597 To identify the bottlenecks in prehospital care through unstructured interviews with government-run ambulance services in New Delhi

Background Prehospital care in India is a growing branch. The Indian Council for Medical Research 2017 study shows that out of the 9.7 million deaths and 486 disability-adjusted life years ( DALY), the top contributors were ischaemic heart disease, perinatal conditions, chronic respiratory disorders, diarrhea, respiratory diseases, cancer, stroke, and road traffic injuries. Road traffic injuries contributed to 11.4 % of DALY nationally. Prehospital emergency care provides that vital link in making the platinum minutes and golden hour in trauma emergencies count. In other medical emergencies, pre-hospital emergency care is the first link in the chain of survival. Aims, Objectives, and Methods Sample Size of 180 Prehospital caregivers from the Government-run ambulance services in New Delhi. Random sampling was done. Method of survey – unstructured interviews, a total 11 interviews conducted as part of Quality Improvement for improving compliance to critical steps in prehospital care. Discussion Unstructured interviews are done to have an in-depth understanding of the problem statement. The responses were graded into 3 categories one being administrative/ operational challenges, human challenges, and medical challenges. All the respondents answered the need for training in recognizing life-threatening emergencies due to poor knowledge and experience. ( n=180) 100%. They also replied about the need for regular Continuing medical education ( CME) for the same ( n=180) 100%. In administrative decision-making, the need for seamless communication with the command center was answered by (n=180), 100% of respondents. Similarly, the definition of emergency care or the scope of care needs to be defined was replied by (n= 164) 91% of respondents. (n = 164), 93% of respondents answered the need for prehospital notifications and (n = 180), 100% answered the need for designated handover personal to prevent handover delay. 62%,( n = 112), answered the need for safety for them, especially women emergency providers. Results The study identifies the need for regular training modules for emergency care providers, for recognition of emergencies and quick medical response, the need for strong command center communication, and the need for prehospital notification and handover protocols with special emphasis on the personal safety of the caregivers.