Ambulances today are better equipped than ever for the worst kinds of emergencies, from cardiac arrests and gunshot victims to car crashes and other life-threatening injuries, and the list of bare minimum essentials consists of over 70 items.

India has two different yet overlapping publicly funded ambulance systems, both popularly known by their helpline numbers, 108 and 102. Between them, they have more than 17,000 ambulances across the union of 31 states and union territories. Almost 23 percent of all traumas that occur in India are transportation-related, with 1,374 accidents and 400 deaths taking place every day on Indian roads. Out of every one million people, 42,800 die every year from sudden cardiac arrest in India. This has caught the attention of the US and European-based equipment manufacturers, who now recognize there is a big market for their products – from spine boards to high-end automated external defibrillators to software for computer-aided dispatch.

Government Policy to Standardize Ambulance Designs

Recently, the Ministry of Road Transport and Highways, in collaboration with the Health Ministry, has notified G.S.R.868(E) dated September 8, 2016 mandating specifications in accordance with AIS:125 (Part 1)-2014 for Road Ambulances of categories L and M manufactured on and after 1st April, 2018. For this, experts from the Health and Transport ministries reviewed the ambulance standards across the world such as those of Europe, USA, the United Kingdom, and Singapore, and noted that Indian ambulances are in a pathetic condition.

Health experts say that the initial first hour (golden hour) is very crucial for an injured patient and therefore trained paramedical personnel with optimum health care service are required.

The National Ambulance Code classifies road ambulances into four types (A, B, C & D) that is First Responder, Patient Transport, Basic Life Support, and Advanced Life Support, respectively. The category of First Responder, which also includes two-wheeled ambulances, caters to the need for providing prompt medical care in congested by-lanes and high-traffic areas. Special care has been given to Care Ergonomics, Patient Safety, Oxygen System Design, Infection Control, Crash Rescue, etc. in the Code. Once implemented, this Code will ensure uniformity and standardization in ambulance design and a minimum level of patient care as per the ambulance designation when appropriately staffed and equipped. So far no guidelines were available for hospitals and other procuring agencies for floating tenders and for industry outlining required specifications.

Increasing Popularity of Air Ambulances

Air ambulances are increasingly becoming popular in India, especially in parts of the country that lack connectivity to hospitals in big cities. Many of the large hospital chains in India, including Apollo, Fortis, and Max, have their own air-ambulance services. Demand for air ambulances is finding increasing popularity in Tier-II and Tier-III cities.

The demand is so high that it has attracted many international companies into the country as well, such as Air Medical Group Holdings (AMGH), one of the biggest privately-held providers of air ambulances in the world who has tied up with an Indian company, Aviators Air Rescue. While there is a complete unanimity among those involved in the healthcare industry that India needs more air-ambulance services, the fact is these services are still very much in their infancy in India.

Technology Trends

As technology advances, so do emergency medical services, adapting to new developments and utilizing them to improve their quality of patient care. Breakthroughs in communications and fleet-tracking technologies are helping save lives while other innovations, such as power-saving devices, are helping healthcare providers reduce the amount of time their vehicles spend idling.

The list of bare minimum essentials needed in an ambulance consists of over 70 items. And while this list continues to grow, emergency responders find themselves capable of providing more lifesaving tactics while transporting patients to the hospital. Where years ago, supplies were limited, there are not many limits to the procedures that can be performed in the ambulance to save a person's life. EMTs and paramedics can actually place IVs, administer medication, even place a patient on advanced life support and perform more advanced airway procedures – all from of an ambulance. And in many cases this could be the difference between life and death as a patient is transported to the medical facility.

Tele-ambulances. Communications technology has come a long way. Teleconferencing helps paramedics treat and diagnose patients on their way to the hospital. The vehicles are equipped with an audio-visual communication platform, empowering ambulance staff to have direct consultation with hospital physicians. This allows paramedics to transmit key information to doctors, including vital signs and, more importantly, photos of the patient's wounds. Thereby, doctors provide critical care instructions and can make necessary preparations for the patient's arrival.

GPS technology. GPS tracking and remote monitoring technologies are now available which give healthcare managers incredible power in managing their mobile workforce. GPS tracking not only lets one know where their vehicles are at any given moment, it can also help to optimize route management, which, in the end, can save precious minutes in response time. Dispatchers can make note of obstacles (such as construction sites) that can slow ambulances down and relay faster, alternate routes to their drivers.

Digital ambulances. Implementing real-time instrumentation, such as a multiplex system, in ambulances improves the overall efficiency of the emergency transportation system. For example, fleet managers can receive real-time data regarding the speed of the vehicle, when lights and sirens are being used, and even maintenance readings from the chassis, resulting in lower operating costs throughout the vehicle's life cycle.

Energy conservation. Traditional ambulances need to stay running in order to provide power for onboard systems (like ECG units, defibrillators, medical cooling units, etc.). This means that these vehicles spend a lot of time idling. When this happens, fuel is wasted, costing money and polluting the environment. However, there are emerging technologies that can help prevent this wasteful practice. New advanced tools provide electricity for vehicle heating, lighting, emergency equipment, and computers. They can be charged from the ambulance while driving, or plugged in at headquarters.Outlook

Things will get even better in the ambulance world, driven by better science. Changes in the interior configurations and the specialty vehicles, such as mobile stroke units, critical care transports, neonate transports, will see a growing trend in the future. Most ambulances today are already hotspots, so they have Internet connectivity and can transmit a variety of information. Therefore, telemedicine could be of greater use over the next few years.

The next generation of ambulance technology will be driverless. Believe it or not, with autopilot technologies, autonomous ambulances could be just around the corner. Driverless ambulances are just one way to help cities meet the increased demand for care. Driverless ambulances and other technology could take some of the strain off the emergency services, freeing paramedics to deal with high-risk patients where each minute waiting for treatment significantly reduces a patient's chance of surviving

One can only imagine how advances in technology will continue to positively affect the world of emergency medical service. As healthcare services continue to improve, boards and committees are formed and looked to for advice regarding what ambulance services can improve on in the future. Among the recent suggestions are side entry doors, better visibility, and specialized units to respond to chronically ill patients. The sky is the limit as technology advances and lucky for those of us living in the modern age; we benefit medically from the improvements to emergency responding units as technology allows them to advance.

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