National Ambulance Services in India: A Narrative Review

Abstract

Background: A strong and effective emergency referral transport network is a prerequisite for a country's assured emergency ecosystem. Ambulances have grown exponentially since the start of National Ambulance Services under the National Health Mission (NHM) a decade ago. This paper aims to understand the referral systems, strategies and the progress and undertaken by the Government of India to upgrade and strengthen the referral transport system. Methods: We conducted a narrative review and secondary data analysis on referral transportation systems from government portals. Key Interviews were held with key stakeholders’ expertise in health systems. Results: The number of ambulances increased by 57.5 % from 2012 to 2022. Hitherto, 32.2 % of Advanced life support (ALS) ambulances have been shorted against population norms. Although the accessibility of referral services has improved, there is a significant gap in delivering timely in-transit service. Conclusions: The existing referral system requires the rational deployment of well-equipped BLS & ALS ambulances as per population norms with adequately trained staff or EMTs (Emergency Medical Technicians). A systematic plan for monitoring and accountability to ensure timely arrival within the “golden hour” is the need of the hour.