Angels Launch- An Untold Story

The Dream Takes Shape

February 18, 2011, is a day that will forever remain etched in my memory. It was the day we had chosen to launch our dream project ”Active Network Group of Emergency Life Savers (Angels), India’s first community-based ambulance network. The initiative was a bold, pioneering step in pre-hospital emergency care, connecting 20 ambulances initially through a GPS-GPRS system with a centralized console established at the Institute of Palliative Care Medicine , Kozhikode. Later this network grown up to a network of 600 Ambulances state wide .

The project was a Public-Private Partnership (PPP) model, a first-of-its-kind in the region, designed to bring emergency medical care to people’s doorsteps. The vision was clear: to create a robust, technology-driven, life-saving network that could revolutionize emergency response in India.

Our greatest honor was securing the consent of Dr. APJ Abdul Kalam, the former President of India, to inaugurate the project. It was a moment of immense pride and excitement, made possible through the efforts of Dr. PB Salim IAS, the then District Collector of Kozhikode and Chairman of Angels.

With Tagore Centenary Hall chosen as the venue, every detail was meticulously planned. The technical trials had been conducted, and our emergency access number, 102, was fully operational. The city was abuzz with anticipation’s everyone was eager to witness the launch of this revolutionary project.

A Sudden Setback

However, just a day before the launch, an unexpected roadblock shattered our excitement.

At a crucial final planning meeting at Adv. Jairaj’s office on Cherooty Road, Calicut, we received a call from Dr. PB Salim. His voice was heavy.

”Tomorrow’s inauguration will not happen.”

We were stunned, frozen, and speechless. The reason? Political pressure and intervention, particularly from ruling parties and local MLAs, who were determined to sabotage the initiative. There were strong objections and unreasonable interference’s something all too common in Kerala when innovative projects are introduced.

The news hit us like a thunderbolt. We had already announced the launch across press, media, and social platforms. Reverting everything now was not only embarrassing but heartbreaking. Months of relentless work, dedication, and hope seemed to crumble in an instant.

That night was sleepless. The entire board of directors, including Dr. PB Salim, Dr. Meharoof Raj, Sri TA Razak, Adv. Mathew Kattikkana, Adv. Jairaj, Dr. VP Balasubramanian, Adv. Suresh Menon, Sri Janardhanan IPS, Dr. KM Abdulla, Sri Mathew C Kulangara, Dr Supriya and Dr.Ajithkumar VT, Mustafa , and other members were devastated.

Mr. TA Razak placed a reassuring hand on my shoulder and said,

”Don’t worry, something good will come out of this”. But deep inside, we all felt defeated.

A Twist of Fate- A Secret Plan

At 10 AM on February 18, an unexpected call from Dr. PB Salim changed everything.

”All Angels board members should stay close by. Don’t be upset. A surprise is waiting for you”

His words sparked a glimmer of hope. Could there still be a way forward?

By 12:15 PM, another call came from Dr. PB Salim:

“Assemble at the PWD Guest House by 1:30 PM. We will launch Angels there-with Dr. APJ Abdul Kalam himself!”

It was a miracle.

The Historic Moment - Angels Takes Flight

We rushed to the PWD Guest House, hearts racing with excitement. The event was no longer grand, no longer public, but it was about to become one of the most significant and intimate moments in our lives.

At exactly 1:30 PM, Dr. APJ Abdul Kalam arrived. His first words were:

“Where is the life-saving Angels?”

We stepped forward, overwhelmed with emotions.

With his characteristic humility and warmth, Dr. Kalam formally inaugurated Angels in a simple yet profound ceremony. The nation’s Missile Man gave his blessings to what would become a historic milestone in India’s emergency care system.

We presented him with the Angels memento, a token of our deep gratitude. Though the event was scaled down, it became even more special, proving that determination and the right leadership can overcome any challenge.

A Tribute to Dr. PB Salim

This incredible turnaround was made possible only because of Dr. PB Salim IAS. His leadership, courage, and unwavering belief in Angels ensured that no political pressure could stop a noble initiative.

Dr. Salim, you were the guardian angel behind Angels. We are forever grateful for your vision and support.

The Legacy Lives On

Despite its turbulent launch, Angels became a transformative force in emergency medical services. It was India’s first community-based ambulance network, proving that a well-coordinated, technology-driven, and community-supported initiative can save lives.

This story is not just about one event; it’s about resilience, passion, and the will to fight for what is right. It is a reminder that every great initiative faces challenges, but perseverance and teamwork can turn adversity into victory.

February 18, 2011, was not the day Angels was stopped. It was the day Angels truly took flight.

A Simple Venous Thrombophlebitis That Cost a Career: A True Story from an Anesthesia Expert

Introduction

In the realm of anesthesia, precision and dexterity are paramount. Every movement of the hand, every controlled motion of the wrist, and every subtle adjustment determine the success of an anesthetic procedure. But what happens when something as seemingly trivial as an IV cannula placement changes the course of an expert’s career?

https://youtu.be/SZ2TClYz4zI?si=VeedEM3mldHrgSvT

This is the real story of Dr. Joseph (name changed), a senior anesthesiologist who once ruled the operating rooms with his unmatched expertise in spinal anesthesia. His skills were revered, his hands steady, and his experience invaluable. But a simple complication- a venous thrombophlebitis - took away his ability to practice, plunging him into professional, emotional, and financial despair.

The Story of Dr. Joseph(in 2000’s)

Dr. Joseph was a respected anesthesiologist at Calicut Medical College. He had mastered the art of spinal anesthesia, particularly in obstetric and gynecological surgeries, where precision and efficiency were critical. With over four decades of experience, he was the go-to expert for challenging cases.

Even after his retirement, his skills remained in high demand. He continued his practice on a freelance basis at a private hospital, earning his livelihood through the very hands that had served countless patients over the years.

But fate had other plans.

A Routine Surgery That Changed Everything

Like many aging professionals, Dr. Joseph developed an inguinal hernia and decided to undergo surgery at the same private hospital where he worked. The procedure was uneventful, and as part of standard preoperative protocol, an intravenous (IV) cannula was inserted for anesthesia and medication administration.

What seemed like a routine step turned into a nightmare.

Postoperatively, Dr. Joseph experienced excruciating pain- not at the surgical site, but at the IV cannulation site on the dorsum of his right wrist. The pain was unusual, persistent, and far worse than what he expected. On examination, the area showed redness and swelling, signs of thrombophlebitis.

The Unexpected Complication

The initial management was conservative. The IV cannula was removed, topical thrombophob ointment was applied, and analgesics were prescribed. However, despite these measures, the pain did not subside. Days turned into weeks, and his discomfort only worsened.

While his surgical wound healed within a few days, the pain in his dominant wrist continued for months. The very hand that had once performed thousands of precise spinal punctures was now a source of relentless agony.

For six long months, Dr. Joseph was unable to work. Spinal anesthesia demands effortless wrist movements, and his dominant hand was now unreliable, weak, and painful. His profession and his passion was slipping away.

The Aftermath: A Career Cut Short

Dr. Joseph faced not just physical pain but also professional and emotional turmoil. The financial strain of not being able to work was another devastating blow.

For someone who had spent a lifetime perfecting his craft, losing the ability to practice was more than just a setbacks -it was an identity crisis. Despite treatments, physiotherapy, and rest, the chronic pain in his wrist persisted, ultimately forcing him into early retirement.

Take-Home Lesson: The Importance of IV Cannula Placement

Dr. Joseph’s story serves as a crucial reminder for all medical professionals, especially those who rely heavily on their hands for their profession.

Key takeaway:

1)Avoid venous access on the dominant hand whenever possible.

2) If no other options exist, ensure the site is carefully monitored to prevent complications like thrombophlebitis.

3) In individuals who rely on their hands for precise works - surgeons, anesthesiologists, artists, and musicians - alternative IV access sites should always be considered.

Conclusion

A simple IV cannulation site complication might seem minor in the grand scheme of things, but for professionals like Dr. Joseph, it was life-altering. It serves as a powerful lesson in the importance of careful medical decisions, no matter how routine they may seem.

As healthcare professionals, we must always remember that even the smallest decisions can have profound consequences. A thrombophlebitic incident due to IV cannula cost Dr. Joseph his career’s ensure such preventable mistakes do not impact others in the same way.

Reversal Nightmare: Unsolved Questions

Reversal Nightmare: Unsolved Questions

(Disclaimers - drug Images are taken from google images and not related to the story narrated in the blog )

In the year of 1990s and then , as we embarked on our anesthesia careers, we took immense pride in being mentored by the esteemed Prof. M.R. Rajagopal, often hailed as the father of modern anesthesia in Kerala. Our operating theaters (OTs) lacked the advanced monitoring equipment we have today; even a basic cardiac monitor was considered a luxury. We relied on the fundamentals: feeling the pulse with our fingers, placing the stethoscope bell on the patient’s chest, and keeping the earpieces in our ears” -these were our gold standards.

Prof MR Rajagopal

I vividly recall the excitement surrounding the arrival of Kerala’s first pulse oximeter at Calicut Medical College’s Anesthesia Department. Prof. Rajagopal demonstrated its unique, life-saving capabilities. At that time, such a device cost around one lakh rupees. Today, pulse oximeters are ubiquitous, found in homes and even integrated into smartwatches” - a transformation accelerated by the COVID-19 pandemic.

Against this backdrop, I recount a harrowing experience that befell many anesthesiologists, particularly freelancers. Dr. Suresh Kumar K. played a pivotal role in unraveling the mystery behind these distressing events when he was working in a leading private hospital in Kozhikode.

The Incident

Dr. Suresh administered general anesthesia (GA) for a thyroid surgery after a thorough pre-anesthesia check. Fortunately, a cardiac monitor was available during the procedure. The standard practice of the 1990s was followed: induction with thiopentone, intubation under suxamethonium, maintenance with oxygen, nitrous oxide, halothane, and pancuronium as a long-acting muscle relaxant. At the surgery’s conclusion, reversal was achieved using five ampoules of neostigmine combined with two ampoules of atropine to counteract neostigmine’s muscarinic effects.

Dr Suresh Kumar K

Unexpectedly, the patient developed tachycardia, hypertension, ventricular ectopics, and pulmonary edema following the reversal. Dr. Suresh was perplexed; despite meticulous anesthesia management, these complications arose in a young, ASA grade 1 patient without comorbidities. He meticulously reviewed every step but found no errors. Thankfully, he managed the adverse events with appropriate interventions.

Determined to find answers, Dr. Suresh seized all medications used during the procedure, categorized them by batch, and sent samples to a trusted laboratory for analysis.

A Disturbing Pattern Emerges

In the interim, Dr. Suresh presented the case at an anesthesiologist’s forum, seeking insights from peers. Alarmingly, over 15 freelance anesthesiologists shared similar experiences- clinical disasters during anesthesia sessions. Tragically, many of these cases lacked proper pre-anesthesia checks and monitoring. Most resulted in patient deaths, with anesthesiologists attributing the outcomes to their own mistakes. These incidents were often recorded as cardiac arrests due to underlying cardiovascular diseases.

The Revelation

During this period, Dr. Suresh received the laboratory analysis reports. Neostigmine, pancuronium, suxamethonium, and thiopentone were all within normal parameters. However, the analysis of the atropine ampoules was shocking: they contained adrenaline.

Adrenaline is a life-saving drug in critical situations like acute cardiac arrest, acute anaphylaxis, and acute severe bronchial asthma- a fact we were taught meticulously by Prof. Hariharan, our veteran pharmacology instructor. However, when administered inadvertently in place of atropine during anesthesia reversal, adrenaline can precipitate severe cardiovascular complications, as observed in Dr. Suresh’s patient.

Unanswered Questions

This discovery raised several unsettling questions:

1- How did adrenaline come to be mislabeled as atropine?

2- Were there lapses in the pharmaceutical manufacturing process?

3- How widespread was this issue?

4-How many patients suffered or even died due to this error?

5-What measures could be implemented to prevent such incidents in the future?

A Call to Action

Dr. Suresh’s relentless pursuit of the truth not only unveiled a critical pharmaceutical error but also underscored the importance of vigilance, thorough investigation, and open communication within the medical community. This incident serves as a stark reminder of the potential consequences of medication errors and the need for stringent quality control in drug manufacturing.

As we reflect on this episode, it is imperative that we, as healthcare professionals, advocate for:

1)Rigorous quality assurance protocols in pharmaceutical production.

2)Comprehensive reporting and analysis of adverse events.

3)Continuous education and training to recognize and manage unexpected intraoperative complications.

Only through such collective efforts can we hope to prevent similar nightmares in the future and ensure the safety and well-being of our patients.

Mega BLS and Trauma Care Workshop for Student Police Cadets – Kozhikode District

Mega BLS and Trauma Care Workshop for Student Police Cadets – Kozhikode District

Empowering Youngsters in Life-Saving Skills

The Mega Basic Life Support (BLS) and Trauma Care Workshop was successfully conducted on February 14, 2025, at the Indoor Stadium, Kodiyathoor Higher Secondary School, Kozhikode. This remarkable event was a collaborative effort of Aster Volunteers, Angels Volunteers, IMA ELS Kerala State, and IMA CGP Kozhikode Chapter, dedicated to equipping Student Police Cadets (SPCs) with essential life-saving skills.

The event also held special significance as it was linked to the 14th birth anniversary of the Angels International Foundation, an organization committed to emergency medical training and community service.

A Day of Hands-On Learning and Empowerment

With 400 enthusiastic SPCs, 45 instructors, and 40 skill stations, the workshop offered 100% hands-on training, covering a comprehensive range of emergency response skills. The cadets were actively engaged in learning:

✅ Cardiac Arrest Management & BLS (Adult & Pediatric)

✅ Foreign Body Airway Obstruction (FBAO) – Adult & Infant

✅ Cervical Spine Care, Log Roll & Helmet Removal

✅ Splinting & Hemorrhage Control

✅ First Aid for Snake Bites, Burns, Fractures, and Convulsions

The workshop was inaugurated by Sri Dileep, Sub-Inspector of Police, Kuttiadi, who emphasized the importance of equipping young cadets with life-saving knowledge.

Expert Mentors & Dedicated Volunteers

Under the guidance of Master Trainer Dr. Venugopalan P P, a team of expert trainers, doctors, and volunteers worked tirelessly to mentor the SPCs. The dedicated support team included:

🔹 Dr. Balasubramanian, Dr. Baby Supriya, Dr. Jithin GR, Dr. Ijaz, Dr. Riyaz, Dr. Shefin, Dr. Luzetta, Nijila, Dr. Sreelakshmi, Dr. Miral, and Dr. Mehana

🔹 Mr. Muneer MP, Mr. Rajeendran Master, Mr. Musthafa KP, Sarath, Mr. Jesily, Mr. Sajith, Mr. Jabi Mukkam, and other volunteers

Their combined efforts ensured an engaging and impactful session, leaving a lasting impression on the cadets.

Unforgettable Experience & Excellent Feedback

The workshop turned out to be an amazing showcase of enthusiasm and commitment, with the vibrant cadets proving to be the livewire of the event. The hands-on approach received excellent feedback, reinforcing the importance of practical, scenario-based learning in emergency care.

By imparting these crucial skills, the program successfully empowered the next generation of first responders, preparing them to act confidently in critical situations.

Kudos to all the organizers, trainers, and young cadets for making this event a grand success!

https://www.instagram.com/reel/DGDxIRjPUR6/?igsh=eXpwcnBuYXYzajY1

https://www.instagram.com/reel/DGDz5u8v9DA/?igsh=MTc2bGJ6aDMxcW0zZw==

https://www.instagram.com/reel/DGFGWPdCpVx/?igsh=MW9wZTUzMWM4bWp6aA==

https://www.instagram.com/reel/DGGJNALPeS9/?igsh=Ym43Nnl0OW4zcDRh

#BLS #TraumaCare #StudentPoliceCadets #AsterVolunteers #AngelsVolunteers #IMAKerala #ima CGP kozhikode #LifeSavingSkills

A Milestone in Emergency Healthcare: Kerala Government Fixes Ambulance Fare Prices

A Milestone in Emergency Healthcare: Kerala Government Fixes Ambulance Fare Prices

Today marks a significant moment in Kerala’s emergency healthcare landscape as the Government of Kerala has officially released an order regulating ambulance fare prices across the state. This long-overdue decision is a crucial step toward ending the exploitation of patients and ensuring fair, standardized pricing in ambulance operations.

A Struggle That Began Years Ago

The need for fare regulation in ambulance operations is not new. Angels International Foundation, an award-winning NGO dedicated to community-based ambulance networks since 2011, raised this issue as early as 2014. The foundation actively advocated for fare fixation and formally represented proposals before Justice Ramachandran Nair’s committee and the state government.

Despite the urgency of the matter, successive governments failed to act, caught in a web of bureaucratic delays and hesitation to confront the powerful ambulance operators. Over the years, these operators have grown into a mafia-like network in Kerala, with decorators and syndicates controlling ambulance services. The field has been riddled with malpractices, unethical pricing, and financial exploitation of patients during medical emergencies.

A Bold and Much-Needed Decision

In this context, the current Kerala government’s bold move to regulate ambulance fares deserves special recognition. This Government Order (G.O.) is a milestone in establishing ethical and standardized operating procedures for emergency vehicles. By implementing this policy, the government is not only protecting patients from financial exploitation but also bringing accountability and transparency to ambulance services in the state.

This decision sets a precedent for other states to follow and reflects a much-needed shift toward patient-centric emergency care. While challenges in implementation remain, this is a major victory for healthcare accessibility and fairness.

Kudos to the Kerala Government for finally taking this crucial step. Now, the focus should be on strict enforcement and continuous monitoring to ensure that the intended impact reaches those who need it the most - the patients.

A New Year to Remember: A Musical Comedy Dance Theatre to Cherish

A New Year to Remember: A Musical Comedy Dance Theatre to Cherish

The New Year brought an exciting and unforgettable experience for me. Along with my best half, Dr. Supriya, I had the privilege of performing in a musical comedy dance theatre at the IMA Hall, Kozhikode. It was a unique blend of music, humor, and storytelling that took the audience through a lighthearted yet meaningful journey- one that reflected not just our personal experiences but also the essence of our professional lives.

The script was masterfully crafted by Dr. Kamal and Dr. Neethu, who ensured that every scene resonated with the audience, blending humor with subtle emotional undertones. Mr. Sudhi Kadalundi’s choreography was nothing short of brilliant, bringing energy, rhythm, and synchronization that made the performance stand out.

We were joined by an incredible team of talented performers- Drs. Lovena Mohammed, Yumna Parerkutty, Fida, and Amal Pulickal- who added vibrance and depth to the show. Together, we brought to life a performance that was both entertaining and reflective of our shared experiences in the medical field.

The ten-minute spectacle was met with tremendous applause, and the overwhelming appreciation from the audience made all the effort and rehearsals truly worthwhile. It was a refreshing start to the year, blending passion with creativity, and sharing moments of joy with colleagues and friends.

For those who missed the performance, here is the YouTube link to relive the fun and excitement: [https://youtu.be/FDDU515ET-E?si=OfMz4mwGN31vdi2W]

Looking forward to many more such creative endeavors in the future!

Empowering Young First Responders: First Responder Training for SPC at Kodiyathoor

Empowering Young First Responders: First Responder Training for SPC at Kodiyathoor

The ability to save a life is one of the greatest skills one can possess. With this vision, Aster Volunteers, Angels, IMA ELS, and IMA CGP Kozhikode are coming together to host a First Responder Training for the Student Police Cadets (SPC) at Kodiyathoor on February 14, 2025.

This large-scale training initiative will equip 400 SPC cadets with essential life-saving skills, including Basic Life Support (BLS), Trauma Life Support, and First Aid. These young cadets will learn the critical techniques required to respond effectively in emergencies, making them valuable assets to their schools and communities.

The training will be conducted using a stage demonstration followed by hands-on skill sessions at 40 dedicated skill stations, each managed by a team of 40 expert instructors. This interactive, practical approach ensures that every participant gains real-time experience and confidence in handling medical emergencies.

By empowering these cadets with life-saving knowledge, we are not only enhancing their personal skillsets but also building a stronger, safer society where prompt and effective emergency response can make a difference.

This initiative reflects our commitment to spreading awareness, strengthening emergency preparedness, and fostering a culture of compassionate first responders among the younger generation. Looking forward to an impactful day of learning and empowerment!