Ambulance code for safe transfer - Rules for vehicles & staff within a year

New Delhi, Feb. 9: India is likely to establish a national ambulance code that will specify minimum standards for vehicles and paramedical staff amid concerns that inadequate care during transport may be harming patients.

A team of doctors and experts from the health and surface transport ministries as well as an automobile research agency are preparing the national ambulance code which is likely to be notified within a year, emergency services doctors said today.

“It’s a free-for-all right now — we have neither standards for ambulances nor for staff inside them,” said Angel Rajan Singh, a senior resident in hospital administration at the All India Institute of Medical Sciences (AIIMS), New Delhi.

“We know of incidents where medical equipment has fallen on patients when their vehicles hit a road bump or lurched,” Singh told The Telegraph on the sidelines of an international conference on emergency medical services hosted by AIIMS.

The move to pencil standards comes after a decade of rapid growth in the use of ambulances. A study by the Christian Medical College (CMC), Vellore, has shown that the proportion of patients who used ambulances to get to hospitals has climbed to 37 per cent in 2010 from only 3 per cent 10 years earlier. “About 85 per cent of patients reached hospitals within an hour,” said Suresh David, professor of accident and emergency medicine at the CMC.

Doctors believe improvements in access to emergency medical services in recent years have contributed to a marginal decrease observed in the rate of road accident deaths in India over the past five years — 1.5 per 1,000 vehicles in 2005 to 1.4 in 2010.

“But we need to prescribe minimum standards for ambulance care,” said Shakti Gupta, the head of hospital administration at the AIIMS and chair of the team designing the ambulance code. “About 40 per cent of patients are lost on the way to hospital,” he said.

The code is likely to classify ambulances into two categories — one for advanced life support, the other for basic life support — each with different sets of minimum standards.

Advanced life support vehicles, for instance, are likely to require a minimum patient compartment length of 10 feet, a maximum loading height of 84cm, and a defibrillator and ventilator, Singh said.

The staff in such vehicles would need to know how to place a seriously ill patient on a ventilator.

A basic life support ambulance may be defined to have a minimum patient compartment length of nine feet, a loading height of 74cm and a defibrillator, among other features.

The ambulance code building exercise will also specify the minimum qualifications for paramedic and nursing staff inside ambulances. “We currently have no national guidelines on paramedic qualifications,” Singh said.

Sections of doctors have in the past argued that concurrent development of emergency medicine departments in hospitals should accompany the improvements in ambulance networks to make a significant impact on the treatment outcomes for trauma victims or other patients requiring emergency medical services.