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Meeting Notes (EMRI - 108 - Ambulance Services)

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Following Vasanth's blog post and the subsequent meeting notice, two of us met with GVK/EMRI team on Saturday. 

Participants:

Praja: Ravi D & KSNandan (@Nandan - Pls post your notes when you get a chance.)

GVK-EMRI: Mr Guru Charan (Sr Partner, Marketing), Mr Parvez (Response Center Head), Ms Kritika and a team of 4 or 5 other participants

Came back quite impressed I should say. Murali Sir (and many other Prajagalu) - you would have loved to see what seems to be a very successful and effective PPP initiative.

Will come back and post a detailed note later. But here is a quick take.

Would I call 108 in case of a medical emergency?

Before the meet - Probably not. It is, after all, yet another government initiated service. 

After the meet - Sure Yes. I'll call them first.

There will be more for us to understand, and more for EMRI to improve on as things progress. Going by what we were presented though, it sure is one good start. And EMRI is justifiably proud of what they have done so far.

 

22 Dec - EDIT: Attached the PPT received from GVK-EMRI 

AttachmentSize
GVK EMRI - Karnataka.ppt425.5 KB

Comments

idontspam's picture

Thanks Ravi & Nandan, more

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Thanks Ravi & Nandan, more information sharing on forums like here will go a long way in spreading awareness and remove misgivings, even though finally the proof of the pudding is in the eating. 

Sorry I couldnt make it was at another meeting on commuter rail.

ashok_n's picture

Ambulances and traffic signal

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Today morning, I saw an ambulance stuck in traffic as the signal (approx 100m) ahead was red and the vehicles ahead were not moving. This was at Arakere juntion on BG Road. The ambulance was coming from Bannerghatta side towards IIMB side (probably going to Fortis or Apollo hosp). The only significant traffic at the junction (it was non-peak hour) was from the Bannerghatta side.

My thought was if there is a system for ambulances to request (using GPS tech) green signals in its route to the central traffic control room, ambulances can save time. Possible?

nl.srinivas's picture

 You can use RFIDs to sync

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 You can use RFIDs to sync up. You can have RF tags on the ambulances and RFID reader linked to the traffic signals. The reader will sense the tag on the ambulance and turn the signal green to make way for ambulance.

 


silkboard's picture

thanks for sharing your notes

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Thanks Ravi & guys for sharing your notes. Sorry for missing out myself, due to an unplanned change in travel plans.

Had some questions if you talked about these as well:

  • What is the structure of this PPP? what returns do the investors, including government expect, and how do tey measure them (since it will surely not be only money).
  • Are there other areas where this successful PPP model can be replicated?

thanks again.

Pranav aka SB.

santosharjun's picture

RFID doesnt help here

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Effective range of RFID tags is very limited. We have to use EMergency Vehicle Preemption using wireless devices. This technology is being used in USA for more than 40 years. I have a written a blogpost on this. http://shapingindiasfuture.blogspot.com/2010/12/emergency-vehicle-pre-emption.html 

Also, I contacted Bangalore DCP about this. Please let me know, if we can work together to accomplish this.  

ksnandan's picture

Integration with the Traffic Management Center

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They have taken very strong exception to vasanth’s blog claiming pizza comes before an ambulance. 

We both were surprised when we were lead into a board room where few of the concerned leads/head were waiting for us with a presentation ready. Thats how serious, dedicated they are about their work.

Will put in more details about the meet in some time.

Regarding Amublance getting stuck in traffic signals,

All the EMRI - 108 ambulances are stationed either near a Police Station or near a Health Care facility.  When ever an ambulance leaves for an emergency the near by police station relays the information to traffic units so that traffic can be cleared. 

We were told by the EMRI officials that the response from the Traffic department.

As of now they are not equipped with GPS but thats in the pipeline and also a plan to integrate with the TMC. 

santosharjun's picture

interested in further details

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how do they do that? Is it that they control every signal from TMC or just inform concerned police officials at each signal? Because I had seen Ambulances waiting in a Kilometer of traffic jam. May be for some cases first aid in ambulance would suffice and time to hospital may not be very critical but cases like accidents and cardiac arrest  would need this critically and automating this is the best option. 

murali772's picture

my happy experience

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The mention of Pizza etc made me think it was some trivial talk, and I didn't pay attention to the discussions. Now, on learning what it was all about, let me recount here my happy experience with EMRI-108.

It was some 4 months back. Along-with four of my buddies, I was playing golf at Clover Greens, beyond Sarjapur. We were at about the 5th hole at around 7.30 in the morning, on a week-day (the green fee is half on a week day), when one of our foursome, mis-hit a ball from close to a plant, which then ricochetted of the plant stub, and hit him very close to an eye. He fell there cupping his eye, blood covering his hands, alongside the shattered frame and glasses. As it eventually turned out, the glass-frame took most of the impact, because of which the direct damage to the eye wasn't too severe, apart from the fact of the timely medical help we could reach him, thanks to EMRI.

Immediately the mishap occured, we gathered together, called up a doctor friend, empanelled with Manipal hospital, who, in turn, advised us to contact EMRI. The response was almost immediate, and we were informed that the ambulance stationed close to the Sarjapur police station was being alerted, and to expect a call from the ambulance staff. Not quite sure about how good their services were, we anyway drove the patient in one of our cars, and headed towards Manipal hospital. Immediately thereafter, a nurse on the ambulance got in touch with me on my mobile, and after getting our location, asked to wait by the roadside, as they were just about 1 km behind us, and catching up. Meanwhile, she collected all details like the patient's blood group, medical history, besides giving a few tips on what to do and what not to do with the patient - all very professionally. Within minutes of our halting, the ambulance caught up wiith us, and the staff, again very professionally, transferred the patient onto the ambulance. I rode the ambulance along-with the patient, and the care the nurse was imparting was indeed impressive. She cleaned the wound, and after talking to the doctor on phone, took instructions on what needed to be done, and went about them systematically.

By then, we were passing through the morning peak-hour traffic, and the ambulance driver very skillfully navigated his way towards Manipal hospital. The traffic police, obviously alerted in advance, waved us on through the on-coming traffic (wherever there were jams), and we reached the hospital in record time, which would not have been possible if we had relied on our cars.

On reaching the hospital, the ambulance staff handed over charge of the patient to the hospital staff, got some info filled out on some form, collected requisite signatures, and said good-bye to me, after wishing the patient a speedy recovery. When I pulled out my wallet in a gesture to settle their bill, I was surprised to learn that it was all free, and that they wouldn't accept any payment. I however insisted that they have a good meal on our account and gave a Rs 500 note, which the nurse very relutantly accepted.

All in all, thanks to EMRI's timely help, the damage to my friend's eye was limited, and he is back to playing golf, though not taking unnecessary chances now.

I had meant to blog about this immediately after the incident itself, but, for various reasons, it escaped my mind. But, such good work certainly needs to be appreciated, even if I am guilty of not having done it on time.



 

Muralidhar Rao
Ravi_D's picture

Notes - Finally

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Sorry for the delay. Here we go.

As you know already, two of us met with EMRI. They certainly expected a lot more from our side (I could sense some disappointment - low turn out and absence of Vasanth) - but guess the proportion in attendance was similar to the proportion of drivers giving way to ambulances in Bangalore traffic! :)

EMRI (Emergency Management Research Institute) is a sort of CSR effort from the GVK group of companies, set up as a not-for-profit organization.

The team we met with were quite disturbed by the 'pizza delivery' angle in the original post that started this all. They seemed to (justifiably) take pride in what they do, and wanted to stress that such analogies tend to work against their good efforts - for example, some, misinformed due to the original post, might decide not to call 108 in an emergency.

Spent a good 2+ hrs with them. There was a presentation (I've asked them to share the PPTs w/ us) that detailed their operations. Here are the highlights (as far as I remember and noted down):

They are an Integrated Emergency Response Service provider - aiming to make the most of the Golden Hour (first critical hour post an emergency incident). In a land where there are no set requirements for such a service (and where most others are just Ambulance Operators, if those Omnis can be called that), EMRI has deployed a integrated system, that is free to use!

There was a talk of 4As. Access to a single toll free number. Availability. Affectionate Care by paramedics. Affordability. 

System works this way. They call this Sense - Reach - Care model.

Sense Part:

You call 108 anywhere in Karnataka. Call lands in their call center in their Magadi Road premises. They currently handle some 28,000 calls / day. A Communications Officer handles the first part of the call. He tries to calm down the caller, tries to understand the situation, locate the caller and hands it off to a Dispatch Offer. 

Since the call center handles all calls that originated in KA, some Qs may sound a bit strange. Guess this shows how important it is to understand citizen's responsibility in such a case - hold on to the call and be patient. From what we saw, the questionnaire may take around a minute. 

Reach Part:

The dispatch officer uses the details to provided to locate the nearest ambulance (ambulances if necessary), and gets in contact with the pilot (driver). Caller may be given an option to choose from one of the 3/4 ambulances nearby - you may know your area better, for example, the street leading to the nearest ambulance might be dug-up.

Each ambulance also has a paramedic (Emergency Medical Technician) who gets on the conference call between dispatch officer and the caller at this time. Ambulance is moving as EMT is trying to understand the scenario, prepare, and guide the caller as needed. 

EMT is also in touch with a Doctor in their premises. EMTs can administer medicine only at Doctor's consent / authorization.

Care Part:

Once on site, patient is handled as the situation demands. They try to stabilize the patient as needed (typical pre-hospital care - stop bleeding, administer IV fluids, CPR, give birth to a baby!). 8000 babies are delivered on EMRI ambulances so far - they showed us a pic of triplets born on the ambulance!

If you have a choice of hospital, you are taken there. If you don't, you are taken to the nearest government facility. EMRI has a MOU with almost all major private hospitals. If necessary they can always stop at a intermediate healthcare center, private or public, en route for further patient stabilization. We were told they have not encountered any problems in admitting patients so far. Good to know. Hospitals are required to stabilize the patient irrespective of his status. And once done, ambulance takes you to the destination facility.

EMRI's responsibility ends once the patient is handed over to the hospital. Intent is to preserve the patient during the golden hour and reach him to a place where he can be further taken care of. This whole thing is done free of cost. We were told that if their staff demands money, they'll be shown the door immediately.

 

The ambulance itself is out fitted with equipment such as defibrillator, ventilator, various stretches / moving aids and other such emergency pre-hospitalization needs I don't understand / recall. EMRI studied US 911 and UK 112(?) system in detail, and have included the equipment that is called for. They have won quite a few awards as well for their efforts - some were on display in their center.

 

I did ask if they complied with any GOI / GOK spec. None seem to exist. Essentially, they are self-regulated at this time.

Some numbers. 517 fully equipped ambulances in KA (one for every 100 to 125,000 people). 70 of them are in BLR. Some 28,000 calls/day that are answered within 2 rings. Around 1,800 or so of them turn out to be true emergencies each day. Rest of the calls unfortunately reflect our insane minds - prank / abusive callers, children having fun with the phone etc. Each ambulance, on the avg, does 3 to 3.5 trips per day. Around 120+ call center employees. Everything is managed by EMRI, including 3,000 staff members. All costs are reimbursed by the Government (at actuals, or on a contract, I don't know). GVK brings in expertise, reach here in India and internationally. Govt the money.

EMRI control center also has full time police rep(s) on call. Call 108 for any emergency, medical, theft, fire. Police on call will coordinate activities thereafter.

Sorry for a long, winding post. Wanted to get it out before my memory completely failed me!.

Ravi_D's picture

Things I wished for

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Trust deficit I guess. Just like I'd was hesitant to call a government ambulance before we met them. The team we met obviously were influenced by Vasanth's post when talking about Praja. 

They were reluctant to share stats and info (it could very well be just their policy). Have asked for the PPTs so we could include in this post. Will do as soon as they send.

I also asked, in vein, for the spec they use to outfit their ambulance. Was hoping that we could take it to the health ministry and ask them to put it in a code of requirement of some sort. This way, we can avoid proliferation of all those boxes on wheels with ambulance sign and a dis-functional siren on them.

Checked on their feedback mechanism. They couldn't point me to a separate system to receive grievance calls, address comments or feedback. They asked us to call 108 itself. Sounded counter intuitive.

They have a SLA with GOK Health department. Not sure what it entails. We were told they keep metrics, and share them. Being a very professional set-up, I'm sure they do. Wish they shared that with everyone.

They are willing to partner with anyone to popularize 108 service. Something for us to keep in mind when we do look at a large scale public event. 108 plays a key role in saving lives in road accidents.  

Ravi_D's picture

Specific Case

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The Pizza Delivery note in the original post was unfair, and certainly got to them. Vasanth - pls take another look at your comments. It seems to single out 108, while, apparently most trouble you had was with others.

Each call is recorded by EMRI, and can be tracked. We did have a ready proof of this - heard the phone calls related to Vasanth's case -  calls that lasted about 2minutes the first time, and for a lesser duration during the second - I forgot the exact numbers. In fact, the second time around, the call was from the Dispatcher / EMT on board the ambulance, and their offer for service was rejected.

Ravi_D's picture

Police & GPS

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They claim that BTP has given them excellent cooperation. I was asking if they have a system to alert traffic cops of the route they may take - none exists at this time, but Police, apparently, go out of their way to help. EMRI said their problem was not the police, it was the people who were insensitive.

Currently they know the location of the ambulances based on frequent contact with the vehicle. Outfitting vehicles w/ GPS is being looked at.

Ravi_D's picture

15 / 24 minutes

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Forgot the most important numbers. In the urban areas, they reach within 15 minutes of the call on the average.  In rural areas, the average is around 24 minutes (due to the travelling distance involved).

I did ask if they have looked at dispatching multiple ambulances to a location from different directions, to ensure quickest reach in traffic. Impractical - as each ambulance taken out for redundancy is one less on standby for real action. Guess the time for the idea hasn't yet come. Hopefully they'd be able to increase their strength to be able to do something similar soon.

idontspam's picture

I think we should really

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I think we should really appreciate the service they are rendering and thank corporates like GVK for supporting this service.

I do not share the thoughts of EMRI folks that the Pizza comment was unwarranted when they havent made adequate efforts to educate people on what are the prerequisites/questions that will be asked. Especially considering they are doing the right thing unlike the rest.

Even I would have agreed, not having seen all this information, that they are on par with glorified omni's that pass of for an ambulance. The pizza comment could be called unfair only in hindsight & when SLA's are known by people and the expectation is that its not just a cab which will come when you call.

Posting and sharing information with Praja is one such effort. If they are hesitant about sharing information they should be willing to live with the kind of feelings that people will express, especially considering that they are going thru a harrowing time during the golden hour.

Conducting programs and setting new standards for ambulance services in conjunction with govt is another effort which they cannot shy away from. They cant rest on their laurels of being good, and have to help push implementation of the standards across the other ambulance services in Bangalore. We are there as people to help them in garnering support if they ask.

Anyway, as santosharjun suggests time for EVP has come to reduce the SLA's from 15 minutes for the urban area. 

kbsyed61's picture

Ravi, Thanks for the meeting and its proceedings!

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Ravi,

Thanks for setting up the meeting with EMRI and educating us about the availability of such services. Really appreciates the EMRI staff in offering such services. Thanks to GVK also for socail responsibility.

I am sure Praja community will be happy to help EMRI in publicizing the service wide and far. We can certainly plan something after the Mobilicity event next month.

May be a week long  "Call 108 for Emeregency" campaign in Feruary, 2011. We can work out the events and activities.

Let me know if this is soemthing we should do?

-Syed

 

Naveen's picture

Great report/s

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Ravi,

Great effort. I think I missed out by not attending the meet & understanding their (EMRI's) position. At least now, through these efforts, people who note your (& Mr Murali's) post will get details & information about how the system functions, given the adverse city conditions.

ksnandan's picture

Few more details

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Thanks Ravi for putting up the Minutes. Sorry, could'nt make time.
 
Few more details.
  • EMRI has a tie-up with the Stanford School of Medicine, USA  for  medical expertise
  • EMRI has been awarded the "Presidential National Emergency Number Association [NENA] award 2007"
  • Govt provides fund under the National Rural Health Mission.
  • Communication would be primarily in Kannada, and if the caller doesnt understand Kannada, then they communicate in Hindi or English. Even if that fails, they have resources who are well versed with other South Indian languages. 

Once a call is received the caller’s identity details are gathered.

  • Name
  • From where they are calling from. During this they might ask you about district, village, hobli , landmark.
  • What type of emergency it is? Medical, Fire, Criminal Acts
  • What is the nature of medical emergency, cardiac arrest, fits, pregnancy?

All these questions may irritate/frustrate the panicked caller, but they are necessary to dispatch the proper help at the earliest. 

Remember, it’s not only calls from Bangalore that they receive but throughout Karnataka. All these details helps them in zeroing on the location.

For callers from Bangalore the question of which village, hobli may be irrelevant, but the “Communication Officer” as they are called, are bound to ask the questions from the standard questionnaire. We were told that all the COs have now been advised to assume all these details if the caller is from Bangalore.

And this is from my personal experience.

I have called 108, 3 times till date and the call was received instantly.  I didnt even get to hear a 'ring'. 

In one particular instance, a patient had fids and he collapsed, I called the 108 and the procedures mentioned by Ravi followed and the ambulance was on the way amidst the Peak hour traffic. It took about 20-25 mins for the ambulance to reach the spot.In the meanwhile the friend accompanying the patient started getting restless and he decided not to wait for the ambulance and take an auto instead. He was literally dumping the patient into an auto. It took almost 10 mins for him to get the patient into the auto and by that time the ambulance reached and he was given proper medical care.

Before deciding to take your personal transport to take the patient to the hospital, please keep in mind these things.

  • You might mishandle the patient and do more damage. 108 ambulances are fitted with immobilisers, which prevents further damage to the body parts.
  • Ambulances with their loud siren, if not full at least gets some priority in the traffic than your personal transport.
  • 108 Ambulances are fitted with all the necessary equipments needed to stabilize a patient, which your car is not.

Waiting for 10-20 mins for the ambulance in most of the cases is worth it. 

 

idontspam's picture

 In the meanwhile the friend

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 In the meanwhile the friend accompanying the patient started getting restless and he decided not to wait for the ambulance and take an auto instead.

Dont know if folks at 108 can keep the affected party engaged and help administer first aid over phone, including how to handle the patient till the ambulance arrives. Do they have medical practitioners who can keep checking on the patient frequently till the ambulance arrives? GPS & EVP are essential if this needs to scale to a really good service fromt eh good service it already is. I am sure they arent resting on the laurels and can redefine the golden hour support in this country. 

Vasanth's picture

Thanks Ravi - Unfortunately Grandmother passed away

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 Thanks Ravi and Nandan for the notes on Meeting. My Grandmother who was shifted to hospital aged around 81 had recovered after 2 days. she was well in the hospital under monitoring till 4th day when she again got the fits. Dosage (to increase the blood sodium levels)  that the neurologist gave to control fits had made her unconcious, although fits stopped. Unfortunately she never got concious and she passed away this Sunday early morning at 4 AM. I immediately rang up Lion's eye club and got her eyes donated. My sincere thanks to Lion's eye club, I called at around 4 30 AM and they were at the hospital by 5. By 5:30 her eyes were taken after eye doctor going through medical history of my grandmother.  They also gave a certificate for her eye donation. I will write in detail about the hospital problems I faced in another blog which I used to think while waiting outside ICU.

Meanwhile I called up 108 twice, that day when I was all alone. The call handler tried to calm me down and he started asking 'Grama, Hobli' questions which really irritated me, second thing is patient's medical history. And the call centre person told unless we finish the form we cannot dispatch the ambulence, which really frustated me. Good to hear from Ravi that they have now changed the process by avoiding questions on Grama, Hobli for cities like Bangalore.

I was not knowing that these process will go in the background which the call centre staff didn't reveal . If the staff would have told that the ambulence is being dispatched from so and so place immediately after taking address,and we want  additional details to handle the patient, I might have calmed down and answered the full questionaire. The caller should be calmed down by assuring him services , and then additional questions should be asked, otherwise we will think he is not taking it seriously. I thought it is fully operated by Government and hence it is like any other lengthy Government form.

After that I closely monitored many 108 ambulences passing by and the equipment standards were pretty good than the private one I took which looked like a Hoarse van rather than ambulence after paying 700 rupees for mere 2 kms ! Reading the post of Ravi, I feel if we have to opt for ambulence we should go for 108 unless if we have other ambulence very closeby  and is well equipped.

 

Vasanth's picture

TV Advertisements on how to use 108 Services

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 I see the TV advertisements by BJP that 108 is a gift of BJP Government raising the collar. Instead of such collar raising advertisements, if they could educate the public on how the service should be used, it would be great. 

I have been invited to their office. I will try to meet them up and express my views. Unfortunately, my ankle got twisted  on the death day of my Grandmother while I was walking on the foot path  where a stone was loosely laid, resulting in hairline fracture of my left feet. This has made me immobile for 5-6 weeks.

kbsyed61's picture

Vasanth, our condolences!

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Vasanth,

Sorry to hear about grandma's demise. Pls accept our condolences. It must have been tough for you and your family. Wishing you a speedy recovery with the fractured foot.

Hope your first hand experience with ambulance would be an excellent opportunity to get to know more about 108 service.

Ravi_D's picture

EMRI PPT

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See the PPT received from EMRI attached to the main post above. Don't quite understand why they'd do this, but would like you all to know that this file is a really stripped down version of the presentation we saw at their facility. From what I remember, nothing in the original version could have been a state or trade secret!

Ravi_D's picture

@ Vasanth

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Condolences - Sorry to hear about your loss.  

Naveen's picture

Vasanth - Condolences

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Vasanth - pls accept my condolences. I'm in mourning too since my aunt just passed away.

Srivatsava's picture

What happened to the 'How-to' feature?

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I know I am deviating from this post and asking a question about a site feature. But, seriously, do we already have the how-to feature? If yes, we can write the 'user manuals' ourselves.

And yes, Praja posts come up very high on the Google engine. (I saw that Praja post on "Bangalore Patrol" come up on top, much higher than the TOI and BangalorePatrol official site). So, the reach within the online community is guaranteed!!

-Srivatsava V

shas3n's picture

Use gyan for How-to's

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Srivatsava,

Surely there is a need for good How-To articles about civic issues. While there is no dedicated feature for that purpose yet on Praja, one way to do that would be to use the Gyan feature.

Just create a Gyan page for each topic (use a tag like 'How-To') and once there is a sizable number of articles, it is trivial to compile them in one place and highlight them.

 

-Shastri

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