Representative photo: Mat Napo/Unsplash
- Singer KK died on May 30 after a concert in Kolkata. He was performing at a hot, overcrowded venue that had glitchy AC and which invited allegations of mismanagement.
- The time between when a person first shows symptoms to when an angioplasty is performed is called the time-to-treatment. It is clinically significant in most cases of heart attacks.
- Medical guidelines say this should be 90 minutes or less. A longer time-to-treatment is associated with greater heart muscle damage and death.
- The organisers of KK’s Kolkata concert claimed an ambulance was present at the venue, but this appears to not have been used. Instead, KK was transported by a private vehicle.
- KK’s loss is tragic. It should spur an in-depth evaluation of emergency medical services at such events in India. Perhaps singers themselves can take the first step by insisting on them.
Singer Krishnakumar Kunnath, a.k.a. KK, died on May 30, 2022, after a concert in Kolkata. He was visibly distressed during his performance, which happened at a hot, overcrowded venue that had glitchy air-conditioning and which invited allegations of mismanagement.
We know that he was taken to his hotel by a private vehicle, and then to a hospital where doctors declared him dead following a cardiac arrest. The post mortem report indicated that KK had significant blockages in his heart vessels, which led to a heart attack. Some news reports also indicated that he had a history of chest pain. At the age of 53, his death was an untimely loss for his family and for fans of his music.
Now, would he have survived if he had been promptly transported to a hospital? There are multiple ifs here: if the event’s venue had had an ambulance, if the ambulance had had cardiac life support, and if the hospital had had better cardiac care facilities… Even if all of these conditions had been met, there would still have been no guarantee that KK could have been saved.
This said, research has shown that one’s chance of survival would have been greatly improved if these conditions were in place. People with chest pain and other related symptoms who call an ambulance receive quicker, more appropriate treatment – and have a better survival rate.
The amount of time between when the person first shows symptoms to when an angioplasty is performed in a hospital is called the time-to-treatment period and it is clinically significant for most classic cases of heart attacks. Medical guidelines say this should be 90 minutes or less. An angioplasty opens the blocked blood vessels and restores circulation, allowing the heart to recover. A longer time-to-treatment is associated with greater heart muscle damage and death.
The organisers of KK’s Kolkata concert claimed that an ambulance was present at the venue, but this appears to not have been used, if indeed it was present. Instead, KK was transported by a private vehicle to his hotel and then to a hospital when he showed signs of worsening.
In the event an ambulance had transported him to hospital, what pre-hospital treatment could have been initiated? Trained staff recognising the signs of a heart attack and beginning cardiopulmonary resuscitation (a.k.a. CPR) are vital to survival. If a defibrillator is present, they can use it to ‘read’ the heart’s rhythm and correct abnormalities if any.
The essential elements of an emergency medical system (EMS) for cardiac patients are: ambulance operations, a call centre, and healthcare facilities. The most widespread emergency response model in India is the one you get when you dial 108, managed by the Emergency Management and Research Institute (EMRI), across multiple states. EMRI began operations in Andhra Pradesh in 2005 with a fleet of 30 ambulances in 50 towns of the state. It is responsible for handling medical, police and fire emergencies through the 108 emergency service.
Currently, almost all states and Union territories in India have EMS facilities in various forms. Of the total number of ambulances in any given state, a fraction is equipped with facilities for basic life support or advanced life support.
‘Advanced cardiac life support’ (ACLS) ambulances are the enhanced versions of regular ambulances and provide services to people with cardiac problems and to those who need such care, such as adequate blood circulation and ventilation, during pre-hospital transport.
The equipment on these ambulances should include advanced medical support, including intravenous supplies, cardiac monitors, intubation equipment and ventilators, along with a dedicated intensive care team to manage various conditions like cardiac arrest and stroke. Most ACLS ambulances appear to be available in the country’s urban centres.
A 2020 AIIMS Delhi report on emergency and injury care at district hospitals in India noted that even though 88% of hospitals had in-house ambulances, trained paramedics needed to assist ambulance services were present only in 3%. Availability of specialised care during ambulance transport was particularly poor: only 12% of district hospitals had a mobile stroke/STEMI programme (for heart attacks). Most hospitals also lacked a pre-hospital arrival notification system.
In 2015-2016, approximately two persons died of a heart attack every hour, representing a significant burden on the healthcare system. The AIIMS report recommended a preventive emergency healthcare strategy, like the National Injury Prevention Programme, that included a robust emergency injury care initiative and the installation of automated external defibrillators in places of where people gather in large numbers, such as schools, shopping malls and railway stations.
Government of India guidelines also recommended, as part of its COVID-19 restrictions, emergency medical services at such venues as well as at political rallies, religious festivals, fairs, processions, concerts and plays. But there doesn’t appear to be a stipulation as to the number of ambulances depending on the number of people at a place. EMS and ambulance operators have also confirmed that ambulances are typically provided at the request of local authorities and the police and not because there is a specific rule or policy that requires them to do so.
While larger gatherings, such as the Kumbh Mela, have comprehensive emergency medical services, smaller gatherings like concerts don’t have specific requirements. Such events are mostly commercial in nature and their organisational costs should also provide for a private ambulance service. KK’s loss is tragic. It should spur an in-depth evaluation of emergency medical services at such events in India. Perhaps singers themselves can take the first step by insisting on them.
V. Ramana Dhara is a physician exploring links between health and the environment and has written extensively on disaster medicine. He is on Twitter at @RamanaDhara.