Opinion BlinkIt’s ‘10-minute’ ambulances and the spectre of a larger malady

More recently, however, several private ambulance services have been introduced both by corporate hospitals and companies that have made investments in providing standalone ambulance services. Blinkit, an online delivery service, has recently launched a “10-minute” ambulance service in Gurugram. A press release says that their ambulances will be equipped with life-saving facilities for patient transport.

A “10-minute” ambulance service, like the 30-minute pizza delivery offers, sounds far-fetched given the bumper-to-bumper traffic in urban India. At any rate, it exerts enormous pressure on the ambulance driver, as is the case with delivery service providers. There is no mention, however, of the cost of Blinkit services and how it compares to other ambulance services available in the market.

According to recent reports, the Indian ambulance market, valued at $1.5 billion in 2022, is projected to grow by over 5 per cent compounded annual growth rate in the 2024-2028 period. Despite this growth, the focus remains largely on patient transfer rather than critical emergency care. Out of 17,495 operational ambulances currently, only 3,441 have Advanced Life Support (ALS) units.

Moreover, there is much variation in the availability of ambulance services across states. Western states, including Maharashtra, Gujarat, Rajasthan and Goa, followed by southern Indian states with a large private healthcare sector, dominate the market for ambulance services. Reports indicate that Gujarat has a very well-worked out ecosystem of hospitals, medical colleges and emergency medical care. There is, however, a significant shortage in northeastern states.

There is much variation in ambulance services offered. These range from just transporting of patients, with no support services, to those that have Basic Life Support (BLS) to Advanced Life Support (ALS) units. Each is designed for specific medical needs. While BLS ambulance services are equipped for immediate care like cardio-pulmonary resuscitation (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.

A recent study by Niti Aayog shows that not all these services have the required infrastructure, equipment and technical staff to qualify as ambulance services. It revealed that 88 per cent of the hospitals had in-house ambulances but only 3 per cent of them had Emergency Medical Technicians. Only 12 per cent of all the hospitals have provisions for specialised care during transportation.

Studies evaluating some of these services have suggested a range of policy issues that need to be addressed. To begin with, one must recognise that a large number of the so-called ambulance services are nothing more than patient transport facilities. Even in the case of well-equipped ambulances, the rapidity of patient transport in a critical condition is dependent on road connectivity and traffic conditions. Poor planning of roads and traffic congestion in metros make navigating ambulances in emergencies problematic and delay timely treatment.

Mere expansion of ambulance services does not ensure quality. In fact, the lack of regulation of quality is a serious concern. Several studies have shown that the lack of availability of assured ambulance service, required and functioning equipment, trained staff and Emergency Medical Technician (EMT) are serious gaps. The non-availability of a standard pan-India toll free number, along with the lack of a systematic plan for monitoring and accountability to ensure timely and optimal care are some of the other areas needing action.

The haphazard and unregulated growth of private ambulance services is a serious shortcoming in the provisioning of prompt and quality services. There is a need for investment in developing standard protocols for general and specialised ambulance services. Skilling and certification of paramedics for ambulance services is absolutely essential. Weak regulatory provisions affect service standards, operational efficiency and liability issues. The regulatory landscape is fragmented with central and state level regulations, guidelines and licensing requirements. This leads to bureaucratic hurdles, inconsistencies and corruption for licensing of ambulance services.

Given increased longevity, contributing to the need for elder care, as well as increasing incidence of health emergencies, the provisioning of efficient and modern ambulance services will remain an attractive field for private investment. However, publicly-funded services, public-private partnerships and civil society sponsored services have a critical role in a society that can ill-afford high cost private services.

The writer is retired professor, Centre of Social Medicine and Community Health Jawaharlal Nehru University, Delhi