At 4:40 a.m. on Might 4, 2026, a 40-year-old man introduced to the emergency division of Khanna Department Hospital complaining of sweating and chest ache. Inside minutes, employees nurses and emergency medical technicians (EMOs) checked his coronary heart fee, blood stress, blood sugar ranges, and, extra importantly, carried out an electrocardiogram (ECG).
The ECG outcomes had been despatched by way of WhatsApp to the hospital’s medical marketing consultant Shiny Agarwal., A case of ST-elevation myocardial infarction (STEMI) was identified, and an EMO was requested to manage tenecteplase injection.
Dr. Shiny Agarwal and emergency employees at SDH Khanna. |Photograph courtesy of Swagata Yadavar
STEMI is a extreme, life-threatening coronary heart assault that entails important blockage of a coronary artery. Injectable tenecteplase is used to dissolve or dissolve blood clots by performing on the proteins that maintain them collectively, restoring blood provide to the guts.
The affected person acquired the injection inside half-hour of the electrocardiogram outcomes and felt speedy aid. Sensing hazard, he was referred to Patiala Authorities Medical Faculty (54 km) for additional investigation and therapy.
This case marks the hospital’s one hundredth thrombolytic therapy case, the very best quantity recorded at any heart in Punjab. Till a couple of years again, chest ache sufferers in secondary well being facilities equivalent to sub-divisional hospitals and district hospitals would have been instantly referred to medical schools for additional therapy.
If that had occurred on this case, the 40 to 70 minutes the affected person spent in transport and additional analysis would have meant irreversible injury to his coronary heart muscle and future means to work.
ICMR venture with a state-wide mission
Since July 2025, the Punjab authorities has been implementing Mission AMRIT (Acute Myocardial Reperfusion) throughout the province, through which employees members at sub-divisional and district hospitals (spokes) are geared up with medicine, tools and coaching to carry out thrombolytic remedy below the steerage of cardiologists or consultants from medical schools (hubs).
To this point, roughly 34,000 folks with chest ache have registered on the Spoke, of which 1,900 have been recognized as STEMI circumstances, 900 have acquired thrombolytic remedy, and lots of have undergone angiography and angioplasty on the Hub. This initiative expanded on the work undertaken by the Indian Council of Medical Analysis (ICMR)’s STEMI ACT venture, which was carried out in a single district of seven states and one Union Territory between 2020 and 2024.
“In our research, not less than about 8,000 sufferers developed thrombosis and we had been in a position to virtually triple the thrombolysis fee when nothing had occurred earlier than,” stated S. Ramakrishnan, marketing consultant heart specialist at AIIMS and nationwide principal investigator of the ICMR ACT venture, which led to December 2024. He stated the present focus of analysis was on growing entry to thrombolytic remedy and never growing angioplasty charges. Lack of catheterization labs and excessive value of surgical procedure.
Hiinder Kaur, director of well being providers, Punjab Division of Well being and Household Welfare, stated STEMI sufferers had been receiving free therapy value Rs 35,000 inside minutes, offering well timed therapy. This work continued in tough (Pakistan border) areas equivalent to Tarun Taran and Ferozepur throughout the 2025 floods and through Operation Sindoor.
This mannequin works merely. Spork is provided with an ECG machine, defibrillator, coronary heart monitor, and a fridge to retailer tenecteplase. Employees are educated to carry out electrocardiograms and administer injections. These employees shall be added to a WhatsApp group together with a senior heart specialist who can monitor them 24 hours a day.
If a STEMI affected person reaches the spoke inside the time-frame (as much as 12 hours after the guts assault) with out issues, the clot is dissolved and the affected person is referred to the hub for additional angiography and angioplasty. This technique, often known as the drug-invasive technique, is good in low-resource settings equivalent to India, the place affected person demand far exceeds the variety of catheterization labs.
Pyramid Mannequin for Thrombolysis Choice Making, Credit score: DMC Ludhiana | Photograph Credit score: Swagata Yadavar
Dr. Bishav Mohan factors to an electrocardiogram acquired on the Mission AMRIT WhatsApp group. |Photograph courtesy: Particular Association
A novel characteristic of ICMR’s venture in Ludhiana was that it was led by Mr. Vishav Mohan, who works at Dayanand Medical Faculty, a personal medical school, and in addition offers technical help for Mission AMRIT. One other exception to the Ludhiana venture is the inclusion of three personal facilities as spokes within the pilot, however personal involvement was discontinued within the precise program.
“It took a very long time and constant efforts to handle the hesitancy and worry of employees to take care of acute emergencies like coronary heart assault/STEMI on the secondary care stage by capability constructing,” stated Ashish Gupta, NCD Cell, Division of Well being and Household Welfare. “Regardless of the challenges, we’re happy to have been in a position to efficiently execute the venture with out the necessity for added personnel,” she stated.
GMC Amritsar’s nursing employees and Dr. Parminder Singh Mangera, Assistant Professor of Cardiology. |Photograph courtesy of Swagata Yadavar
Correct take care of spokes has additionally had a major affect on enhancing affected person outcomes in medical college. The Authorities Medical Middle (GMC) in Amritsar serves as a hub for six surrounding districts. Parminder Singh Mangera, assistant professor of cardiology at GMC, stated that previously 10 months, the hub had acquired 272 sufferers with blood clots within the spokes, of which 265 underwent angioplasty at GMC.
Lots of them will be capable of avail the process freed from cost below the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) or the Punjab authorities’s Mukhyamantri Sehat Bima Yojana, which is able to present them with a stipend of Rs 200,000. 1 million compensation for every family.
Run this system throughout the state
The success of this venture is essentially depending on the efforts of well being officers like Dr. Gupta, who spends a lot of his private time partaking and coordinating with heart docs by WhatsApp teams, accumulating information, and sustaining the provision of tenecteplase throughout 65 centres. Equally, Dr. Vishab Mohan spends hours daily answering questions, advising docs on required remedies and inspiring additional thrombolytic remedy by a number of WhatsApp teams.
Many of those emergency departments have infrastructure gaps, employees turnover and shortages, and excessive affected person volumes. Due to this fact, preserving these overwhelmed medical groups engaged requires motivational conversations, treating nurses as equal companions, utilizing Punjabi language throughout coaching and technical supplies, recognizing month-to-month prime performers from the district, and internet hosting an award ceremony by the well being minister, Dr. Mohan stated. “As soon as folks begin working, they understand they’ll save lives, which in itself helps enhance morale and maintain engagement,” he stated.
STEMI fashions throughout India
After a profitable pilot in Tamil Nadu and STEMI that confirmed how the hub-and-spoke mannequin can enhance reperfusion charges and scale back mortality, it has been launched in quite a few states together with Tamil Nadu, Goa, Karnataka, and Andhra Pradesh. In most states, the spokes are neighborhood well being facilities (CHCs), and the hubs are sub-hospitals, district hospitals, and medical faculties with catheterization labs.
Tamil Nadu was essentially the most profitable state with greater than 72,000 sufferers present process thrombolysis over 5 years, with a 67% annual enhance in STEMI sufferers present process thrombolytic remedy and a 68% enhance in sufferers present process main angioplasty.
Nonetheless, heart specialist Thomas Alexander, who piloted the TN-STEMI mannequin with Ajit Murasali, stated together with solely authorities hospitals as hubs lowered the mannequin’s effectiveness. “Sufferers coated by authorities insurance coverage schemes ought to have entry to their nearest reperfusion heart, public or personal, with safeguards to forestall overuse and overbilling,” he stated.
far forward
A 12 months after the implementation of Mission AMRIT in Punjab, some limitations of this mannequin are evident and it depends upon particular person curiosity and energy. Whereas some PRs, like SDH Khanna, are doing an distinctive job, many others have solely carried out thrombolytic remedy a couple of occasions, regardless of the provision of medicine and educated employees. Additionally, right now, there isn’t any follow-up research on what occurs after the affected person leaves the spoke. This follow-up with tertiary care establishments is a part of the subsequent section of the mission, Dr. Mohan stated.
However regardless of the challenges, officers say this system has improved entry. “We’re seeing extra girls over 50 years of age in villages with signs as spoke facilities are nearer to their properties and simpler to entry. Earlier, we might not have missed this demographic,” Dr Mohan stated.
(Swagata Yadavar is an unbiased journalist. swagatayadavar@gmail.com)
(This text is the second in a three-part collection by Nivarana, a digital public well being platform, on the well being system’s response to emergency cardiac care in India. Printed in collaboration with Sunfox Applied sciences)
