THIRUVANANTHAPURAM: Sujith Radhakrishnan, a resident of Ambalamukku in Thiruvananthapuram, vividly recalls his first experience with an ambulance. There was no emergency, and the ambulance was not for him. Instead, Sujith had hired one to take his elderly father home after a spine surgery. Little did he expect how harrowing the ensuing journey would be.
“The driver was a young lad. He put on the siren and whizzed past vehicles, jumping signals casually. There was no emergency, but the driver’s action made it seem like one. When I protested, he assured me there won’t be any issue. We reached home within 10 minutes, shaken to the core,” recounted Sujith.
In Kerala, where the frequency of road accidents, drownings, and snake bites is alarmingly high, ambulances are considered frontline responders, racing against time to save lives. However, in the absence of stringent regulations to govern them, this noble mission of theirs sometimes spirals into perilous situations, like on May 7, when a speeding ambulance carrying a patient rammed into a car at Talapady in Kasaragod. A man and his two sons who were in the car died.
One of the most pressing issues stemming from unregulated ambulance driving is the proliferation of reckless driving. Lack of clear guidelines and oversight means there’s a risk of drivers succumbing to the temptation of speeding, disregarding traffic rules, and engaging in other hazardous manoeuvres in a bid to reach their destinations swiftly. Such actions not only jeopardise the safety of patients and emergency responders but also pose a significant threat to other commuters.
“Anybody with a light motor vehicle licence can become an ambulance driver,” said an ambulance driver who did not wish to be named. “Most of the drivers are youngsters. The remuneration is low, but it is the thrill (of driving at high speeds) that gives them a high. The recent fad is to make reels for social media while driving at crazy speeds. These ‘ambulance reels’ are getting immense reach,” he said.
While others on the road largely accommodate the emergency nature of ambulance service and the latter’s ‘right of way’ privilege, there have been plenty of instances where the privilege has been misused. There is also the issue of fare. While an array of ambulances parked in front of hospitals is a common sight and provides an assurance about the service, lack of regulation or standardisation in fare can give nightmares to the needy. In fact, even Transport Minister K B Ganesh Kumar had voiced his frustration over how he was overcharged by ambulance drivers sought measures to regulate the service, standardise the fares and take action against erring drivers. The transport department had then formed a five-member committee to fix tariffs for ambulance services in Kerala.
There have been attempts in the past to regulate the services of nearly 9,000 ambulances registered in the state. However, almost always, there were differences over controlling the speed and the fare. “There are ambulances that operate like tourist taxis with high-decibel sound systems and flashy lights,” said T Elangovan, former executive director of the Kerala Road Safety Authority (KRSA). He also said ambulances should follow the same speed limit as others.
“The drivers are not exempted from the speed limit as they would like to believe. It is okay if their speed is 10% above the permissible limit. However, most ambulances hardly operate below 100 kmph. The Motor Vehicles Department (MVD) and the police overlook these violations,” he said. In its training, KRSA tries to educate drivers about the impact potential at high speeds.
When AI cameras, to check for traffic violations, went live in the state, emergency services, including ambulances, got an exemption. This meant no challan would be issued even if ambulances jump signals or exceeded speed limit. It is felt this can foster a culture of impunity where the drivers may not be held accountable, even in cases where their negligence or recklessness leads to harm.
Enforcement officers in the MVD said they have limitations on restricting ambulances. “We can of course issue them challans for violating body code, having extra fittings, etc, but it is difficult to stop an ambulance to ascertain the purpose of its trip; whether it is an emergency or not. For, if anything happens to the patient everyone will blame the officer who effected the stop,” said an officer at the Transport Commissionerate.
He said 5,247 ambulances have been fitted with Vehicle Location Tracking & Emergency Alert System (VLTDS), which helps the control room track them. However, they are part of a large fleet, which includes school vehicles and stage carriers, making tracking difficult under the existing capacity of the servers.
While minister Ganesh Kumar is following up on his directives to standardise the fee, it has proven difficult. It begins with the classification of ambulances. There are several types; cars and tempo travellers have been modified as ambulances. “The trip is not assured every day. So when they get trips they try to make maximum money. The Omni ambulance and traveller ambulance cannot operate on the same fare,” said Elangovan.
Dr Althaf A, a public health expert and professor at Government Medical College in Thiruvananthapuram, stressed on the importance of bringing in technology to regulate ambulance services in the state. “Across the world, ambulances are part of a registered network having trained staff. There is a need to regulate the services by bringing in standards, and they need to be enforced using technology. Even a dash camera mandate will help enforcement agencies verify the trips without hindering emergency service. Omni ambulances should not be part of emergency services as they offer little safety,” he said.
Althaf also stressed on the importance of decentralised trauma care centres and government funding for emergency care for the first 48 hours. “The government can mobilise CSR funds, especially from life insurance companies, and pay for both ambulance and hospital expenses,” he said.
KANIV-108
Introduced in 2019, KANIV-108 (Kerala Ambulance Network for Injured Victims) has revolutionised trauma care across the state. The initiative boasts of 315 basic life support (BLS) ambulances strategically stationed near accident-prone areas.
Catering not only to road accidents but also to emergencies like pregnancy complications, strokes, and heart conditions, the service has become a lifeline for those in distress. It operates free of charge, with the government reimbursing the private entity managing the network. Equipped with essential medical apparatus, including oxygen cylinders, suction pumps, and pulse oximeters, the ambulances are manned by trained emergency medical technicians (EMTs).
Each vehicle is outfitted with a GPS, facilitating tracking from the Technopark control room in Thiruvananthapuram. Here, skilled technicians assess incoming calls, dispatch the nearest available ambulance, and guide it to the location. Upon arrival, the EMT evaluates the patient’s condition and transports them to the nearest hospital, prioritising urgency. The success of the 108 service has curtailed the reliance on private ambulances, reducing instances of patient diversion to profit-driven medical facilities. Moreover, a hospital pre-arrival notification system is in the works, ensuring swift treatment upon the ambulance’s arrival. To enhance accessibility, a mobile app for KANIV-108 ambulance requests is slated for launch in June, ensuring further streamlining of emergency response efforts.
Types of ambulances
Type A: Medical first responder
Type B: Patient transport vehicle
Type C: Basic life-support ambulance
Type D: Advanced life-support ambulance
Type E: Vehicle to carry a body (hearse)
Who owns ambulances?
Hospitals, community service organisations, NGOs, trusts, societies, political parties/fronts
Aggregated ambulance service providers include the Active Network Group of Emergency Life Savers (ANGELS) in the Malabar region, the Indian Institute of Emergency Medical Services (IIEMS) and Indian Medical Association (IMA)
Suggested solutions
Bring norms for vehicles, services
Standardise fares
Use tech to track, and verify the trips
Recruit experienced, trained staff
Take strong action against violations
Mandate certification by biomedical engineer for fitness clearance
Pitfalls
Issues stemming from unregulated ambulance services
Tendency to speed
Misuse of sirens and flashlights
Overcharging
Victim’s family
Crew driving/working while intoxicated
Poorly trained staff
Poor fitness of vehicles
Oxygen used in most ambulances not certified for medical purposes
Golden hour
The first 60 minutes following an accident, referred to as the ‘golden hour’, are crucial. Chances of victims’ survival are highest when they are brought to the hospital and treated within this time
The average response time - 25 minutes
Less than 20 minutes is the response time that the state targets to achieve
9,491 - Ambulances registered in Kerala
138 - Hearses registered in Kerala
5,247 - Ambulances equipped with Vehicle Location Tracking System