EMS Around the World: India’s Chaotic COVID Response

The Indian EMS sector is facing possibly the biggest challenge in almost 76 years of existence in its present form, as the country’s catastrophic situation with COVID-19 puts tremendous pressure on the country’s physicians, paramedics, and entire healthcare sector.

While India’s daily growth of new COVID-19 cases remains around 200,000 a day (after peaking at twice that in late April/early May), a significant growth in mortality from the disease and the rapid spread of mucormycosis (black fungus)—a rare, life-threatening infection considered a complication of COVID-19—may force authorities to revise earlier plans to relax coronavirus lockdowns.

According to a recent report in the Hindustan Times, an Indian English-language newspaper, at least 7,250 people are confirmed to have mucormycosis in India, but the actual spread may be much wider, and the situation continues to deteriorate.

The Role of EMS

As the current situation with the disease and its complications in India remains complex, much depends on the work of the country’s EMS. Since the beginning of the pandemic, its performance has frequently been criticized by both the public and healthcare analysts, and its inefficiency has been cited as exacerbating the rapid spread of the disease in the world’s second most populous country.

Currently India does not have a centralized body that provides guidelines for training and operation of emergency medical services. Local EMS is therefore fragmented and not accessible throughout all the country. Most citizens do not know the number to call in case of an emergency; services promote different numbers to summon ambulances, and both centralized and private models exist, with wide variability in their dispatch and transport capabilities. EMS education standards also vary, though EMT-Basic and paramedic courses have recently been established in some areas, along with trauma technician certifications and postgraduate diplomas in EMS.

A U.S.-style federative framework, with power decentralized, has prevented India’s federal government from acting more decisively to reduce the rapid spread of the disease months ago. EMS in India is within the responsibility of the country’s 28 states and territories.

A significant increase of the number of COVID-19 patients since the beginning of 2021 and lackluster response by regional authorities to the deteriorating situation led to shortages of both ambulances and medical equipment needed to treat patients. Worse, a lack of state response contributed to the formation of a black market for anti-COVID drugs, medical equipment, and even oxygen, which for a time became one of the scarcest items for COVID patients.

Despite India’s status as one of the world’s largest producers of both finished drugs and active ingredients, most emergency hospitals in the country (especially those in rural provinces) currently experience serious shortages of drugs to use against COVID-19. The biggest is remdesivir, with current prices in the local market exceeding 43,000 rupees (INR; about U.S. $585) per 100-mg bottle, compared to its original price of INR 1,000–5,400.

With the country’s lack of ambulances, many local private operators began charging exorbitant fees for the transfer of COVID-19 patients. In addition, many emergency hospitals charge hundreds of thousands of rupees for treatment.

India has a multitude of EMS providers, especially in urban areas (individuals, charities, private and publicly funded hospitals, self-help groups, nonprofits, political institutions and parties, institutions of religious practice, and more); however, many have tried to benefit from the pandemic by raising prices for their services.

Emergency Measures

As the shortage of ambulances in the country deepens, Delhi authorities have recently approved the use of rickshaws and tourist buses as ambulances to deliver patients to emergency hospitals. Authorities have provided dozens of such vehicles with disinfectants, face masks, and, if necessary, oxygen cylinders.

As part of its fight with profiteers, the government has decided to fix charges for private ambulance services, at least in Delhi, at INR 1,500–4,000. Chief Minister Arvind Kejriwal warned of strict action against violators, saying, “Some private ambulance operators are charging illegitimately amid a rush of COVID-19 patients to secure beds in hospitals.”

According to some Indian journalists, the real numbers of COVID-19 patients could be five times higher than official state counts. Some report authorities are trying not to spread panic, but outside the major cities, where the coronavirus is now moving, the situation is even more complex. In addition, many Indian citizens prefer not to inform authorities about their diagnoses.

Larger Problems

According to analysts, the current troubles of local EMS are also a consequence of a disproportionately small health budget for the country, which has just one doctor for every 1,700 people.

Despite the reforms of recent years, local authorities still struggle to provide timely and quality EMS to the public, particularly in rural areas. Per a (pre-COVID) report by the health ministry’s National Commission on Macroeconomics and Health, villagers have to travel an average of more than 12 miles for hospital care.

A shortage of personnel remains a problem as well, with more than 100,000 vacancies in India for trained EMTs. Most analysts believe the smooth, well-coordinated work of a trained and competent EMS sector is a necessity for countries such as India, with its variations in climate and generally poor popular immune resistance to infections like COVID-19. Unfortunately for its current fight against COVID-19, India has far to go to get there.

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.