CHANAKYA NATIONAL LAW UNIVERSITY, PATNA

EMERGENCY MEDICAL SERVICE IN INDIA: A LEGAL STUDY

On

Health Law

SUBMITTED TO – Mr. Kumar Gaurav

Assistance Professor of law

COMPILED AND PREPARED BY-

AKANKSHA DIPANKAR

ROLL NO- 14121005

B.B.A,LL.B

10th SEMESTER
 INTRODUCTION
As human beings, our health is a matter of daily concern. Regardless of our age, gender, socio-
economic or ethnic background, we consider our health to be our most basic and essential asset.
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the
general condition of a person's mind and body, usually meaning to be free from illness, injury or
pain. By the same time, we are willing to make many sacrifices if only that would guarantee us
and our families a longer and healthier life.1 In short, when we talk about well-being, health is
often what we have in mind. The term ‘healthy’ is also widely used in the context of many types
of non-living organizations and their impacts for the benefit of humans, such as in the sense of
healthy communities, healthy cities or healthy environments. In addition to health care
interventions and a person's surroundings, a number of other factors are known to influence the
health status of individuals, including their background, lifestyle, and economic and social
conditions; these are referred to as ‘determinants of health’.2

The right to health is a fundamental part of our human rights and of our understanding of a life in
dignity. The right to the enjoyment of the highest attainable standard of physical and mental
health, to give it its full name, is not new. Internationally, it was first articulated in the 1946
Constitution of the World Health Organization (WHO), whose preamble defines health as ‘a
state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity’.3 The preamble further states that ‘the enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition.’

The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an
adequate standard of living (Article 25). The right to health was again recognized as a human
right in the 1966 International Covenant on Economic, Social and Cultural Rights. 4 Since then,
1
Sujit Das. “Right to Emergency Medicare: A Landmark Judgment.” Economic and Political Weekly, vol. 31, no.
43, 1996, pp. 2851–2853. JSTOR, JSTOR, www.jstor.org/stable/4404701.
2
Bajpai Asha, 'Child Rights in India-Law Policy and Practice', Oxford University
Press, New Delhi, 2013.
3
Ramchandran, L. and Dharmalingam, T. : Health Education : A New Approach.
New Delhi, Vikas Pub., 2009.
4
Phadke, Anant. “Right to Health Care: Towards an Agenda.” Economic and Political Weekly, vol. 38, no. 41,
2003, pp. 4308–4309. JSTOR, JSTOR, www.jstor.org/stable/4414128.
other international human rights treaties have recognized or referred to the right to health or to
elements of it, such as the right to medical care. Moreover, States have committed themselves to
protecting this right through international declarations, domestic legislation and policies, and at
international conferences. In recent years, increasing attention has been paid to the right to the
highest attainable standard of health, for instance by human rights treaty-monitoring bodies, by
WHO and by the Commission on Human Rights (now replaced by the Human Rights Council),
which in 2002 created the mandate of Special Reporters on the right of everyone to the highest
attainable standard of physical and mental health. These initiatives have helped clarify the nature
of the right to health and how it can be achieved.

RESEARCH METHODOLOGY

For the purpose of research, the researcher has used the Doctrinal Method of Research. The
Research is entirely a Library-based Research, where the researcher has made use of books,
journals, magazines, reports, legislations, internet websites, etc., for the purpose of research.

AIMS AND OBJECTIVES

The aims behind this Project are:

 To study and evaluate the various legal aspects of emergency medical services in India.
 To make a comparative analysis of Indian scenario against EMS in other jurisdiction
 To assess the problems and challenges with respect to EMS in India

SOURCES OF DATA

The entire research work has been done in the library and on the internet websites. Thus, the
sources of data include the books, e-books, articles, commentaries and concerned documents on
the subject.

HYPOTHESIS

Emergency Medical Services in India is still in its infancy and is very fragmented.

RESEARCH QUESTIONS
 1. Is right to Emergency Medical Service guaranteed under the Constitution of India? Does
there exist any obligation of the state to provide for EMS?
2. What is the status of EMS in India when compared with the same in other jurisdiction?
3. What are the various challenges that India faces in the growth and development of EMS?

PROJECT OUTLINE

Chapter 1. Historical Development and Obligation of the State

The first attempt toward establishing EMS in India wasn't a countrywide movement, but a city-
based effort in 1985 in Mumbai where 15 ambulances were connected to a central wireless
dispatch centre by the Association for Trauma Care of India.

The Constitution of India, to a large extent, embodies the moral-ethical principles of human
rights and social rights jurisprudence of the international human rights law. In the late 1970s, i.e.
the post-Emergency era, and the 1980s, the Supreme Court India broke out of the traditional
legal framework to venture to interpret the Constitution from a liberal standpoint, which gave
rise to the phenomenon of public interest litigations (PILs). A series of PILs filed after that
helped develop the jurisprudence of personhood, upholding the primacy of the right to life and
dignity.5 Article 21 of the Constitution was thus established as the cornerstone of social rights
and civil-political rights, including health and healthcare.

Chapter 2. Meaning Of Right To Emergency Medical Aid

Emergency medical services are a type of emergency service dedicated to providing out-of-
hospital acute medical care, transport to definitive care, and other medical transport to patients
with illnesses and injuries which prevent the patient from transporting themselves. Emergency
medical services may also be locally known as a first aid squad, emergency squad, rescue squad,
ambulance service, ambulance corps or life squad.6 The goal of most emergency medical
services is to either provide treatment to those in need of urgent medical care, with the goal of
5
Ramchandran, L. and Dharmalingam, T. : Health Education : A New Approach.
New Delhi, Vikas Pub., 2009.
6
Perry, Donna J., et al. “The Right to Life in Peace: An Essential Condition for Realizing the Right to
Health.” Health and Human Rights, vol. 17, no. 1, 2015, pp. 148–158. JSTOR, JSTOR,
www.jstor.org/stable/healhumarigh.17.1.148.
satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to
the next point of definitive care. This is most likely an emergency department at a hospital. The
term emergency medical service evolved to reflect a change from a simple system of ambulances
providing only transportation, to a system in which actual medical care is given on scene and
during transport.

Chapter 3. Right to Health as evidenced by International Instruments

Under international law, there is a right not merely to health care but to the much broader
concept of health. Because rights must be realized inherently within the social sphere, this
formulation immediately suggests that determinants of health and ill health are not purely
biological or “natural” but are also factors of societal relations. The various International
instruments evidencing Right to Health are as follows:

 Constitution of the World Health Organization

 Universal Declaration of Human Rights
 International Convention on the Elimination of All Forms of Racial Discrimination
 International Covenant on Economic, Social and Cultural Rights
 Convention on the Elimination of All Forms of Discrimination Against Women
 Convention on the Rights of the Child
 Convention on the Rights of Persons with Disabilities

Chapter 4. EMS : Indian Scenario

Accidents where victims require emergency medical care are not confined to motor accidents.
Emergencies may arise due to motor accidents, fire, floods, cyclone, earthquakes etc. or even
sudden collapse of victims or emergent deliveries in pregnancy. Among these, road accidents,
however, contribute the largest number of deaths or injuries. As compared to developed
countries with proper emergency systems in place, there is no single system which could play a
major role in managing emergency medical services in India. There is a fragmented system in
place to attend the emergencies in the country. 102 is the emergency telephone number for
ambulance in parts of India.7 There are different emergency numbers in India’s 28 states and

7
Ramchandran, L. and Dharmalingam, T. : Health Education : A New Approach.
New Delhi, Vikas Pub., 2009.
seven Union Territories. Hospitals in the country provide different telephone numbers for
ambulance services. Clearly, India is in need for proper emergency medical service that can be
accessed from anywhere in the country.

Chapter 5. MODELS OF EMS IN INDIA

In India, EMS is a relatively new concept, where the most dominant model is the EMRI services.
As of December 2009, more than 2,600 ambulances are operating under EMRI across around10
states in India. Some other states like Bihar, Kerala, Himachal Pradesh and Delhi, have adopted
EMRI-like model, but have some other agencies operating the EMS in those states. States like
Madhya Pradesh and West Bengal had opted for basic transportation services (without
stabilization care) in the PPP mode through multiple agencies (mostly NGOs) contracted at
district/block level. The central government support to the above mentioned schemes is mainly in
the form of capital expenditure (capex) support.

Chapter 6. Emergency Medical Services in Other Jurisdictions

In the United Kingdom and also to the Centralized Accident Trauma Services (CATS)
introduced in a small measure in certain places in India. But, it is necessary to refer to the
emergency accident-care procedures in other jurisdictions in some more detail. U.S.A.:
Protection to those who render emergency care of injured: In the State of Virginia, the Code of
Virginia (as amended in 2000) contains sec. 8.01.225 which exempts a person from civil liability
when he renders emergency care or assistance. The section provides that any person who, in
good faith, renders emergency care or assistance without compensation, to any person who is ill
or injured at the scene of the accident, fire or life threatening emergency, or en route there from
to any hospital, medical clinic or doctor’s office, shall not be liable for any civil damages for acts
or omissions resulting from the rendering of such care or assistance.

Chapter 7. Indian Legal Frame-work on Emergency Medical Services

The demand for legislation for EMS has been rising steadily in India. Supporters of such
legislation opine that it would mandate a common access number, formation of an EMS council,
trained paramedics, gradation of ambulance and hospitals, network of hospitals and define
physical and human resources needed for the service. This could help save lives by making
access easy for all the patients. Methods, technology, personal skills need to be standardized with
formation of legislation in emergency services to provide protection for the providers.

Associations like Society of Emergency Medicine-India (SEMI) and American Association of

Physicians of Indian Origin (AAPI) have submitted proposals for EMS legislation to the Central
Government and State Government of Gujarat, Maharashtra and Andhra Pradesh. A word of
caution comes from Dr Rao as he says ‘making emergency medical service legally compulsory
without ground level preparedness will not be enough.’ He adds that people need to be aware of
their responsibilities towards fellow citizens—insist on and be aware of the best emergency
service available.

Chapter 8. Problems and Challenges

Quality of Emergency Care is to a large extent, reflective of the overall performance of the
health sector. It is universally accepted that the functioning of the public health sector in India is
far from satisfactory.

a. Lack of proper codified laws

b. Human Resources for Emergency Care
c. Financial constraints
d. Urban- Rural disparity

It is terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that typify the importance of
Emergency Medical Services (EMS) all over the world. It is a well-accepted fact that a patient
who receives basic care from trained professionals and is transported to the nearest healthcare
facility within 15-20 minutes of an emergency has the greatest chance of survival. EMS is an
essential part of the overall healthcare system as it saves lives by providing care immediately.
It’s this recognition that has led to research and development in EMS. Over the years several
advancements have been made and research is underway to create services that provide medical
assistance to patients at the earliest. However, the state of EMS varies drastically from developed
to developing countries like India. In spite of the development in the healthcare sector over the
past decade, India is yet to create a single, comprehensive EMS that can be accessed throughout
the country.
Bibliography

Primary Sources

 Convention on the Rights of Persons with Disabilities (2006)

 Convention on the Rights of the Child (1989).
  International Covenant on Economic, Social and Cultural Rights (1966).
 United Nations Convention on the Elimination of All Forms of Discrimination against
Women (1979).
 United Nations' International Convention on the Elimination of All Forms of Racial
Discrimination (1969).
 United Nations' Universal Declaration of Human Rights (1948).
 World Health Organization (WHO) (1946). 

Secondary Sources-

Books-

 Bajpai Asha, 'Child Rights in India-Law Policy and Practice', Oxford University Press,
New Delhi, 2013.
 Davar V. Bhargavi, 'Mental Health from a Gender Perspective', Sage Publications India
Pvt. Ltd., New Delhi, 2011.
 Ramchandran, L. and Dharmalingam, T. : Health Education : A New Approach. New
Delhi, Vikas Pub., 2009.
 Singh, Parduman, Health Protection in India in the Year 2000. New Delhi, Friedrich
Ebert Stiftung, 2000
 Srivstava S.C, Verma S.K., 'Legal Framework for Health Care in India', Lexis Nexis
Butterworth's, The Indian Law Institute, New Delhi, 2012.
 Swarup Jagdish, 'Constitution of India', Modern Law Publications, Allahabad, Vol.
1,2016.
 Tones, Keith et al, Health Education : Effectiveness and Efficiency. London, Chapman
and Hall, 2010.
 Verma, S.K., Legal Framework for Health Care in India. New Delhi, Lexis Nexis
Butterworths, ILI, 2012.
Journals-

 British Medical Association. “Future Of Medical Services Of India Under Proposed New
Constitution: Memorandum” The British Medical Journal, vol. 2, no. 3800, 1933, pp.
239–241. JSTOR, JSTOR, www.jstor.org/stable/25319159.
 Gloppen, Siri. “Litigation as a Strategy to Hold Governments Accountable for
Implementing the Right to Health.” Health and Human Rights, vol. 10, no. 2, 2008, pp.
21–36. JSTOR, JSTOR, www.jstor.org/stable/20460101.
 Perry, Donna J., et al. “The Right to Life in Peace: An Essential Condition for Realizing
the Right to Health.” Health and Human Rights, vol. 17, no. 1, 2015, pp. 148–
158. JSTOR, JSTOR, www.jstor.org/stable/healhumarigh.17.1.148.
 Phadke, Anant. “Right to Health Care: Towards an Agenda.” Economic and Political
Weekly, vol. 38, no. 41, 2003, pp. 4308–4309. JSTOR, JSTOR,
www.jstor.org/stable/4414128.
 Sujit Das. “Right to Emergency Medicare: A Landmark Judgment.” Economic and
Political Weekly, vol. 31, no. 43, 1996, pp. 2851–2853. JSTOR, JSTOR,
www.jstor.org/stable/4404701.