Open Access Research Article
THE NEED FOR INTRODUCING AMBULANCE LEGISLATION IN THE INDIAN LEGAL FRAMEWORK
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THE
NEED FOR INTRODUCING AMBULANCE LEGISLATION IN THE INDIAN LEGAL FRAMEWORK
AUTHORED
BY - ARYAN RAGHAVENDRA
ABSTRACT
This
research paper mainly focuses on the absence of laws which should have been
specifically enacted for the ambulances in India under the advanced emergency
medical services which has not been done, and this continues to lead to many
accidents while travelling through an ambulance. Every patient experiences a
“golden hour” when they are being transported through an ambulance. This makes
it important for them to train every ambulance driver to handle of such
critical situations which is necessary to transport each and every patient to
designated places. It is also necessary to understand that in India due to the
absence of laws that is specified to ambulances, it is very easy for anybody to
get a driving's license to drive an ambulance which does not require any type
of special requirements or special training which is not the case in countries
like the USA where there is a particular system established which is known as
the Advanced Medical Emergency Services. This failure of not having specific
laws further increases the possibility of the patient getting injured in the
golden hour that is before even reaching the hospital for the treatment. One of
the main reasons for the lack of training in India is the increasing illiteracy
rate which deprives people of the required education and also lacks of money
which adds up to the above-stated problem. Even the medical institutions are
very ignorant about the emergency medical services in India which also leads to
accidents. In other countries, like USA and UK the requirements are to be
trained in EMT for at least 2 years.
They are also required to have an Emergency Vehicle Operator course certificate
and special driver license in states. They are also supposed to have Basic life
support and cardiopulmonary resuscitation certification. Since India does not
have any particular legislations in relation to the regulation of the advanced
medical emergency services and maintenance of the ambulances like it is
prevailing in countries. There is also negligence found in the selection of
vehicles which is used as ambulances there are largely these very congested and
narrow vehicles that are used with absolutely no safety whatsoever which not
only puts the patient under the risk of accidents but also increases the
probability of accidents by putting the general public also in danger and
risk. With my above stated analysis it
further becomes evident that the inefficiency of the Indian Ambulance drivers
as well as the medical service providers is clearly exposed. There is also no
particular thesis that particularly disagrees with my above analysis as the
efficiency in emergency medical services which needs to be implemented in India
in order to avoid accidents and save as many life’s as possible during the
golden hour. Another major drawback that can be essentially highlighted in
India is when it comes to Emergency Medical Services is lack of centralized
system or helpline number that could address all the issues of accidents. There
was 102 and 108 established but this inturn proved to be a failure because it
did not gain popularity due to the inefficiency and their lack of resources.
KEYWORDS
Advanced
Emergency Medical Services, Emergency Life Saving Tech, Basic Life Support,
golden hour, Emergency Vehicle Operator,etc.
INTRODUCTION
Emergency
Medical Services
Emergency
Medical Service (EMS) is a division of emergency services dedicated to
providing out-of-hospital acute medical care and/or transfer to final care to
patients with diseases or injuries that the patient or medical practitioner
considers constitute a medical emergency. The purpose of emergency medical
services is to either offer treatment to people in need of urgent medical care,
with the goal of properly treating the illness, or to arrange for the patient's
quick transportation to the next stage of final care. This is most likely a
casualty in a hospital or other location where doctors are available.
RESEARCH OBJECTIVES
- To determine that the emergency medical service offered in India is
very poor and is directly impacting people’s life.
- Lack of legislations in respect to the ambulances is causing high
negligence in its operations across India.
- The need for special license and special training to the ambulance
drivers should be made mandatory so as to avoid all the road accidents
occuring during the “Golden Hour”
- The need to have laws enacted which in turn mandates all the
medical service providers to ensure the standard of Advanced emergency
Medical Services.
RESEARCH
METHODOLOGY
Research
undertaken is purely doctrinal and the data collected is primary source which
includes statutes, legislations, case-Laws etc. Secondary source includes
books, journals, articles etc.
RESEARCH
QUESTION
- India being one of
the most populated countries in the world, does it not require to adapt
the advanced emergency medical services in order to keep up with the
growing population?
- Are there no specific laws required in relation to these emergency
services and in regards to the operation of ambulances?
- Is a Special mental training required for the ambulance drivers to
drive and handle the critical situation?
- Can a normal person
with a driving license be trusted with the driving of an ambulance?
PRE-HOSPITAL
TRAUMA CARE
The
majority of deaths are caused by road traffic injuries that occur outside of
the hospital. However, India's trauma care system is still in its early stages
of delivering emergency pre-hospital care services. In India, emergency
pre-health trauma healthcare treatments are primarily restricted to
metropolitan regions. Heavy traffic in metropolitan areas, inadequate health
infrastructure, and a lack of competent human resources in rural regions limit
the use of traditional automobile ambulances to provide prehospital trauma care
services in India. Inadequate public financing, a lack of rules, and a
competent personnel are causing a bottleneck in the expansion of ambulance
services throughout India. The government may use the services of a broad
network of non-governmental organisations, self-help groups, and other social
organisations to make this effort a model for providing optimal prehospital
emergency trauma care services.
Access
to timely and high-quality medical care is critical in saving lives in emergency
situations. Prehospital trauma care services, which are the first point of
contact for emergency trauma care, vary greatly and are dependent on
infrastructure, resources, and trained staff. As a country progresses from the
pre-industrial to the industrial, developed, and urbanised eras, the number of
accidents and deaths is projected to rise. The vast majority of fatalities
caused by accidents occur before the patient arrives at the hospital.
In
India, prehospital trauma treatment services confront challenges in delivering
appropriate timely patient care and geographical coverage. India's emergency
auto ambulance services are in disrepair. The main disadvantage of traditional
ambulance services is accessibility, and more than half of the population resides
in areas without a regular EMS auto ambulance system. The prehospital trauma
vehicle services are weakened by a lack of rigorous traffic laws, poor
transportation facilities, insufficient logistics, and skilled human resources.
Driving an ambulance is a common activity for emergency medical service workers
in order to reach the person in need. In the National Road Traffic Regulations,
specific exclusions are made for ambulances, and other road users are
instructed on how to act if a special unit approaches with warning lights and
sirens. These legal reasons for driving with special privileges are analogous
to those in many other nations. Driving an ambulance with warning lights and
sirens, on the other hand, frequently results in emergency situations and has a
substantially greater accident rate when compared to other road users.
Furthermore, driving with warning lights and sirens had little effect on
patient outcomes. Higher accident rates are also a key cause of EMS staff
injury and death rates. Accidents occur most frequently at red lights and
during overtaking manoeuvres. significant speed and tailgating are significant
risk factors for catastrophic traffic accidents, both for the ambulance and in
general. Training has the ability to positively impact road safety. There are
two sorts of trainings that are commonly available: low and high order
trainings. Low-level training focuses on skill development and vehicle handling
and manoeuvring in crucial situations. In contrast, high-level training focuses
on insights into driving behaviour while reflecting on one's own driving
performance in order to predict and avoid crucial circumstances rather than
having to face them. Although driver training has the potential to improve
knowledge or behaviour, modifying behaviour does not automatically lower
traffic accidents or crash risk. Transporting patients from one area to another
is an essential component of emergency medical care. However, there has been
little interest in the actual driving of the ambulance. The ambulance driver
has an effect on the patient and the medical care delivered in an emergency
medical scenario. One of the most basic functions of any ambulance service is
to carry patients from point A to point B, most commonly while providing
medical care of some form. In emergency situations, the transportation itself
may be life-saving.
The
majority of the ambulance services were concerned with a significant rise in
calls, particularly treating on the scene or treating and referring to another
healthcare institution rather than being transported by ambulance. As a result
of the ambulance services' concentration on response times and transportations
to an end destination, there may be a significant underestimation of the value
and cost-effectiveness of actions at the site.This was reinforced by the
performance measurement regime's emphasis on reaction times. However, the
majority of industrialised nations do not merely emphasise response time as a
primary measure; they also promote clinical outcome indicators, concentrating
on medical emergency prevention and community volunteer engagement.
Furthermore, we believe that the process of generating new indicators should be
deliberate and involve a diverse range of stakeholders, such as healthcare
organisations and law enforcement. The main issue here is the information gap
between healthcare providers and their patients, which implies that the
traditional economics idea of the completely informed client is missing. It is
possible that the highlighted information problem is the primary impediment to
the closer participation.
Few
things are more upsetting than an unexpected death or severe handicap caused by
physical assault or an accident. It is especially heartbreaking when an
injured, potentially recoverable patient dies prematurely as a result of a
delay in treatment.
Inadequate
evaluation, retrieval, or treatment. This not only maims many young lives, but
also deprives everybody impacted of the 'Right to Life' granted by Article 21
of the Indian Constitution.
REGULATIONS REQUIRED IN INDIA
The
need for India to adapt and accept the Advanced Emergency Medical Services
which is followed in countries like USA and Japan which includes that the
ambulance drivers to be specially trained and be given special driving licenses
which can only be attained after several hours of mental training to handle
such critical situations. Further the expenses that are incurred by the
patients on the pretext of transportation is extremely high and not at all
affordable by 80% of the Indians due to the high prices and rates that is
quoted by such medical service providers. There has to be specific law that
needs to be legislated where such prices and rates should be regulated by the
government and it should also subsidise the amounts payable to such services
from the taxes paid by the people of the country. The vehicles that operate as
these ambulances need to be equipped with minimum of 6-8 airbags, speed
limiters,ABS and ESP should also be made mandatory and the old ones being in use
should be put through emission test and other safety test. If it fails to pass
the same then such vehicles should be retired from serving as ambulances. To
elaborate further there should also be ample amount of focus and importance
given to the crew members who are there in the back of the ambulance attending
the patients during their golden hour of time that is when the patient is being
transported from place A to place B. Such crew members have to be sufficiently
trained under aspects of such as stabilization,transportation and advanced care
of traumatic and medical emergencies. We also need to mandate the requirement
for drivers to have training in paramedics or atleast to have done an
apprenticeship in their local ambulance service trust. Simultaneously we need
to run through all the checking of basic requirement of state license which can
be derived only through passing all the training stages and also each person
wishing and willing to become a server under the advanced emergency medical
services must have a clean criminal record and driving record. This is
basically to make sure that each person enrolling themselves under this
advanced emergency medical services are in the right frame and state of mind
which is possible only when there are having clean criminal and driving record
that is they should not have caused any deaths in their lifetime that is during
driving of vehicle and causing accidents or by any other means. All these above
stated are already in functioning in other countries, however it is important
for India also to adapt the Advanced emergency medical services in order to
keep up with the population of the country.
A person with a normal driving license cannot
be entrusted with a responsibility of driving a ambulance because this particular
profession and job involves lot of critical situations. By critical situation
it is defined as situations where a person is required to maintain utmost
calmness and work with extreme sincerity and presence of mind. This is only
possible when a person is provided with such education regarding the same and
he is made to go through different stages of education as well as special
mental training which becomes absolutely vital for a person to deal with thoose
critical situations that are stated above. If such education and mental
training are not given then it tends to lead to inefficiency that leads to
causing of accidents which is dangerous to the patient inside the ambulance and
also it is violation of Article 21 for the general public who will also be exposed
to such dangers on the road. Hence a person with normal license cannot be
entrusted with such a responsibility whereas the person needs to be educated
and also the special mental training should be made mandatory. There should
also be certain checking to be on the existing vehicles which do not pass the
emission tests as well as the safety requirements. All these above stated
requirements are already in existence in other countries where countries like
USA,Japan and UK have already adapted and made it mandatory under their
Advanced emergency medical services. Considering India has overtaken and become
the most populated country it is high time it adapts such provisions and also
brings in specific laws in respect to such these emergency services in India.
EXISTING REGULATIONS IN INDIA
The
existing regulations in India are only related to the exterior requirements of
ambulances which is followed by the registration of ambulances. This is later
followed by the rules and regulations that needs to be followed and abided by
the general public in respect to such ambulances travelling on the road.
The Ambulance Conspicuity Code (Recognition) is given in
Annexure 1 of the Ambulance Code. It has been split into six sections:
1. Colour: The basic colour of the van should be brilliant
white, RAL code 9010. It should also sustain daily cleaning and washing and
should be weather-resistant.
2. Conspicuity Improving Items (C2I): This includes all
marking, striping, and symbols, and they should be brilliant red colour, RAL
Code 3024. The Conspicuity items include: chevron patterns - red/silver and
red/yellow, Battenburg patterns, "AMBULANCE" markings, the Star of
Life, emergency number.
3.Emblems: Emblems are government/ private / operator
signs, corporate identities (XXX) & any other sign, symbol, ambulance
calling number marking, or striping that is not referred to in
"Conspicuity Improving Items" section. Their size cannot be bigger
than 60% of the word "AMBULANCE" marking.
4. Warning Lights: Type A and B Road Ambulances should
have flashers fitted at appropriate locations as per the vehicle type. Type C
and D Road Ambulances should have warning lights.
5. Sirens: The sirens on all ambulances shall be mounted
on the front side of the vehicle. The sirens should be in acc
6. Recognition of personnel: Safety garments for ambulance
personnel should conform to at least ISO 14116:2008.
Chapter IV of the Motor Vehicles, Act, of 1988, talks
about the registration of vehicles, it states that no person shall drive a
vehicle that is unregistered with the state registering authority in whose
jurisdiction the place of residence or owner is. Section 53 states the grounds
for suspension of registration such as its use in a public place would constitute
a danger to the public, or that it fails to comply with the requirements of
this Act or of the rules, or used for hire or reward without a valid permit for
being used as such. Different states have their own requirements for ambulance
regulations.
Punishment for those who obstruct ambulances The 2019
amendment of the Motor Vehicles Act, of 1988 brought in the provision for
punishment for obstructing emergency vehicles, so under section 194E, causing
obstruction to an ambulance is punishable with imprisonment for six months and
a fine up to 10 thousand rupees.[1]
ANALYSIS
From the above stated data of existing laws and the news
laws that needs to be enacted it is clear to ascertain and understand that the
major part of the requirements which covers the special mental training and the
safety of vehicles and also the costs that are incurred which becomes a burden
on the common people. To resolve all these issues there needs to be a set of
legislations that needs to be enacted in the interest of protection of
fundamental right of general public that is article 21 of the constitution
which reserves a right for everyone to protection of individual life and
liberty. This further needs to be given importance and different laws need to
be enacted with a blend of subsidies that needs to be given to public in order
to reduce the price at which these medical services are offered and operated.
The whole idea of this research paper was to highlight the need to adapt the advanced medical emergency services
in India and to introduce legislations with which thoose services and can be
regulated and provided to public. Essentially there is no thesis which
particularly disagrees with my above analysis as the efficiency in emergency
medical services needs to established and implemented in India in order to
avoid accidents and help reduce the pre-hospital time which will in turn
fulfill and satisfy the entire motive of the Advanced Emergency Medical
Services of saving life’s during most critical moments.
Article Information
THE NEED FOR INTRODUCING AMBULANCE LEGISLATION IN THE INDIAN LEGAL FRAMEWORK
Authors: ARYAN RAGHAVENDRA
- Journal IJLRA
- ISSN 2582-6433
- Published 2023/04/26
- Volume 2
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
- Access Open Access
- License CC 4.0
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