India's EMS Growing Pains Sound Familiar

Times and places change, but the problems we face in EMS are universal

Don Lundy is a featured speaker at EMS World Expo, scheduled for October 29–November 2 in New Orleans, LA. Visit for more information.

To truly understand the state of EMS in present-day New Delhi, India, one needs to take a look at our own past.

It is 1966 and the American College of Emergency Physicians produces a paper entitled, “Accidental Death and Disability: The Neglected Disease of Modern Society.” Eventually, it will be known to us in the business as “The White Paper” and, among other things, it discusses unnecessary trauma deaths and the ineptitude of ambulance service in the United States (the term “EMS” had not been invented yet and prehospital care was a dream).

Prior to the publication of the White Paper there was no plan—no plan to improve a nonexistent EMS, no training models, no textbooks and no operational objectives on the board for any such improvement. Because no one had done this before, we had no model to go by. It was, in fact, uncharted territory.

When the White Paper arrived everything changed almost overnight in the U.S., and the start of what we now know as modern EMS, with its high power ambulances staffed by highly trained EMTs and paramedics, and its coordinated attack on the diseases and injuries of its customers, was born.

It’s important to reflect on where we all came from and how hard it was for the EMS industry to get to the point it’s at today. And development and implementation are still ongoing in the U.S. EMS system.

Now let’s take a look at New Delhi in context.

Before presenting at the International Congress on Emergency Medical Service Systems in New Delhi this past February, I was sent a copy of the 2010 “Workgroup Report on Emergency Care in India.”

It all seemed so familiar. The points identified as weaknesses in U.S. emergency prehospital care in the White Paper in 1966 are the same issues currently plaguing India. In response, a group of EMS professionals from around the world convened in New Delhi to share their systems.

I was honored to share information on the development of the U.S. EMS system and listen to other countries as they struggle, like us, with the continued need for better, faster and more data-driven medical care in the prehospital world. It was particularly enlightening to witness the continued struggles—and improvements—in the development of India’s EMS system. As exciting as it is to see what’s happening in other countries, it’s even better knowing they have many models to follow, unlike the U.S.’ first push into the prehospital arena.

The 2012 International Congress was hosted by the All India Institute of Medical Science (AIIMS), the sole medical school in India. AIIMS, noted around the city in both road signs and conversations, is a first class medical institution at the center of this change. With AIIMS’ help, 53 EMS practitioners, administrators and physicians, representing different delivery models from all over the globe, came together to share their views, wins, losses, improvements and futures.

In what’s likely not a surprise to experienced U.S. EMS providers, the similarities regarding operational, logistical and developing technologies crossed thousands of miles and spanned oceans. Violence against crews is on the rise in the U.K., as it is in the U.S. The numbers of patients who utilize EMS services for non-emergency situations increased during the global economic downturn, but many think it’s a bigger issue than money, pointing to instant access and scheduling issues. Equipment failures (batteries and air-ride systems, along with radio and/or IT communications were top on the list) continue to plague the industry in all corners of the world.

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