Ambulances, in varied types, have existed since mankind indulged in struggle. The intuition to avoid wasting lives, to succeed in a healer in time, is as outdated as civilisation itself.
Trendy ambulances, nonetheless, are a product of the economic revolution, formed by higher vehicles and advances in drugs, particularly trauma care. The 2 World Wars, in addition to the Korean and Vietnam wars, grew to become nice lecturers in emergency medical response. Battle introduced not solely destruction but additionally self-discipline, the precision of fast evacuation, organised triage, and well timed resuscitation. These arduous classes laid the muse for what we now know as trendy emergency drugs.
‘Platinum Ten Minutes’
The concept of the ambulance is grounded within the science of human physiology. Acute sicknesses, particularly trauma, set off sudden circulatory and pathological disturbances that may rapidly flip deadly. Immediate analysis and intervention can reverse such pathological disturbances and restore normalcy. Delayed therapy results in irreversible pathological adjustments in main organs, usually leading to preventable mortality. Therefore, the ‘Golden First Hour’ idea is now universally accepted not simply in trauma care however in coronary heart assault and stroke circumstances too. It has developed from fast transport from the location of the accident to beginning therapy proper from the accident website, and persevering with therapy whereas transporting the affected person to a hospital.
Right this moment, most ambulances are geared up to ship oxygen, begin intravenous fluids, safe the airway, handle respiration, together with intubation and intercostal drainage, and management bleeding. Many are fitted with defibrillators, ECG and ECHO machines, and a few even carry cell CT scanners which permit early stroke analysis and therapy throughout transit. Deliveries might be carried out if vital, and the new-born might be stabilised till the ambulance reaches the hospital. From the golden hour, the world is now transferring in the direction of the ‘Platinum Ten Minutes’ normal — the objective that medical assist, not simply an ambulance, ought to attain the sufferer inside 10 minutes. Many nations aspire to this, although challenges stay, together with tough terrains, distant areas, struggle zones, excessive climate, and overcrowding throughout mass occasions. The ‘Platinum Ten Minutes’ isn’t a slogan however an moral accountability that defines how a society values human life.
Operational challenges
Broadly, there are two fashions of ambulance care. One is manned by paramedical personnel educated in fundamental life assist, and the opposite is led by docs, the place the ambulance capabilities as a cell hospital. India follows a mixture of each. The success of both mannequin relies upon not solely on expertise but additionally on the coaching, motivation, and coordination of the folks concerned in it.
Nevertheless, there are numerous technological and operational challenges. Ambulances require particular designs to securely use oxygen and different inflammable gases. They need to stay in good situation, be strategically positioned, and be pushed by educated drivers who can transfer quick with out inflicting accidents, which aren’t unusual. Well being employees or nurses should be expert to deal with crucial sufferers, make fast selections, and act successfully in a transferring car. A central name centre with GPS is crucial to determine the closest obtainable ambulance, estimate journey time, alert hospitals, and guarantee readiness of medical personnel, blood, and ventilators. Amenities for dwell communication with specialists, picture transmission, and real-time steerage can save essential minutes throughout resuscitation. In lots of superior programs, the hospital staff displays the affected person’s vitals even earlier than arrival. India has the expertise to do that; what we regularly lack is a system that ensures it each single time.
The Nationwide Ambulance Code (AIS-125), mandated by the Union authorities, standardises the design, building, efficiency, and tools of ambulances. The Motor Automobiles Act, 1988, and its 2019 amendments, present the authorized foundation for granting ambulances the appropriate of means. The calls for of the ambulance fluctuate from transporting a secure affected person to transporting one who requires superior life assist. The design and staffing of the car varies accordingly and the decision centre ought to be capable of determine which kind of ambulance can be applicable for every emergency name.
The necessity to standardise
In India, whereas the Nationwide Well being Mission offers essential monetary and technical assist to States, the States have flexibility in implementation. This results in a disparity within the high quality of service throughout States. For the document, the State-run 108 Ambulance service is without doubt one of the most profitable examples of public-private partnerships. About 10,000 ambulances are deployed within the nation transporting between seven to 9 million sufferers a 12 months. Tamil Nadu is without doubt one of the finest performers. It has a fleet of 1,353 strategically positioned autos. The common response time in Tamil Nadu is 10 minutes and 14 seconds — virtually reaching the internationally recognised ‘Platinum Ten Minutes’ normal.
Nevertheless, aside from the State-run 108 service, non-public ambulances function in most States with little standardisation of companies. There’s a want for a central organ to supervise, regulate and standardise all emergency companies throughout States and Union Territories together with air ambulance and drone companies which can turn out to be crucial autos for transporting life-saving organs for transplantation. There’s a want for a uniform syllabus, certification and periodic drills for all those that are concerned in rescue missions. Expert personnel aren’t so simply obtainable in rural areas and attrition charge is kind of excessive even in cities. The shortage of a uniform pay construction, promotion alternatives and excessive ranges of stress preclude even individuals, together with medical personnel selecting this subject. Extra usually, non-public ambulances owned by small hospitals lack certified personnel and tools.
It’s excessive time that each State establishes an Emergency Companies Regulatory Authority to make sure that ambulances serve the aim of saving lives and never simply transporting sufferers.
A constitutional responsibility
However even the most effective ambulance is of little use if it can not attain the location of a catastrophe. This has been witnessed repeatedly throughout giant public gatherings. The current stampede in Karur, Tamil Nadu, is one such grim reminder. Although ambulances responded promptly, they may not enter the scene attributable to chaos and blocked routes. This isn’t new, for comparable tragedies have unfolded time and time once more. Each time, we mourn and transfer on, with out fixing the fundamentals.
The State has an obligation in the direction of its residents. The suitable to life contains the appropriate to emergency medical care. No mass gathering ought to be permitted with out making certain unobstructed entry and exit routes for ambulances. This ought to be non-negotiable. Occasions mustn’t prolong past a number of hours, as most deaths happen attributable to dehydration and compression asphyxia relatively than the stampede itself. Individuals can suffocate even whereas standing, crushed by the group round them.
The State should deploy well-trained and licensed paramedical employees or volunteers, identifiable by uniform, inside such gatherings, geared up with fundamental emergency kits. Fast on-site cardiopulmonary resuscitation can save many lives; it’s a confirmed intervention. The ‘Platinum Ten Minutes’ normal begins the very second catastrophe strikes. Each passing minute decides the road between life and dying.
A nation able to performing superior organ transplants and robotic surgical procedures can not afford to lose lives to preventable tragedies like stampedes. Our ambulance companies should be standardised, regulated, and built-in, together with air and drone ambulances, with contemporary normal working procedures drawn up on the earliest. Tamil Nadu, with its very fast response time, should come out with a Complete Customary Working Process on the earliest. The time has come to deal with emergency medical response not as a service however as a constitutional responsibility. Ultimately, the true measure of a well being system isn’t what number of hospitals it builds, however how rapidly it reaches the injured when each second counts.
Dr. J. Amalorpavanathan is member, Tamil Nadu State Planning Fee and a vascular surgeon concerned in trauma care. Views are private.
