Forgotten pandemic lessons? India's ambulance system needs urgent reforms

A recent report revealed that the focus of the Indian ambulance market, valued at $1.5 billion in 2022, still remains largely on patient transfer rather than critical emergency care

The Covid-19 pandemic exposed the chinks in global healthcare systems’ armour. India’s ambulance services were no exception, a new report has revealed. The sight of patients being transported in personal vehicles and auto-rickshaws during the pandemic underscored a dire need for a robust ambulance infrastructure. 

However, despite being two years past the second wave, major improvements remain elusive, raising concerns about the nation’s preparedness for future health crises, a report titled ‘Going Beyond patient transfer’ by consultancy firm Primus Partners has noted.

How big is the Indian ambulance market?

The Indian ambulance market, valued at $1.5 billion in 2022, is projected to grow at a 5.12 per cent CAGR in the 2024-2028 period. Despite this growth, the focus remains largely on patient transfer rather than critical emergency care, the report highlighted. Out of 17,495 operational ambulances currently, only 3,441 are Advanced Life Support (ALS) units, with a significant shortage in high-focus areas like the Northeastern states, where only 26 ALS ambulances are in service.

“ALS ambulances need a strategic push as these are lifesaving vehicles which are required is critical for the golden hour. A push is required towards high-tech Ambulances equipped with Tele-medicine, which can be used for such terrains and can stabilise patients,” said Anurag Singh, managing director at Primus Partners.

Ambulance services with life support

India’s ambulance services range from Basic Life Support (BLS) to Advanced Life Support (ALS) units, each designed for specific medical needs. While BLS ambulances are equipped for immediate care like CPR and oxygen therapy, ALS units offer advanced interventions with cardiac monitors, defibrillators, and ventilators. Additionally, there are specialised ambulances such as air ambulances for swift long-distance transport and ICU ambulances equipped for critical care during transit.

Ambulance registrations dip after pandemic

While the annual registrations from 2020 to 2023 averaged 11,648 ambulances, with notable spikes in 2020 (7,814) and 2021 (14,236), it was followed by declines in 2022 (12,737) and 2023 (11,950). However, the operational capacity of ambulances is frequently compromised by maintenance issues and ageing vehicles. Additionally, this fluctuation underscored a reactive rather than proactive approach to healthcare infrastructure, the report highlighted. 

It further noted that prompt medical intervention within the first hour following an emergency is crucial. However, nearly 80 per cent of patients in India do not receive timely medical attention, emphasising the need for a more efficient emergency response system. 

Availability of ambulance well-below international standard

While international benchmarks recommend one ambulance per 50,000 people in low- and middle-income countries. However, the Ministry of Health and Family Welfare aims to achieve a ratio of one BLS ambulance per 100,000 people and one ALS ambulance per 500,000 people, it said in an announcement last year. Many BLS ambulances function merely as patient transport vehicles (PTVs), lacking essential equipment and trained personnel.

Additionally, with India’s road traffic fatality rate at 18.9 per 100,000 population, significantly higher than the global average of 8.7 in high-income countries, there is an urgent need for enhanced emergency medical services, the report said.

Public-private partnership as a way out?

Talking about successful public-private partnerships (PPP) as a means to bridge the existing gap, the report cited the example of promising results of PPP, as evidenced by Tamil Nadu’s successful model which has led to an increase in the availability of ambulances in the state. 

“The focus needs to shift from patient transfer to ALS systems. Many innovative ideas like medical taxi, bike ambulances, etc are being considered for patients with minor injuries, or patients who need to be transported to home post-discharge. These kinds of solutions will reduce the burden on existing advanced ambulances. We also do not have many high-tech ambulances with telemedicine facilities, which can be crucial for difficult terrains. This is another area private players can work towards bringing excellence and bridging the gap,” Singh remarked.