly greater risk of death from
traumatic causes when compared to urban counterparts. A significant number of such
deaths can be prevented if timely access to specialized trauma centers and resources
can be ensured.
The reasons for such discrepancy in access to trauma care remain largely unclear,
although various contributing factors have been postulated. Rural health care facilities
are often staffed with providers with limited expertise in traumatology which may lead
to deviations from the “standards of care.” Moreover, such facilities are limited in
their ability to provide continuing medical education and skills training to their
providers. As a consequence, trauma patients in rural settings often lack access to
timely care and interventions delivered by trauma subspecialists. This challenge is
partially addressed through the nationwide implementation of trauma transfers; i.e.,
the physical transfer of a trauma patient from a referring rural facility to a definitive
tertiary trauma center. The decision to initiate such transfers typically originates from
the referring rural physician and is carried out via a telephone conversation with the
consulting and/or accepting traumatologist at the specialized receiving trauma center.
Nonetheless, natural barriers to transportation, distance between referring and
receiving institutions, the great cost of such transfers and the time-sensitive nature of
traumatic injuries make the transfer system suboptimal. Therefore, it remains a
significant challenge and important objective to bridge the gap between care delivered
to rural trauma patients and their urban counterparts both on a national and
international level.
A potential solution to bridge this gap may lie in developing telemedicine for trauma
and emergency care (“teletrauma”). Advances in technology and demonstrated
success in the applications of telemedicine on both national and international levels
represent a significant opportunity in making the most advanced resources and highly
trained personnel available to the most remote of settings in a timely fashion. The
concept of “telepresence” involves providing access for smaller and more rural health
care facilities to trauma surgeons at major trauma centers on an around-the-clock
basis. The implementation of such “telepresence” extends beyond mere video-
teleconference (which remains a valuable component of collaborative and educational
applications) but also includes expert evaluation of patients and processes which
begins from the initial evaluation of the trauma patient and continues on to all aspects
of care delivered for the patient. This review focuses on the evolution of telemedicine
programs on both national and international levels as it pertains to trauma and
emergency medical care.
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Historical Perspective
The origins of telemedicine in the setting of emergency management and trauma date
back to military disaster exercises staged by R. Adams Cowley, M.D., who used
satellite transmission to communicate images of burn victims to medical centers
across the Washington DC area using now outdated technology. Thereafter, several
efforts have been made to expand upon this initial effort to both evaluate and treat
trauma patients remotely. Mattox’s group reported the successful remote evaluation of
17 trauma patients using real-time video observation combined with verbal
interaction. While this study was performed “in-house” with the remote evaluation
occurring in a separate room within the confines of the hospital, it demonstrated that
the trauma team leader does not necessarily need to be physically present during
evaluation and initial resuscitation in order to attain good outcomes. The immediate
physical availability of the traumatologist in this study provided not only a safety
mechanism in case of equipment failure or potential inferiority of telemetric
resuscitation but also allowed for the unbiased evaluation of remote evaluation and
resuscitation in a setting where clear physical presence of the expert was readily
available but not required. Subsequent studies extended this principle to truly remote
locations of evaluation. Rogers et al. reported their experience with telemedicine for
the management of trauma patients in rural Vermont. Their study, which involved
predominantly blunt trauma victims, demonstrated the utility of telemetric
consultation in providing (1) identification of the need for, and expediting, transfer of
complex trauma patients to a tertiary center, (2) recommendations for obtaining or
forgoing diagnostic tests such as CT scans, and (3) recommendation for therapeutic
interventions such as nasogastric tube and chest tube insertion. Lambrecht et al.
reported in their study evaluating telemedicine consultation for the evaluation of
extremity and pelvic injuries that 68 out of 100 patients evaluated were allowed to
remain at the referring facility.
Much has changed in the field of telemedicine technologies. Initial experience with
such communication ranged from the use of digital cameras to obtain and transmit
pictures of radiographic studies of orthopedic injuries to closed circuit television and
recording devices in the on-site evaluation, to provision of trauma care from the
distance in real time. The simplicity of using smartphone technology to transmit
images and recordings of patient wounds and radiographic images has been shown to
be efficacious in more than one study, although their ubiquitous use has not occurred
due to Health Insurance Portability and Accountability Act (HIPAA) concerns and the
security of patient data. Within the last decade, more advanced technologic programs
were created and demonstrated to be highly functional. The use of bidirectional
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videoconferencing has been demonstrated in several settings of trauma and acute care
to be an effective method for evaluation and teleconsultation. For example, the
Southern Arizona Telemedicine and Telepresence (SATT) program initiated in 2004
used real-time transmission of video, audio, and vital signs on a secured, separate line,
which was monitored around the clock by technical personnel, to link a major
university medical center in Tucson, Arizona with a rural medical center over 100
miles away .
TRAUMA REGISTRY
A system of timely data collection that aids in the evaluation of trauma care for
injured patients is called trauma registry. Trauma centre shall have a trauma
registry unit with necessary equipment such as desk top computer with internet
connectivity, file rack, table and chairs.
Morgue/Body Holding Area
The Morgue/Body holding area is a facility for the temporary holding / storage of
dead bodies prior to transfer to a destination. The area should allow for the
following:
 Direct access from the facility for delivery of the body

 It should allow easy and discrete access to deliver and/or remove bodies
 Consider away from public area to ensure that is appropriately screened from
visibility
Store
Trauma care shall have separate room to store all kind of medical supplies and
equipment.
Other Facilities for Patient Relatives
The centre should provide enough facilities for the patient families and relatives
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such as toilets, waiting area with seating facilities and entertainments as required.
Facilities for Staff
Trauma centre shall have enough facilities for staff including nurse station,
changing room, and toilet and administrative office.
The faculty will be having office for functional purposes.
15.2 DESIGN PHILOSOPHY
 To configure all the important norms, the service delivery of the entire hospital
has been divided into three sections, viz., Outpatient Department, Wards,
Operation Theatre and Laboratory.
 These parameters have, further, identified a broad division of an extreme type

and a coastal type of climate to address the objectives comprehensively. It also
sums up the total population pressure into two zones, viz., plateau (moderately
populated) and desert / mountain (thinly populated).
 To maintain an asepsis condition in a hospital, due care in planning, designing

and detailing is required in terms of right location and choosing the right
material & specifications. This acts as a preventive measure against infection
to the patient. To this effect it is important to ensure that the corners of
floors, walls and ceilings are coved (rounded off). This is because a ‘Right
angle is not always the right angle while designing a clinic area where
sterility is of critical importance’.
 In the planning process location of various departments has a very important

role to play. All the departments are the ‘activities’ of the hospital and an
architect’s role is to rightly identify the ‘activity’ and ‘activity sequence’ in
working out a functional program of spaces. In the words of Emerson Goble,
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“separate all departments yet keep them close to each other; separate types of
traffic yet save steps to everybody. That is all there is to hospital planning”
Hospital provides Preventive, Curative, Restorative, Rehabilitative, Promotive

and Comprehensive community health care to the public. Segregation of
patients is recommended on the basis of the following:
 Curative and preventive services, for instance immunization, well baby clinic
and anti natal area should be separated from medicine, skin, ENT or other
OPD areas
 All elements of progressive patient care viz intensive care, intermediate care,
self care and ambulatory care must receive due consideration.
 Separate room and ward units for critically ill patients and general ward for
normal care.
 Sex (separation of sexes will be achieved by room assignment which is

applicable to all nursing units except post operative).
 The landscape, facility mix, bed mix, availability of utilities in the vicinity will
have to be considered. Considerable inputs from the other agencies like
HVAC(Heating Ventilation Air Conditioning), electrical, plumbing, medical
gases and inputs from equipment vendors especially in speciality areas like
MRI, CT Scan, Operation Theatres will be essential to finalize the working plan
of the hospital.
 Patient being the main focus, protection of the patient is the primary rule. Too
much of traffic will disturb the patient and affect the efficiency in patient care
and increase the risk of infection.
 The functional circulation with the shortest possible traffic route helps in
economizing construction cost. Also, segregation of dissimilar activities such as
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movement of dirty utility and clean utility, quite and noisy activity, different
types of patients and traffic, both inside and outside of the building is an aid to
economizing construction cost.
 High quality of health care can be achieved only if the hospital design is
efficient, functional and economical.
 Plan and design for segregation of traffic i.e. inpatients, outpatients, visitors,
staff goods and waste.
 Environment plays a dominant role in the healing process of a patient and

selection of aesthetically pleasing building material, which is also sustainable,
and patient friendly goes a long way in complementing patient healing.
The following services may be added to add value to The Hospital:
• Guide Maps • Well decorated & furnished waiting

areas
• Signage / sign posting
• Security and safety system – CCTV
• Touch screen & Infra red cameras
• Planters • Fire prevention, detection and fire

fighting systems
• Cafeteria – Staff & visitors
• Prayer room / facilities
• Flower Shop/Fruit Shop
• May I Help You counters
• Book Store
• Underground / Multi storey
• Vending machine – Tea, Coffee, parking lots
Juice
• Public conveniences
• Communication facilities – STD etc
• Garbage station
• Cyber café – Internet
• Ramp
• Aquarium
• Intelligent lift and escalator system
• Water curtain / water fountain /
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waterfall • Wellness / Fitness Centre
• Food junction • Special facilities for Geriatric,

Physically challenged
• ATM Facility/Xerox facilities
• Subways / Over-foot bridge /
connecting bridge
The built environment enhances patient flow, overall efficiencies and functional
operation of the healthcare facilities.
 Architects, Interior Designers and Health Care Administrators have realised

nature’s influence on patients and their need to nurse their soul. Their
approach now combines this inherited wisdom with modern technology by
applying a “Holistic” approach in designing health care environment. With
a preventive approach
 There is a greater need to be cognizant of the blend of technology and human

behavior by promoting development of landscapes, gardens, which are
proportionate to the scale of the building and the population, it serves.
 Building ventilation, external and internal appearance, landscape and internal

and external traffic patterns, energy efficiency, orientation are very important
points to be kept in mind while designing an effective health care environment.
 Keep Patient as the focus of planning and designing.
 Material and services flow - It is also important to separate transport of clean

and soiled material.
 Privacy (separation of in and out-patient area), Degree of illness
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 Utilize energy saving/optimizing techniques such as solar energy for healing
water, biogas units for lighting, heat reclaim from boiler exhaust and
incineration.
 Use of Eco friendly materials (Green Building Concepts)
 Various support services such as kitchen, CSSD and laundry to be planned for
or to be outsourced
 Waste management to be planned for or to be outsourced.
15.3 BASIC PLANNING ASPECTS
(Like equipment planning, functional circulation, critical areas of hospital

services are the most important planning tools that deserve special
attention.)
Planning Grid: In an urban situation where the hospital generally adopts the
vertical form comprising of diagnostic/therapeutic and interventional services and
a multi-storey block houses the in-patient facilities. The planning grid is largely
determined by the layout of the in-patient facilities housed in multi-story and also
this is generally the accommodation desired for a single bed patient room and a
double bed patient room and their toilets.
The structural grid need not necessarily be the same as the planning grid but
usually derived from it
The position of the structural determined by the planning grid will continue
downwards through the rest of the hospital, through the lower floors till their
respective foundations where they will transfer their load to the ground below.
Hence, the lower floors which will house the operation theatre suite, the radio
diagnostic unit, the services unit like kitchen, laundry and mechanical services in
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the basement to name just a few will need to be designed within these column
positions.
Even the lower floors are extended beyond the footprint of the in-patient multi-
storey block above. It is almost certain that the position of the additional column
required would be derived from structural grid used for the multi-story block
accommodating the in-patient facility.
In semi urban or rural situation where available land area is much larger with
respect to the built-up area desired the planning grid has much greater flexibility
and it gives more elbowroom to the architect and this freedom enables many
different types of building layout and form.
The following aspects are to be considered in the sustainability of the hospital

building design: -
 SITE: The hospital building must have easy approach, enough land availability,
sufficient supply of water and electricity. The guidelines recommended for
various sizes of hospitals are as follows.
 WATER EFFICIENCY: Water conservation and re-utilization by rainwater

harvesting should be made mandatory. Sustainability also lies in selecting
water efficient fixtures and appliances specifying materials that do not waste
excessive water in their manufacturing process and selecting landscape
vegetation requiring minimum irrigation. Recycling water to support the entire
mechanical and horticultural requirements approx 500 l of water/bed/day are
required.
 ENERGY & ATMOSPHERE: Designing the building, utilizing energy efficiency

more in terms of passive solar architecture and selecting the right material for
making it energy efficient, and following the various pollution control and local
utility conservation guidelines.
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 MATERIAL & RESOURCES: Based on the local pollution control norms,
eliminating the usage of PBC products used during treatment such as IV bags,
vinyl gloves, plasma collection bags and sharp containers to name a few.
 INDOOR AIR QUALITY: The aim of the planner should be to humanize the
hospital in spite of techno medical needs of the patient related to advanced
diagnostic, surgical or life support treatment with high level of precision.
Hence, human scale is very important as a design factor evoking the feel of
homeliness. Hospital design objective is to integrate healing spaces depending
upon the user’s need successfully both physically and psychologically, e.g.
warm and friendly, stress reducing, life enhancing and produce positive
responses, enrich the environments, foster civic pride; enhance reputation,
sense of belonging and fit with the surroundings, efficient in operation,
economical in use of resource, flexible and durable, reflect the aims and
objective of the owner,
 Design and function must be symmetric.
 Data such as dermographic data, socio economic data, climatological data;

geographical data, availability etc should be known and analyzed.
 Regulations and Bye laws and legislative enactments related to health care
facilities should be meticulously read, analyzed and followed.
 Resource availability in terms of man, money and materials should be analyzed
 Factors such as travel time and travel distance by the users must be
considered while planning.
 Plan for flexibility, convertibility and expandibility.
 Modular approach helps in achieving the above
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 Covered waiting areas should be near the treatment space to avoid patients
walking through public places after wearing the gown.
 The definition of a hospital as enumerated by WHO must be kept in

consideration while planning.
“ Hospital is an intergral part of the social and medical organization of the

community, the functions of which are not only curative but preventive,
whose outpatient services reach out to the family in its environment, is also
a center of training of health workers and for bio-social research”.
Space Determination: The factors which must be considered include scope of

services that the department provides type of equipment being utilized, inpatient,
outpatient work load, procedures and facilities being provided.
15.4 DESIGN CONSIDERATIONS
Flooring is one of the most important components of buildings especially that

of healthcare facilities.
The various factors which must be taken while selecting flooring to maintain and
aesthetically pleasing in healthcare facilities are as follows:
 It should provide a safe, non-slippery, comfortable surface for use by patients,

staff and visitors.
 It should facilitate cleaning. Coved skirting with a minimum radius of 3 cm and

minimum of 10 mm should be done to prevent dirt/dust accumulation.
 Floor loading capacity/wear resistance should be appropriate to the human

traffic and equipment utilized in the facility.
 Laboratory flooring should be abrasion and water resistant.
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 The flooring should be conducive to movement of objects such as trolleys and
wheel chairs should minimize noise generation.
Surface Materials: The following consideration:
 Fixtures and fittings should be designed to facilitate easy cleaning and

discourage accumulation of dust.
 Horizontal, textured or moisture retaining surfaces should be avoided.
 Inaccessible areas soil/dust/moisture would accumulate should be avoided.
 Surfaces should be smooth, impervious and easily cleaned. They should be of

seamless materials in high risk clinical areas such as operating unit, ICU
obstetric unit etc.
Wall & Ceilings: Wall materials in areas such as OT should be impervious,

jointless, non-absorbent, easily cleaned. X Ray View box, electrical
plugs/switches should be flush with the wall. Surface to facilitate cleaning.
Walls and also floors if situated above ground level of imaging department must
be provisioned with shielding material such as lead to prevent radiation
exposure. Corners of the wall to be protected against banging of Stretchers.
Ceilings to be made interesting especially in paediatric area
Doors & windows: Doorways should have minimum 90 cm clear opening width
to allow easy passage to patients/visitors/staff including those on wheelchair.
A level space of at least 152 cm wide should extend about 45 cms on either
side of the doorway for facilitating opening/closing by a wheel chaired person.
The door should be designed to be opened by application of no more than 4 kg
of pressure.
 In paediatric rooms, two sets of door handles should be provided one at a high
level and one at low level rooms occupied by patients/staff should have
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windows to have external views and make use of direct or borrowed natural
light where practical.
 Each window and/or glazed door should have direct glazed area of not less
than 15% of the floor area of the room.
 All doors in the toilets of Inpatient area to open outside.
Stairs: Recommended height of risers is 0.15m and 0.32 m threads. It should

have level and non skid surfaces. Hand rails should be positioned on both sides of
stairs and extend beyond the first and last step to facilitate people with leg braces
to pull themselves beyond these points.
Lifts: Passenger lifts are ideally recommended for all health care facility with
patient services located on a level other than ground floor. Lifts required for
transporting patients on beds and emergency lifts should be capable of accepting
hospital beds with emergency equipment and attendants. Lift openings should be
wide enough to carry stretcher and wheel chairs.
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15.5 Area Requirement
The Area requirement for the hospital building has been done in accordance with
the rules and needs of the hospital. It is divided into area requirement for Hospital
block & service Block.
Hospital block
Sq.m. Sq.ft.
Total area on ground floor 9652 103856
Total area on first floor 9976 107342
Total area on second floor 9652 103856
29280 315053
Total Built up area
Ground floor
Sq.m. Sq.ft.
Entrance 1005 10814
Emergency department 3049 32807
Blood bank 1107 11911
Administrative Area 630 6779
Imaging Department 798 8586
Lab 416 4476
Pharmacy 413 4444
Core areas 2234 24038
Total area 9652 103856
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First floor
Sq.m. Sq.ft.
Training centre 693 7457

Endoscopy 150 1614
Dialysis 299 3217.24
Wards (12 bed unit) 6010 64668
Single occupancy room 302 3250
Double occupancy room 288 3099
Second floor
Sq.m. Sq.ft.
OT 3885 41803
ICUS 1356 14591
HDU 952 10244
Invasive Radiology Cath lab 1325 14257
CSSD 900 9684
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Service block
Sq.m. Sq.ft.
Total area on ground floor 1500 16140
Total area on first floor 1000 10760
Total area on second floor 1200 12912
Total Built up area 3700 39812
Ground floor
Sq.m. Sq.ft.
Kitchen & canteen 1500 16140
First floor
Sq.m. Sq.ft.
Mortuary 500 5380
Laundary 500 5380
Second floor
Sq.m. Sq.ft.
Services(Mantainance & Electrical) 700 7532
Central store 500 5380
TOTAL BUILT UP AREA OF BOTH BUILINGS Sq.m. Sq.ft.

Hospital block 29280 315053
Service block 3700 39812
Total 32980 354865
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15.6 Floor Plan
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106
107
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Design Concept & Planning
Design philosophy of this project is based on the connectivity and segregation of
spaces as per the demand of the areas. The site is divided into 2 zones, first one
is front of the medical facility i.e. hospital building and other one is back of the
medical facility i.e. service block which is placed on the back side of the site.
Site have one entrance and two exits which help to manage the traffic flow of
patient.
Form of the hospital building is taken from the Mass and void concept which we
had shown in our layout by giving the terraces at alternate floors. Mass and Void
concept help to break the monotony and connect the indoor spaces to outdoor
areas.
Flow of patient and staff is segregated by the different cores. Right core at the
entrance is given for staff only and left will be used by patients. This help us to
manage the traffic in the hospital. In hospital building, time is most important
constrain for the patients as well as doctors. Departmentation had done as per the
utility and internal connections with other areas. Training areas for ex. Labs,
seminar hall etc. is also provided with departments.
Building block has 3 entries i.e. one is main entry for emergency, second for the
OPD & staff and third one is back entry for services. Emergency is the most
critical and important area of any hospital that’s why we placed that at the
entrance of the building on ground floor. Emergency is directly connected with
blood bank and imaging department which is the need of the emergency patients.
OPD is also connected on the other side to take the follow up by the patients.
Pharmacy, labs & admin is also connected with imaging and OPD areas for the
better proximity.
On the first floor we have placed the wards area with dialysis, endoscopy, single
occupancy room & double occupancy rooms.
Second floor is occupied with all critical area and services. OT’s ICU’s, HDU’s are
placed on the same floor and connected by the corridors. Staff is entering from
109
right core and get into their staff zone and Patients is coming from the left core
from emergency and direct entering to the pre OP area. Cath lab is connected
directly to the OT complex. CSSD is also provide adjacent to the OT area to make
it more accessible to the OT facility.
In service block kitchen, laundry, mortuary, electrical & maintenance and store is
provided. MGPS is provided on the site adjacent to the service block.
110
111
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16.0 Statutory Requirements
1. Building Completion Certificate
2. NOC Fire
3. BMW & Handling Rules,2016
4. Pollution control certificate for DG sets
5. License for Pharmacy
6. Permit to operate lifts under the Lifts and Escalator Act
7. License for the blood bank
8. Radiation Protection Certificate in respect of all x-ray, Cath lab and CT
scanners from the BARC
9. Atomic Energy Regulatory Body approval
10. Excise permit to store spirit
11. Permit to operate lifts under the Lifts and Escalator Act
12. Narcotics and Psychotropic Substance Act & License
13. Vehicle registration Certificate for ambulance
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17.0 Cost Implications
17.1 Capital Cost

Capital Cost Cost in INR
Cost of Construction 1419459200
Cost of Equipment 771530000
Cost of Computers & Peripherals 100000000
Cost of Audio Visuals 120000000
Cost of Furniture ( Medical & Non – Medical) 120000000
Cost of Software
HIS – Hospital Information System 10000000
PACS - Picture Archiving and Communication System 6000000
Access Control 3000000
RFID - Radio Frequency Identification Devices 2500000
iBMS - Integrated Building Management System 7500000
Total Cost 2559989200
115
However, Cost of Construction Includes Civil Work, Air Conditioning,
Electrification, and Plumbing & Firefighting along with Elevators & Lifts.
Note: 1.1 it has been calculated on the basis of total area required for the
hospital building
Cost of Construction = Total Area x 4000 per Sq.ft.
= 354864.8 x 4000
= Rs 1419459200
Please Refer to Section No. 15.2 detailed Cost of Construction
1.2 Please Refer to Section No.14.0 detailed Cost of Equipment
116
17.2 Operational Cost
Operational cost
Cost in INR ( Per Month )
Cost of Manpower ( Other than Housekeeping & Security 151424000
Cost of Housekeeping 4000000
Cost of Security 3000000
Cost of Electricity 10000000
Cost of Consumables 50000000
Total Operational Cost 218424000
Note: Please Refer to detailed Cost of Manpower
117
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18.0 Project Summary
The project has been conceived as a centre of Excellence with in AIIMS Jammu
Campus in subsequent phases.
The felt need of Centre of Excellence in the field of trauma does not need any
Explanation.
Centre of Excellence are conceived and commissioned in a long drawn period of

time. Creating such facilities will not necessary benefit the patients but the totality
of Hospital & Medical Workforce.
Secondary review of Published literature on Centre of Excellence have been

referred apart from India Guidelines & hence this Proposal have been prepared.
A Snapshot of salient Features are as Under:
 Total Built Up Area of the Hospital – 354864.8 Sq. ft.
 Number of Floors – 3
 Electric Load – 2500KVA
 Total Water Needs Consumption – 2-2.5 lakh litre per day
It will highlight the Trauma needs of not only Jammu & Kashmir , Leh & Ladakh
but also of the whole country .
If organised and made to function in an advance level of Clinical, Technical and

Managerial Care it will be emerge as a centre of Excellence not only in India but
will emerge as a towering centre in Asia.
119

Final Trauma Aiims Jammu-Update

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1

The population of jammu as of 2020 is 13.6 million. There are 10 districts in

Districts in Kashmir Region: Kashmir Valley Region consists of 10 districts, which

1.1 Health System & Status of Jammu & Kashmir

Human capital, as characterized by good education and good health is an

In J&K, Government institutions are overloaded: 91% in-patients load is on the

Moreover adequate number of Anesthesiologists has to be posted at District and

Community Health Centre (CHC) is a 30 bedded hospital/Referral Unit of 4 PHCs

Health Institutions Average Rural Area (sq.Km) covered by a Health Intuitions

As a state with unique features and a strategic location, the speedy

There is a need to streamline the functioning of the Out Patient Department’s.

All training programs (Symposia, Conferences, Workshops, Seminars) must fetch

Arrangements can be made to make CHCs functional round-the-clock and PHCs

Following Table I narrates the position of health care infrastructure in

Besides that, considerable achievements have been made to improve health

Life Crude Crude Total Infant Couple Institu Full

1.2 Changing face of Healthcare in Jammu and Kashmir

 Health and Wellness Centres (HWCs)

Sanitation coverage, which ought to be a way of life to safeguard health, is

In India, only 50 per cent of households had access to sanitation facilities. In

The All India Institutes of Medical Sciences (AIIMS) is a group of autonomous

All India Institute of Medical Sciences, Vijaypur is a public institute of national

A Centre of Excellence is an area of health care specialization in a medical

• A comprehensive clinical continuum of care

A Centre of Excellence means more focused care in a critical medical field. It

It is a program within a healthcare institution which is assembled to supply an

Specialized programs within healthcare institutions which supply exceptionally

1. Organization Design- In a centre of excellence, work responsibilities and

2. Service space Design- Upgraded materials, design, and workmanship

3. Personnel- The most notable features of centres of excellence pertains to the

4. Medical Care- Possessing a deep understanding of its patient populations,

 Safety pertains to overall care quality, patient outcomes, and team

 Satisfaction relates to patient’s perception of excellent care, department

 Solvency addresses current opportunities for fiscal improvement through

 Support involves relationships with administration and medical staff, adequacy

 Systems refer to work flow processes, care pathways, and technological

Risk Category Phase of Risk Risk Mitigation Plan

- Finalization of Employing consultants with

Incorporating the concerns

Project Construction The project This risk should be

Project Cost Construction If the EPC The detailed Project Report

Regulatory & Operations During the Debt Service Reserve:

Commercial Operations This category The demand estimates

a. Interest Rate Operations Determination The project should be

b. Foreign Operations In the absence Tariff adjustments

c. Inflation Risk Operations The tariff rates Tariffs to be adjusted for

9. Termination Operations The risk Compensation package

10. Force Throughout This risk Comprehensive Insurance

11. POLITICAL & SOCIAL RISKS

B. Throughout The political The Concession Agreement

C. Social Risk Throughout This is the risk Appropriate insurance

12.Lack of Throughout Lack of business Based on the source of

6.1 Project Level Risk

Failure of the Functional Plan Functional plan

Resources Resource Allocation Resource Project

New demands Partner to keep note Project Policy

Designs (in Design Guide International Project

Transaction is Transaction plan bDetail PERT Day wise Project

Likelihood of Incidence Recurrence Score

Level Descriptor Description

Not expected to occur, except for exceptional

2 Unlikely Not expected to occur given existing controls.