By setting up specialised centres for paediatric emergency care, Tamil Nadu has significantly improved child survival rates in recent years. The State’s Paediatric Resuscitation and Emergency Medicine (PREM) initiative has strengthened paediatric emergency care in government secondary care institutions — district headquarters hospitals and taluk hospitals — through dedicated protocols and appropriate infrastructure.
PREM is one of the six pillars of the Tamil Nadu Accident and Emergency Care Initiative (TAEI).
There are 116 PREM centres across government tertiary and secondary care institutions — 41 Directorate of Medical Education and Research institutions (36 medical colleges and five allied institutions) and 75 Directorate of Medical and Rural Health Services institutions (district headquarters and taluk hospitals), said M. Vijayakumar, Deputy Director-Team Lead, TAEI Commissionerate, Tamil Nadu Health Systems Project.
Data shows a steady rise in survival rates among children treated at PREM centres — from 93.44% in 2021 to 96.26% in 2024. In the current year (up to August 2025), the survival rate is 94.34%. Admissions have also surged sharply, rising from 21,586 in 2021 to 80,907 this year.
The concept was built on a model formulated by the Institute of Child Health (ICH) and Hospital for Children in Egmore, said Indumathy Santhanam, Project Coordinator, Regional Collaborative Center, PREM Skills Laboratory, ICH, Madras Medical College.
‘Guidelines developed’
“The Paediatric Emergency Medical Course was started at ICH. We developed guidelines to treat paediatric emergencies. This included training postgraduates to conduct a 60-second analysis of sick children, and make independent decisions. These efforts reduced hospital mortality. The lessons learned formed the basis for PREM guidelines, and units were launched at 28 hospitals (22 district headquarters and six sub-district headquarters hospitals) in 2017,” she said.
This was pioneered by the National Health Mission, Tamil Nadu, as a strategy to reduce post-neonatal under-five mortality.
PREM has saved the lives of numerous children brought in critical condition. “Earlier, it used to be a ‘scoop-and-run’ approach, as paediatric emergency services were unavailable in taluk and sub-district hospitals. A large number of children were taken to these secondary care hospitals, and quickly referred to tertiary care centres. This changed in 2017, when PREM units were first established in secondary care hospitals, and later revived post-COVID. We developed two books for PREM, which include diagnosis and treatment protocols for common paediatric emergencies such as asthma, sepsis, dengue, snake bites and foreign body ingestion,” she said.
SOPs for centres
A major highlight is Standard Operating Procedures (SOPs) for PREM centres. ”PREM has put in place uniform standards for handling paediatric emergencies. It has a trained team, equipment, and drugs essential for emergency resuscitation. We are able to provide immediate care during the golden hour,” Dr. Vijayakumar added.
Dr. Indumathy cited a recent example. The EM team at Government Headquarters Hospital, Kancheepuram, received a two-year-old child from Ranipet, who suffered from a left temporoparietal injury after a television fell on her head. Doctors stabilised her, initiated treatment to reduce cerebral edema, and performed CT brain and CT facial bones with 3D reconstruction. Subdural hematoma and subarachnoid haemorrhage were established. She was intubated in anticipation of declining sensorium and referred to an ICH in a 108 ambulance. She was treated, recovered and discharged.
“Early resuscitation at the PREM unit in a secondary care hospital, prior to referral, ensured neurologically intact survival. Previously, shifts without resuscitation resulted in morbidity and mortality,” she said. “The brain is still in the developing stage for children. Delayed resuscitation can cause permanent damage. PREM units have enabled neurological intact survival for children, and has reduced the burden on intensive care units across Tamil Nadu,” she added.
Hundreds of doctors and nurses are trained at the PREM skills lab established at ICH under the Tamil Nadu Innovative Initiative Fund in 2019.
Published – November 16, 2025 10:49 pm IST
