The current situation of Ambulances and Emergency Medical

Service(EMS) in India:

It is well established that about 50% of road crash deaths can be averted if victims
receive definitive medical care within the first hour.
India’s network of ambulance services could play a key role here, but it falls short
on several counts. It is disorganized, lacks adequate equipment and trained staff,
and has poor regulatory mechanisms.Impact of Traffic on Ambulance Response
Times

A large number of patients in India die due to relentless delay in medical care
caused by traffic jams and ill equipped ambulances. These tragic delays are
exacerbated by numerous factors such as carts standing on road, unauthorized
parking on roads, insufficient infrastructure, lack of a robust public transport
system and widespread disregard for the civic duty of yielding to ambulances.
These issues combine to create a dangerous environment where emergency
services struggle to navigate and reach those in critical need.

In India, ambulance services are a crucial element of the healthcare system, tasked
with providing emergency medical care and transporting patients to appropriate
medical facilities. Ambulance market in the country was valued at $1.5 billion in
2022 and is projected to grow at a 5.12% CAGR from 2024 to 2028. Despite this
growth, the focus of many ambulance services remains predominantly on patient
transfer rather than critical emergency care. The broader problem is compounded
by inadequate infrastructure for both general transport and emergency vehicles.
Poorly maintained roads and insufficient designated lanes for ambulances further
hinder their ability to navigate congested urban areas swiftly.

Moreover, there is a severe mismatch between the medical burden of road crashes
and the capacity of the emergency system. Approximately 90% of road ambulances
lack essential medical equipment, and 95% are operated by untrained personnel.
Alarmingly, 98.5% of these ambulances are predominantly used for transporting
deceased patients rather than providing critical emergency care. This stark
discrepancy underscores the urgent need for improved infrastructure,
better-equipped ambulances, and enhanced training for personnel to address the
growing demand for effective emergency medical services.

Impact of Delays

The delays in ambulance services have severe consequences for patient outcomes
and overall public health. According to a 2021 report by the Comptroller and
Auditor General of Karnataka, approximately 90,000 crash victims did not receive
timely medical care due to ambulances being stationed far away. The report also
highlighted that in 6,000 cases, there was a delay of more than 30 minutes in
dispatching ambulances after emergency calls were received, revealing a critical
shortage in fleet strength. The implications of such delays are profound. This
inefficiency not only exacerbates the suffering of patients but also leads to a
deterioration in their condition while they wait for medical intervention.More than
450 people lose their lives due to road accidents everyday in india, among which
more than 60 percent of these deaths could have been prevented if basic sufficient
pre hospital care would have been given.

Nearly 1.5 lakh people die in the four lakh road accidents that take place every
year.

Even though 91% of hospitals had in-house ambulances, trained paramedics

needed to assist ambulance services were present only in 34%. Provision of
specialized care during ambulance transport was largely poor: only 19% of
hospitals had a mobile Stroke/ STEMI (for heart attack) program, with only 4%
having a mobile Stroke unit. Most of the hospitals lacked a Pre-hospital arrival
notification system.

Pre-hospital care is being provided by the state government regulated ambulances

in many states by Emergency Management and Research Institute with a common
toll-free number 108. The command centre is however not situated or run by the
government or the Emergency Departments. 108 do not provide any pre-hospital
notification to the Emergency Departments. Thus it is a rudimentary form of
pre-hospital EMS that exists in India and needs modernization and integration with
the hospitals at state and national level. India also lacks a universal toll free
number and there are more than one numbers that lead to ambulance services for
different emergency conditions. With more than 150,000 road traffic related deaths,
98.5% ‘ambulance runs’ transporting dead bodies, 90% of ambulances without any
equipment/oxygen, 95% of ambulances having untrained personnel, most ED
doctors having no formal training in EMS, misuse of government ambulances and
30% mortality due to delay in emergency care. India has two different yet
overlapping publicly funded ambulance systems, with both popularly known by
their helpline numbers, 108 and 102. In India almost 23% of all trauma is
transportation-related, with 13,74 accidents and 400 deaths every day on roads.
Blood Availibility :

69 hospitals out of 100 had licensed in-house blood bank, out of which 66 hospitals
ran 24 X 7 services. It was observed that 34 hospitals had a tie-up with an external
blood bank facility, 57 hospitals had separate component facility for packed cell
(RBC), FFP, Platelet Cryoprecipitate, 57 hospitals had availability of O- (Negative)
blood in their hospitals

It was observed that the majority of hospitals did not have facilities for storage of
blood at ED. Only 20 hospitals {10 government hospitals [6 district hospitals and 4
medical colleges], 10 private hospitals} had separate blood storage for ED. Most of
the hospitals did not have protocols for massive blood transfusion and ED blood
transfusion

An in-house 24*7 functional Blood Banks were available in 90% of Govt Medical
Colleges, 70% of Govt Hospitals with >300 beds and 35% of Govt Hospitals with
< 300 beds. While in Private there were 85% of Hospitals with > 300 beds and
65% of Hospitals <300 beds. Most of the Hospitals did not have a dedicated Blood
Bank in the Emergency Department nor an existing standard protocol for massive
blood transfusion.

Sample these:

​ 95 percent of ambulances don’t have trained personnel

​ 90 percent of ambulances don’t have equipment or oxygen
​ 80 percent of ambulances don’t have mobile stroke units
​ 30 percent of mortalities happen due to delays in emergency care
​ Most emergency department doctors don’t have formal training in
Emergency Medical Services
Not quantity, quality is the issue
The problem lies in the quality of emergency services, not mainly with the
quantity. The World Health Organization recommends at least one ambulance per
lakh population, and India is barely in line with the recommendation. “There are a
total of 2,423 Advanced Life Support (ALS) ambulances, 17,135 Basic Life
Support (BLS) ambulances, 3,676 Patient Transport Vehicles, 17 boats, and 131
bikes presently supported by the National Health Mission in the country,” Bharati
Pravin Pawar, Junior Minister in the health ministry apprised the Parliament on
February 3, 2023.
ALS is supported for an average population of five lakh and a BLS ambulance is
supported for over one lakh population. India has 0.88 ALS ambulances per five
lakh people and 1.25 BLS ambulances per lakh population.

What is the Solution? This is where we come in.

We aim to centralize the Ambulance and Emergency medical services to ensure

efficiency and availability.
Our ambulance provides all the facilities that an advanced life support ambulance
provides along with the advanced equipment it provides real-time medical
assistance by trained specialists helping the patient, providing in hand first aid and
bringing the doctor virtually near the patient during their journey to the hospital.
This can help the patient be assisted during the journey and fulfills the need for a
medic or an ER specialist doctor in the ambulance. Also the ambulance transmits
the patient’s complete telemetry data , including vitals, in near real time to doctors
and esports at the hospitals. With real time camera feed available, the doctors and
paramedics in the ambulance can use the camera to collaborate with the ER
specialists doctors at the hospitals who are equipped with advanced technology to
undertake procedures if necessary. The doctors can virtually guide the paramedics
to carry out the procedures and save precious lives. The advanced equipment is
powered by AI(Artificial intelligence). It has robotic arms to provide CPR and
minor surgeries to bring the patient to a stable condition for temporary purposes.
We rather focus on providing emergency care than transporting the patient to the
hospital. With the help of telemedicine, virtually present ER doctors guiding the
trained specialists(particularly trained in providing emergency care) and
autonomous first aid systems we ensure that the best care will be given to the
patient during their journey to the hospital.
In emergency cases the first hour after an accident is referred to as the ‘golden
hour’ and every decision made in this time decides the way to life or death. We
make sure that the patient receives complete medical assistance in this time itself.
We also notify hospitals before the arrival of the patient to ensure timely care is
given to the patient.

We also provide Drones for surveillance purposes mostly during the night time
controlled by a person sitting on national highways hauls, this will allow prompt
reporting of incidents, road accidents, in outlying areas particularly outlying
highways, thus helping in definitive medical care.

We also provide a network for hospitals, emergency services and ambulances. Our
application looks for the availability of beds, equipment and blood if required and
chooses the hospital that's the closest and fulfills all the requirements. Incase of a
major blood loss, it contacts all the emergency departments of hospitals and blood
banks for the availability of the blood required. It notifies the blood banks of the
requirement so that it can be shipped as soon as possible to the hospital that the
patient is headed to, to save crucial time.

To provide a centralized ambulance system, the ambulance services are

government controlled making it a non profit institution

Thus, increasing the availability and deployment of ALS ambulances, especially in

high-demand areas. These ambulances are equipped with essential medical
equipment and are staffed with trained health professionals who can provide
critical care during transport.

Lack of dedicated lanes or corridors for emergency vehicles, is another challenge

faced by the ambulances. To reduce the time of the journey of the patient, we
provide a green corridor system, allowing the patient to save their time. (green
corridor system: all the signals in the way of the ambulance to the destination turn
to green to allow ambulances for a safe and prompt journey of patients).

According to a report by AIIMS and Niti Ayog these are some of the changes
required in the EMS currently being provided in our country.

● Strengthen the prevailing pre-hospital services such that a world-class

ambulance services are made available 24*7, encompassing on-going
definitive care through effective paramedics, for all citizens of the country
and, these should be optimally integrated with hospital care with an efficient
pre-hospital arrival system using latest Information Technologies.
● Expand Blood Bank related services such that even smaller Government
Hospitals are ensured timely availability of on-demand blood and its related
products.
● Create standalone Central/ State level efficient funding mechanisms to
ensure continuous upgradation of emergency related issues at all hospitals,
with built-in mechanisms for periodic assessments to check optimal delivery
of services.
● Develop mechanisms to ensure free treatment for emergency care services
for all citizens covering the minimal required period for early stabilization.

Shravan Sanjeevani ensures all of the above mentioned requirements are fulfilled
and works towards giving patients the best EMS possible.