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Untold Story of Chennai Floods 2015: A Mission of Rescue, Relief, and Recovery

The 2015 Chennai floods remain etched in history as one of the most devastating natural disasters to have struck the city. Triggered by heavy rainfall from the northeast monsoon between November and December, the catastrophe claimed over 500 lives and displaced more than 1.8 million people. The economic impact was staggering, with losses estimated between ₹200 billion (US$2 billion) and ₹1 trillion (US$11 billion), making it one of the costliest disasters of that year.

A Call to Action: Rising to the Challenge

As responsible citizens, we decided to extend our support to Chennai during its most critical hour, both in the acute phase of disaster relief and potentially in the rehabilitation phase. Under the visionary leadership of Dr. Azad Moopen, Chairman of Aster DM Healthcare, and through the global initiative Aster Volunteers, we mobilized resources and expertise to provide immediate medical assistance. Although Aster Volunteers had not been formally established in 2015, the spirit of humanitarian service was deeply ingrained in the ethos of Aster DM Healthcare.

At that time, I was serving as the Director of Emergency Medicine at Aster DM Healthcare, coordinating emergency medicine activities across Aster institutions in India, including Aster MIMS Calicut, Aster MIMS Kottakkal, Aster Medcity Kochi, DM WIMS, and Aster CMI Bangalore. The group's CEO, Dr. Harish Pillai, was highly committed to social initiatives, and his proactive leadership enabled us to act swiftly.

Dr Harish Pillai 

Initial Challenges: Navigating Chaos and Political Realities

In the initial days, access to Chennai was virtually impossible due to submerged roads and disrupted communication networks. Three days after the flooding began, I managed to contact some of my Emergency Physician (EP) colleagues in Chennai, including Dr. Tausif Thanganvadi, Dr. Sai Surendran, and Dr. Adil. They painted a grim picture—while rescue and relief efforts were reasonably efficient within the metropolitan limits, the outskirts and suburbs of Chennai were in a state of complete neglect. No medical attention was reaching the camps located in these peripheral areas.

Dr Tausif Thanganvadi - Renowned EP and well-known Radio Jockey in Chennai, played a pivotal role in Chennai flood relief 

Dr. Sai also warned us about a potential challenge—local political parties might intercept relief materials and forcibly rebrand them with political symbols or the image of the then Chief Minister. He advised that if we encountered such situations, we should comply and avoid resistance, as tensions could escalate into violence.

On the way to Chennai 

Mobilizing the Medical Relief Team: A Herculean Effort

Recognizing the urgency, we assembled a 48-member medical relief team comprising:

The medical Aid team for the Chennai floods 2015 from Aster DM Healthcare 

• 20 Doctors: Emergency Physicians, EM residents, Family Physicians, Pediatricians, and General Physicians.

• 15 EMS Personnel and Nurses

• 5 Pharmacists

• 4 Driver-EMS Personnel

• 4 Ambulance Assistants

The team was drawn from Aster MIMS Calicut, Aster MIMS Kottakkal, and Aster Medcity Kochi. We procured essential medications worth ₹25,00,000, including antibiotics, painkillers, oral rehydration salts (ORS), anti-diabetics, anti-hypertensives, and other necessary drugs. Along with life-saving equipment and medical camp gadgets, we hired a bus and mobilized three ACLS Mobile ICUs for the mission.

Mission Chennai 2015

The Journey to Chennai: A Mission Begins

On December 9, 2015, at 4:00 PM, the mission was flagged off by Mr. Babu Parasala, Kozhikode District Panchayat President, in the presence of Sri V.M. Vinu, a renowned film director, Mr.Kamal Varadoor the President Press Club and Mrs. Sudheera K.P., a celebrated writer. Senior administrators from Aster MIMS graced the occasion. By 7:00 PM, we crossed the Kerala border, with real-time updates being provided by Dr. Sai Surendran, who used his influence in Tamil Nadu to ensure safe passage and smooth coordination.

Mission Chennai 2015 , Flagged off by Sri Babu Parassala 

Connecting with Ground Reality: Partnering with Local Heroes

Upon entering Chennai, we were connected to Mr. Zikander, the head of a dynamic NGO - India Thowheed Jumaah(INTJ) actively involved in flood relief operations. His team had extensive knowledge of the ground reality in the outskirts of Chennai, where medical relief was either lacking or minimal. They had ample supplies of food, water, clothing, and utensils but lacked adequate medical aid.

Mr Zikkander Bai( Black shirt), who coordinated the camps locally 

Mr. Zikander’s team welcomed us with open arms, providing comfortable accommodation and food. His volunteers treated us like family and took us to various flood-affected villages in the suburbs of Chennai, where medical assistance was desperately needed.

Conducting Medical Camps: Bringing Relief to the Forgotten

Campsites

Over the next 7 days, we conducted 5 to 6 medical camps daily, with an average attendance of 200 to 300 patients per camp. This meant that we attended to over 1,000 patients every day and served nearly 10,000 patients during the mission. Several mosques and schools had been converted into makeshift camp sites. The primary health issues we encountered included:

• Skin infections, especially fungal

• Respiratory tract infections

• Gastrointestinal infections

• Exacerbation of diabetes and hypertension

• Trauma and fractures

• Asthma and COPD exacerbations

• Convulsions and hypoglycemic attacks

• 

  Media coverage 

The Epidemic Scare: A Critical Intervention

We identified 18 cases of pediatric diarrheal disease in two campsites. According to national guidelines, any cluster of more than five such cases in a single site during a disaster scenario warrants notification and investigation. However, when we attempted to report the cases, we faced significant resistance from local authorities and district medical officials. They were hesitant to notify the outbreak, fearing government action and negative media attention.

Pediatric gastroenteritis -Epidemics 

Large numbers of pediatric cases were reported 

This placed us in a moral dilemma—to report and face possible local hostility or stay silent and compromise public health. Thankfully, Dr. Tausif took charge and directly reported the situation to national authorities. Within five minutes, directions came from national authorities to the state and district authorities, initiating an epidemic investigation and immediate disinfection efforts for local water sources. Thanks to these efforts, no mortality was reported from this outbreak.

Dr Sai Surendar Chennai coordinated and arranged a reception for all team members in Chennai

A Mission Fulfilled: Gratitude and Recognition

After completing 7 days of intense service, we returned to Kerala with a sense of deep satisfaction and gratitude. The Emergency Physicians of Chennai, under SEMI Tamil Nadu, organized a special reception for our team, where all EPs of Chennai were present. Later, at the national level, SEMI awarded Aster DM Healthcare and me the "Bravery Award 2015" for our commitment and contribution.

SEMI Bravery Award 2015

A Moment of Lasting Bond: Chennai Honors Kerala’s Heroes

Three months after the floods, a team from Chennai led by Mr. Zikander traveled to Kochi to felicitate and honor all the warriors from Kerala who supported Chennai during its darkest hour. The event was held at Aster Medcity Kochi, marking a moment of heartfelt gratitude and lasting friendships.

A memento from INTJ-an NGO supports conducting medical Camps in outreach Chennai

Conclusion: An Everlasting Memory

The 2015 Chennai floods left behind a trail of destruction, but they also revealed the power of humanity and compassion. Our mission not only provided immediate relief but also helped contain a potential epidemic, ensuring the safety of thousands. The memories of this mission continue to inspire us, reminding us that in the face of adversity, true service lies in standing by those in need.

National CME/Workshop on Lesson learned in Chennai floods Conducted in Kochi. Dr Tausif, Dr Venu, Dr Sai Surendar ,Dr Adil , Dr Renuka  

"Service to humanity is the best work of life." Our Chennai mission was a testament to that philosophy, and its lessons will resonate forever in our hearts.

Received memento from TN Governor Rosayya, courtesy to Dr Narendranath Jena 

A True Story of Sabarimala Sanjeevini: A Life-Saving Mission That Transformed Pilgrim Safety

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A True Story of Sabarimala Sanjeevini: A Life-Saving Mission That Transformed Pilgrim Safety 

Introduction

Sabarimala, a majestic mountain nestled in the Western Ghats of Kerala, India, is home to the Sree Dharma Sastha Temple, dedicated to Lord Ayyappa. This sacred site attracts over 50 million visitors annually, making it one of the largest pilgrimage destinations in the world. Perched 4,133 feet above sea level, Sabarimala is surrounded by 18 lush green hills and is located within the Periyar Tiger Reserve, a biodiversity hotspot.

Trek way to Sabarimala 

Situated in the Ranni-Perunad village, Pathanamthitta district of Kerala, the temple opens only during specific seasons—Mandala Pooja (mid-November to late December), Makaravilakku (January 14), Maha Thirumal Sankranti (April 14), and the first five days of each Malayalam month. The Sabarimala pilgrimage is not just a religious journey but also a test of faith, endurance, and devotion.

A Test of Faith and Physical Endurance

Unlike most other temples, Sabarimala is accessible only by foot. Devotees, known as Ayyappans, undertake a 41-day Vratham (austerity and self-discipline period) before making the trek, abstaining from meat, alcohol, tobacco, and personal indulgences. Pilgrims wear black or blue clothing, walk barefoot, and carry the 'Irumudi Kettu' (a sacred travel kit with offerings for Lord Ayyappa).

The trek to the temple involves navigating steep forest routes, rocky terrain, and physically exhausting climbs. While spiritually fulfilling, the journey also presents significant health risks—a challenge that led to the implementation of the Sabarimala Sanjeevini Mission.

Health Challenges During the Pilgrimage

Despite its religious significance, the pilgrimage poses serious health hazards due to the physical exertion, extreme weather, overcrowding, and lack of timely medical intervention. Several studies highlight the high incidence of medical emergencies among devotees.

Alarming Health Statistics

• 43.4% of pilgrims reported experiencing at least one health issue during their journey.
• The patient presentation rate at health centers (2014–2017) was 4,999.6 per 100,000 pilgrims.
• Hospital referral rate: 19 per 100,000 pilgrims.
• Mortality rate at health centers: 18.5 to 21 per 100,000 pilgrims.
• Coronary Artery Heart Disease (CAHD) accounted for 97.6% of fatalities, though it reduced slightly to 85.1% over three  years
• https://www.sciencedirect.com/science/article/abs/pii/S1477893920302738

Recent Reports on Pilgrim Fatalities

During the 2023–24 Mandala Pooja season, 24 deaths were reported due to heart attacks. Although emergency medical camps were set up along the pilgrimage routes, the sheer volume of devotees and the intense physical strain made cardiac complications a serious concern.

https://english.mathrubhumi.com/news/kerala/24-devotees-died-of-heart-attack-during-mandalam-season-in-sabarimala-1.8173651

Common Health Issues Among Pilgrims

1. Cardiovascular Problems: Many middle-aged and elderly devotees suffer from undiagnosed or unmanaged heart conditions, leading to sudden cardiac arrests.
2. Dehydration & Heat Stroke: The combination of humidity, exhaustion, and inadequate hydration increases the risk of heat-related illnesses.
3. Respiratory Distress: Dust, high-altitude oxygen variations, and overexertion trigger respiratory illnesses and asthma attacks.
4. Musculoskeletal Injuries: Pilgrims frequently experience sprains, fractures, and slips due to the rugged terrain.
5. Infections & Gastrointestinal Disorders: Unhygienic food, lack of clean drinking water, and improper sanitation lead to diarrhea, food poisoning, and infections.

Sanjeevini Mission: A Lifesaving Initiative for Pilgrims

Between 2013 and 2016, I was fortunate to be associated with the Sabarimala Sanjeevini Project, a public-private partnership (PPP) model aimed at saving lives through quick response, resuscitation, and pre-hospital emergency care for collapsed devotees.

The Need for Sanjeevini

Before Sanjeevini, emergency medical care was limited to two cardiology centers—one at Pamba and another at Sannidhanam, with an additional center midway. The trekking path is approximately 4–5 km uphill or downhill, making it extremely difficult for emergency patients to reach medical aid.

Cardiology Center in Sabarimala

When a pilgrim collapsed due to cardiac arrest, reaching the nearest cardiology center was often impossible in time, leading to irreversible cardiac conditions and fatalities. The actual death rates were much higher than documented in government records, as proper emergency response mechanisms were lacking.

Implementation of the Sanjeevini Project

Hands-on training in life-saving skills at Sabarimala from 2013 to 2016

The Sanjeevini project introduced a structured emergency response system, including:

• Training for Ayyappa Seva Volunteers & Police in:
  • Basic Life Support (BLS)
  • AED Operations
  • Trauma Transport Principles
  • Disaster management
  • First Aid for Snake Bites, Burns, Syncope, and More
• Deployment of Emergency Care Centers every one kilometer along the trekking route, equipped with:
  • AEDs (Automated External Defibrillators)
  • CPR Equipment
  • Glucose Monitoring Kits
  • Oxygen Therapy Facilities
• Round-the-Clock Emergency Response:
  • Two ANGELS EMCT volunteers stationed at each emergency care center.
  • One ACLS ambulance and five BLS ambulances positioned at Pamba for critical patient transport to Kottayam Medical College (the nearest tertiary care facility).
• 260 Hours of Specialized Training for Emergency Medical Technicians (EMTs) to handle critical on-scene emergencies.

  

  The team received special training in disaster management from SDMA

  
  

Key Contributors to the Mission

Dr Saiju - On the extreme left side was the man who supported the project passionately 

This mission was possible due to the dedicated efforts of:

• Dr. Shaiju (NRHM Program Coordinator)
• Dr. Devakiran (District Medical Officer, Pathanamthitta)
• Justice Sri. Babu (Special Commission for Sabarimala Affairs)
• District Collector Sri. S Harikishore IAS, who officially recognized the impact of the mission.
• ANGELS EMCT volunteers, Aster DM Healthcare EMS Team, and Emergency Medicine Residents from Aster Group of Hospitals, Kerala.

Impact of Sanjeevini Mission

Prior to 2013, emergency care in Sabarimala was uncoordinated and ineffective. After meeting Justice Sri. Babu, I explained the urgent need for a structured emergency response. He issued a judicial order to implement a life-saving mission in Sabarimala, leading to the successful deployment of Sanjeevini in 2014 and 2015.

Quality time with Justice Babu - He made the palpable changes in emergency care in Sabarimala 

The project:

• Saved 15–25 lives per year during the pilgrimage season.
• Prevented 150+ morbidities annually.
• Created a blueprint for emergency response models in large-scale religious pilgrimages.

• 

  The district collector officially recognized the efforts   

However, in 2016, a new government took office, and the Sanjeevini project was discontinued due to policy changes.

Conclusion

The Sabarimala Sanjeevini Mission was a pathbreaking initiative in emergency medical response for mass religious gatherings. The PPP model effectively mobilized government support, private healthcare expertise, and trained volunteers to save lives.

While the project may no longer be operational, its impact remains undeniable. As a devotee of Lord Ayyappa, I feel truly blessed and honored to have led and contributed to this life-saving mission.

The media reported the efforts vividly

Final Thought:

Sabarimala is not just a spiritual journey—it is a test of resilience. Pilgrims must prioritize their health, while authorities must continue investing in emergency response systems to prevent avoidable tragedies.

"Faith and safety must go hand in hand."

                                      "Swamy Saranam"

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EMCON 2013: The Untold Story of Rapid Action and Evacuation in the History of Medical Conferences

The year 2013 remains one of the most unforgettable milestones in my career. As the Chairman of the Organizing Committee and the President of SEMI Kerala, I was entrusted with the enormous responsibility of organizing EMCON 2013, India’s biggest Emergency Medicine Conclave, under the aegis of the Society for Emergency Medicine in India (SEMI). This was a daunting task, but I was fortunate to have an extraordinary and committed team by my side.

EMCON 2013 Leads

 Our core team included Dr. Zulfikar Ali, Dr. Fabith, Dr. Pradeep R, Dr.Sajith Kumar, Dr.Hafeez, Dr. Abeer, Dr. Jinesh V, Dr. Ramkumar, Dr. Rahna, Dr. Prem Sankar Pandyan, Dr Ramani Dharan,Dr.Nihar Lokur, Dr. Kabeer,Dr. Binu Kuriakose, Dr. Shafi Ijaz, Dr Samsekhar , Dr Botla ,Dr Jiju ,Dr. Alex, Dr. Renuka, Dr. Jasir VP, Dr. Yasser Chomayil, Dr. Firoz, Dr.Javad, Dr . Lajeesh , Dr . Obaid, Dr Shihana, Dr Faheez and many others. Our EMS team, led by Augustine, Binto Baby, and Jefsin, played a crucial role in the event’s success.

EMCON 13 campaign started in Delhi EMCON 2012, and DR.Jena was the first registrant for EMCON 2013

The SEMI National President, Dr. Tamorish Kole, and Immediate Past President (IPP), Dr. VP Chandrasekhar, entrusted me with this mission, and with the unwavering support from the SEMI National Board and past presidents, we ensured global participation. Dr. Narendra Jena served as the Vice Chairman of the program. The event was hosted at Vythiri Village, a newly constructed resort in Wayanad, Kerala, a stunning yet logistically challenging location, approximately 70 km from Calicut, the nearest metro city with an airport and railway connectivity. The event received generous support from Dr. Azad Moopen, Chairman of Aster DM Healthcare, ensuring financial stability and smooth execution.

EMCON 2013 Venue and access to Conference hall
https://www.vythirivillage.com/

A Groundbreaking Medical Conference

EMCON 2013 was meticulously planned as a three-day conference, featuring 1,200 registered participants and 10 well-attended pre-conference workshops. However, the highlight of the event was the Road Show, a groundbreaking awareness initiative in the history of medical conferences. Spearheaded by Angels (Active Network Group of Emergency Life Savers) EMCT volunteers, the EMCT coordinator Munir MP and his team, along with Mr. Pradeep Hudino, the renowned magician, transformed this campaign into an unforgettable experience.

Statewide emergency medicine public awareness roadshow, which demonstrated life-saving skills and accident care skills in front of the lay public 
YouTube video of complete roadshow done in EMCON 2013

The roadshow commenced in Trivandrum and traveled across 14 districts, covering 102 locations, both rural and urban. Operating under the motto "Caring People, Bridging the Gap," this initiative generated widespread public awareness about Emergency Medicine, a specialty that was relatively unknown at the time. Looking back, I strongly believe that this campaign played a crucial role in shaping the future of emergency care in Kerala. Today, Kerala has the highest number of emergency physicians in the country, and its emergency care services surpass many other states in both quality and accessibility. However, the road to success was not without its challenges.

Padma Awardee, Father of Palliative care medicine in India Prof .MR Rajagopal delivering Key note address in EMCON 2013

Behind the grand success of EMCON 2013 lay a frightening and nerve-wracking crisis, a test of our skills as emergency medicine professionals and crisis managers.

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The Crisis: A Sudden Harthal That Threatened Everything

Kerala has long been infamous for sudden Harthals (public strikes) that disrupt public transportation and daily life. These shutdowns, frequently called by opposition political parties, often escalate into violence, roadblocks, and destruction of property. Many of these protests are orchestrated by hooligans, resulting in injuries, hospitalizations, and even deaths due to lack of access to medical care.

Emcon 2013 Banners and flyers. The flyer caption for the Disaster management workshop was "Expect the unexpected! " . And incidentally, it came true 

Given Wayanad’s geographical isolation, accessible only via steep, winding roads with dangerous hairpin bends, our primary challenge was transporting international and national delegates from Calicut to the conference venue safely.

The Unexpected Disaster

Our conference was scheduled for Friday, Saturday, and Sunday, with most delegates and faculty arriving on Thursday and Friday. As we finalized our preparations at MIMS Hospital, a shocking TV flash news broke at 4 PM on Thursday—the release of the Madhav Gadgil Report on Western Ghats. The report emphasized environmental conservation, calling for stringent restrictions on activities harming the ecosystem.

https://scienceindiamag.in/madhav-gadgil-report-in-a-nutshell/

This triggered an immediate backlash. Opposition parties, including LDF and other political groups, declared a state-wide lightning strike and Harthal for Friday. Our worst fears had materialized overnight.

https://economictimes.indiatimes.com/news/politics-and-nation/ldf-hartal-over-western-ghats-report-hits-normal-life-in-kerala/articleshow/25995700.cms?from=mdr

Assessing the Risks

With 1,200+ delegates, including 150 international faculty members, expected to travel to Wayanad overnight, we faced an imminent crisis:

• Political mobs were already blocking roads, setting fires, and throwing stones at vehicles.
• Police and political leaders were uncooperative, providing only vague responses.
• By 10 PM, reports confirmed that road violence had begun.
• Waiting until morning posed severe risks—delegates could be stranded, attacked, or completely unable to reach Wayanad.

This was an emergency within an emergency, and as Emergency Medicine professionals, we had to act with speed and precision—just as we do in disaster situations.

---

The Emergency Evacuation Plan

At 5 PM, I gathered my core team and made a decisive call:

"We are Emergency Medicine people. We manage disasters. This is a disaster. We have 3-5 hours to act. From now on, we are in disaster mode. Start transportation immediately!"

Our Action Plan:

1. Set Up a Safe Meeting Point:

   • All delegates and faculty were instructed to assemble at Hotel Copper Folio on the bypass road in Calicut.

2. Mobilize Maximum Transport Options:

   • 15 buses were arranged by Mr. Mubashir (Air Travels India) and Dr. Kabeer.
   • 15-20 Angels ambulances were deployed as emergency transport vehicles.

3. Execute Rapid Evacuation:

   • Transport began at 5 PM sharp—buses left as soon as they filled.
   • By 9 PM, the last bus departed Calicut.
   • Most buses cleared Wayanad’s hilly terrain before 11 PM.
   • The last few vehicles faced minor troubles—some stone-pelting incidents occurred, and one driver was manhandled.
   • Fortunately, all delegates and faculty were transported safely.

By 3 AM on Friday, the evacuation was complete. By 8:30 AM, EMCON 2013 started on schedule!

After the massive evacuation plan, we finished the final setup early in the morning at 3 am and checked the final arrangements and the functioning of the auditorium. The man with the Black shirt is Mr.Mubashir, who coordinated the transport system

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A Hard-Learned Lesson

EMCON 2013 was not just a conference—it was a test of resilience, teamwork, and emergency crisis management in real time. This experience reinforced the idea that Emergency Medicine is more than just hospital care; it’s about rapid decision-making, leadership, and executing complex operations under extreme uncertainty.

The entire conference was portrayed vividly by the Magazine Color Doppler

However, this experience also left a lasting impression. That day, I made a solemn pledge:

"In the future, I will not take the lead in organizing an international event in Kerala—a state totally unpredictable in terms of Harthals."

Since 2016, Harthals have significantly reduced, primarily due to LDF’s governance, which has curtailed opposition-led strikes. However, the unpredictability of Kerala’s socio-political landscape remains a persistent concern.

The whole event was well-covered by the media 

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Final Thoughts

EMCON 2013 was a landmark event in the history of Emergency Medicine in India. The Road Show, the awareness campaign, and the conference itself played a key role in transforming Kerala into a pioneering state for emergency care. However, the successful evacuation of 1,200+ delegates amidst a violent Harthal remains an untold story of teamwork, resilience, and strategic crisis management.

This incident reaffirmed a fundamental truth—

"Emergency Medicine is not just about treating patients. It's about being prepared for anything, anytime, anywhere."

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The Evolution of POCUS in Emergency Medicine: A Journey from Resistance to Revolution

The Evolution of POCUS in Emergency Medicine: A Journey from Resistance to Revolution

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The Modern-Day Visual Stethoscope

In today’s emergency departments (EDs), a Point-of-Care Ultrasound (POCUS) machine is no longer a luxury—it is as essential as a stethoscope. Often referred to as the "visual stethoscope," ultrasound has become an indispensable tool in emergency medicine. Modern EDs are now equipped with multiple probes, making POCUS an integral part of primary surveys, procedural guidance, and critical decision-making. From vascular access and nerve blocks to joint aspirations and trauma assessment, ultrasound has become an inseparable companion in emergency care.

However, the journey to integrating POCUS into emergency departments was not always smooth. It took years of advocacy, training, and persistence to overcome resistance and skepticism from hospital administrations. My own journey with POCUS began in 2007, and it has been a story of persistence, belief, and transformation.

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The Beginning: My First Encounter with FAST

My first exposure to POCUS was in 2007, when I learned about the Focused Assessment with Sonography in Trauma (FAST) exam. To gain hands-on expertise, I underwent formal training in FAST ultrasound at Al Ain University, UAE. I was fortunate to be accompanied by esteemed colleagues—Dr. Babu Palatty, Dr. Sunitha, Dr. Tamorish, and Dr. Ashish Nandi—all of whom shared a common vision of bringing ultrasound into Indian emergency medicine practice.

This training was made possible by Dr. George Abraham, Chairman of IIEMS, who sponsored our participation. Dr. George was a visionary leader who played a pivotal role in the early days of Emergency Medicine (EM) development in India. His commitment to training and innovation laid the foundation for the integration of ultrasound into emergency care.

Dr George Abraham and Dr.Giji Abraham -A family contributed significantly in the inception of Emergency Medicine in India 

Upon returning to India, I was determined to incorporate FAST ultrasound into trauma protocols. At MIMS (now Aster MIMS), we had a portable ultrasound machine—Sonosite Micromaxx—which was shared between the ICU, anesthesia, and emergency department. However, accessing the machine was a bureaucratic challenge. The Managing Director (MD) controlled its usage, and a designated staff member held the key. Every time we needed the machine, we had to go through a lengthy approval process, making real-time emergency scans difficult.

POC machine, which was used in a common pool

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The Struggle for an Exclusive Emergency Ultrasound Machine

Recognizing the critical need for a dedicated POCUS machine in the ED, I proposed acquiring an exclusive ultrasound unit for the department. However, in 2010, this idea was met with strong resistance. The MD outright rejected the proposal, questioning how the hospital would recover the ₹18 lakh investment.

Determined to push forward, I restructured my proposal to demonstrate financial feasibility. I suggested:

1. 60% of the cost could be covered from the MEM (Master of Emergency Medicine) program fees, which was already generating revenue.
2. 40% could be funded by the hospital, ensuring minimal financial strain.
3. Each ultrasound scan could be charged as low as ₹300, ensuring cost recovery within 2-3 years.
4. As a personal assurance, I even offered to pledge my salary as a guarantee for the investment.

Despite this well-reasoned approach, the MD remained unconvinced, and the proposal stalled.

---

Breaking the Barriers: The Chairman’s Intervention

Realizing that a breakthrough was necessary, I escalated the proposal directly to the Chairman, Dr. Azad Moopen. During his next visit to Calicut, he convened a boardroom meeting to discuss the matter. The attendees included:

• Dr. Abdulla
• Prof. K.K. Varma
• Engineer Abdul Rahman
• Engineer Salahudhin
• CFO Jayakrishnan
• Other board members

The Chairman invited everyone to share their perspectives. I presented my case again, emphasizing the clinical and financial viability of having an exclusive POCUS machine in the ED. While the MD remained silent and the CFO stayed neutral, I persisted in making a strong case for its necessity.

Finally, the Chairman made a decisive statement:

“Abdulla, why don’t we give this machine to Dr. Venu? As an end-user, he is confident that it will be useful and successful. In that case, we must give them a quality machine with high-end features. We must give the M-Turbo from Sonosite.”

With this, the decision was made. The MD nodded in agreement, and the CFO approved the funding.

Sonosite -M Turbo

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A Landmark Achievement: India’s First Exclusive ED POCUS Machine

This historic decision led to MIMS Emergency Medicine Department receiving India’s first exclusive POCUS machine. The Sonosite M-Turbo became a game-changer, transforming emergency care at MIMS and setting a precedent for other hospitals across India.

First USG machine for the Emergency medicine department in MIMS Calicut 
Prof .Jeffry Smith ( Director International EM -GWU) launched it . Dr Abdulla Cherayakkatt nearby

Today, we no longer struggle for ultrasound access. We now have the luxury of two ultrasound machines in our Calicut ED, and all rural emergency centers are also equipped with POCUS machines. What was once a dream and a battle for acceptance has now become a standard of care.

Magazine Color Doppler portrayed the story vividly

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The Future of POCUS in Emergency Medicine

Looking back, the journey from skepticism to widespread adoption has been inspiring. Today, POCUS is:
✅ An essential tool in emergency care
✅ Used for rapid diagnosis in trauma, cardiac arrest, and shock
✅ A standard for procedural guidance in vascular access, nerve blocks, and more
✅ A cost-effective investment with significant returns in patient outcomes

I am deeply grateful to Chairman Dr. Azad Moopen and the Board of Directors for their vision and trust in this initiative. Their support in those early days helped lay the foundation for modern emergency medicine in India.

Chairman Dr Azad Moopen

As emergency medicine continues to evolve, POCUS will remain at the forefront, ensuring faster, safer, and more effective patient care. The visual stethoscope is here to stay, revolutionizing emergency medicine for generations to come.

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Final Thoughts

This story is not just about acquiring a machine—it is about challenging resistance, pioneering change, and transforming emergency medicine. The journey of POCUS in Indian emergency departments is a testament to the power of perseverance, vision, and innovation.

To all aspiring emergency physicians, I say this: Never stop advocating for what improves patient care. The road may be difficult, but the impact is worth it.

In 2010, the MIMS emergency Medicine department conducted a 3-day workshop for ER doctors. Prof Keith Boniface (Emergency Ultrasound director - GWU) leading the hands-on session 

After a decade in 2020, an Exclusive USG machine in a rural emergency room at Malappuram. Ex minister  and MLA Sri.P K Kunhali Kutty  inaugurating  

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The Story of India's First Makeshift ICU: A Journey of Pain and Gain During the Second Wave of COVID-19

The COVID-19 pandemic shook the world in every possible way—mentally, socially, and economically. The first wave instilled deep apprehension, amplified by the media, leaving people shattered and locked in fear. However, it was the second wave that truly tested the resilience of India's healthcare system, bringing hospitals to their breaking point.

The Beginning: A Call to Action

At the time, I was leading the Emergency Medicine Department at Aster MIMS Calicut. Our emergency department had 35 beds, including a 10-bed Acute Care Unit (ED ICU). The Medical ICU (MDICU), under the able leadership of Dr. Mahesh, had 30 beds dedicated to critical care with ECMO facilities. The hospital's COVID-19 surveillance team, led by Dr. E.K. Suresh Kumar, ensured strict adherence to protocols and guidelines.

Dr Mahesh and Dr Suresh Kumar EK

In April 2021, warnings from the national government indicated an impending second wave—one that would be stormy and overwhelming. Our team at Aster MIMS took proactive steps, reserving 50% of MDICU beds for COVID patients and setting up First Line Treatment Centers (FLTCs) in hotels and hostels for milder cases. However, as we braced for impact, we knew these efforts might not be enough.

Then, I received an unexpected phone call from Dr. Azad Moopen, our Chairman. His words were direct and urgent:

Dr Azad Moopen

"Venu, I have a suggestion. I’ve seen makeshift ICUs and field hospitals in war zones. The second wave is coming, and our current ICU capacity may not be sufficient. If we set up a makeshift ICU in a car park or another suitable location, it could save lives. Would you take the lead?"

Hearing this concept for the first time, I immediately recognized its potential. It was novel, urgent, and necessary. Without hesitation, I responded:

"Yes, sir, we will do it. I will lead this effort with pleasure. We have a very supportive CEO here. Please ensure the final approval, and we will make it happen immediately."

Building the Makeshift ICU: A Race Against Time

Within 30 minutes of my conversation with Dr. Azad, our CEO, Mr. Farhan Yaarsin, arrived in the Emergency Department with key personnel—Mr. Liju, our chief of projects and engineering, and Mr. Aneesh, head of biomedical services. The plan was set into motion at lightning speed.

Team leads - Mr Farhan( CEO), Mrs.Sheelamma (CNO), Mr Briju Mohan ( Group HR Head), and Mr.Liju( Project and Engineering Head

We identified the ideal site for the makeshift ICU, ensuring it would include:

1. 10 high-end ICU beds equipped with ventilators, monitors, ABG machines, HFNC devices, BiPAPs, and other essential COVID-management equipment.
2. Dedicated rooms for donning and doffing PPE, Audio-visual controlled counseling room, and utilities to maintain strict infection control.
3. A fully air-conditioned setup to ensure patient and staff comfort.

Mr. Liju assured us the ICU would be operational within a week, while Mr.Briju, our HR head, expedited the recruitment of additional emergency physicians, nurses, and EMTs. Simultaneously, we launched advanced COVID-19 training programs for our existing staff, covering intubation, ventilator management, prone positioning, and crisis communication.

Within just one week, we established three Acute Care ICU units exclusively for COVID-19 patients—10 beds in the ED ICU (Acute Care 1), 10 beds in the makeshift ICU (Acute Care 2), and 10 beds in the adjacent mosque prayer hall. By the time Kerala was hit by the second wave, we had already created 30 additional ICU beds. It was a historic achievement.

Residents received advanced training prior to the make-shift ICU launch

Expanding Capacity: Meeting an Unprecedented Surge

As patient inflow surged, Mr. Farhan quickly initiated the construction of two additional makeshift ICUs, increasing our capacity by 70 more beds. In total, we created 100 ICU beds in makeshift facilities, an unprecedented milestone in India’s pandemic response.

Make-shift ICS under Emergency Medicine department

Every day, I began my rounds at 8 AM and worked late into the night, clad in PPE that was physically and mentally exhausting. But looking into the eyes of our patients—filled with fear and helplessness—gave our team the strength to push forward.

Despite strict protocols prohibiting bystander visits, I made a difficult yet humane decision: I allowed relatives, in full PPE, to see their loved ones. The impact was profound, reducing distress and bringing emotional relief to both patients and families. I also introduced music therapy, which showed remarkable psychological benefits in stabilizing some critically ill patients. I used to counsel bystanders in the briefing room, and I took at least 15 minutes for one patient, consoled them, and met them daily. This strategy worked well. My team also followed the same strategy.

Truenat's COVID-19 screening machine was operated by our EMTs in the ED. This helped to speed up the testing and decisions

The Mental and Emotional Toll

The work was relentless. The sorrow of losing patients, the helplessness in the eyes of their families, and the daily trauma of death took a mental toll on us. Our Emergency Department became a hospital within a hospital, operating with nearly 300 personnel, including doctors, nurses, ambulance crews, and security teams. At any given time, 5–8 ambulances lined up outside, waiting for a bed to become available.

Dr. Vineeth Chandran, my consultant colleague, once asked me, 

"Can the Emergency Department handle this burden alone?" My response was clear:

"No one knows where this will end. But we know the science. Let’s join hands and lift this together."

Our emergency medicine team, including Dr Vineeth Chandran, Dr. Vineeth N, Dr. Sivaraj, Dr. Rashad, Dr. Faisal, Dr Abhiram, Dr Alex Antony, Dr Aboobacker, Dr Swaroop, Dr Honey, Dr. Noorjahan, Dr. Veena, Dr. Bindiya, Dr. Sajina, Dr. Sameeh, Dr. Amit, Dr. Arshad, Dr. Neethu, Dr. Kamal, Dr. Shaheem, Dr. Deepak, Dr. Sasha, Dr. Nadia, Dr Aventika, Dr Vernas, Dr. Anjana, Dr. Jumeena, Dr Sujith and many others, worked tirelessly. Mrs. Nirmala Thomas, our nursing supervisor, ensured seamless operations, while Mrs. Sheelamma, our CNO, provided unwavering support. CFO Arjun also played a critical role in securing resources.

Until the second wave, intensivists were considered the backbone of critical care, but we proved that emergency medicine specialists could rise to the occasion and lead ICU-level care in a crisis.

A Family on the Front lines

On a personal level, my family was deeply involved in this mission. My wife, Dr. Supriya, a sonologist, supported me in every way possible. My daughter, Dr. Neethu, an emergency medicine resident, and my son-in-law, Dr. Kamal, also an emergency medicine resident, stood beside me, serving tirelessly on the frontlines. Three out of four members of my family were actively treating critically ill COVID patients—each of us knowing we might not see the next morning.

With Family 

We, too, contracted COVID-19, along with my team members. But thankfully, our symptoms were mild, allowing us to continue serving those in desperate need.

Recognition and Legacy

The success of our makeshift ICU gained international attention. The American College of Emergency Physicians (ACEP) International Journal published our story, with special thanks to Dr. Kate Douglas, Dr. Sweta Gidwani, and Dr. Kevin for documenting our journey so vividly.

Dr.Kate Douglas,Dr Sweta Gidwani, and Dr Kevin Duvey

ACEP story link 

https://www.acep.org/intl/newsroom/aster-mims-calicut-a-southern-india-hospitals-investment-helps-turn-the-tide/  

What we achieved at Aster MIMS Calicut was more than just a temporary solution. It was a model of resilience, innovation, and teamwork—a blueprint for future crisis management in India. The makeshift ICU concept saved thousands of lives, proving that visionary leadership, rapid decision-making, and a committed emergency medicine team can turn the tide during a catastrophe.

Even today, when I reflect on those dark days, I feel immense gratitude for the unwavering dedication of my colleagues, the courage of our patients, and the trust placed in us by our leadership. We fought together, we suffered together, and in the end, we created history together.

This is not just a story of pain and loss. It is a story of hope, courage, and the power of human resilience—a testament to the fact that, even in the face of overwhelming adversity, we can find ways to save lives and make a difference.

A period of extreme agony ....We can't forget ...