Indian guidelines for registration of ambulance is tedious. The Jargon is nauseating. But they are important. So, how to make sense of them? We will help you there. This article from AMB life is an attempt to understand ambulance registration guidelines for Delhi – in simple language.
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Representational image. Credit: The spectator/Dredge[/caption]A recent study by India Today showed that three out of five ambulances in India are not in working condition. While this may be due to the scarcity of money, the investigation revealed that most of the service providers either don’t care to follow the norms or are unaware of them. One of the ambulance proprietors, named Vinay (name changed), that AMB life talked to feigned ignorance. When coaxed further to explain, he replied, ‘’Bahut pechida hai, sir. Agar chahein bhi toh unka requirement fulfil nhi kr skte.’’ (It’s too complicated, Sir. Even if we try our best, we won’t be able to fulfill their requirements). This is just one of the many similar replies that we got.
It was not until we had talked to many of them that we understood the root cause of the problem. The pathetic state of ambulance services can be attributed to three reasons. One, authorities don’t trouble themselves in enforcing the regulations. Two, people just don’t know (and neither understand) what the mandatory guidelines are. Three, there is a serious issue of investment. While we can scarcely do anything regarding the enforcement and funding, we can at least make you aware of the guidelines or necessary requirements for registering an ambulance in Delhi.
But before getting to the guidelines, it will be better if we are able to understand the meaning of some common terms. It is not necessary just because it is a good thing to know but also because you will be encountering them every now and then. So let’s begin.
Advanced life support (ALS) ambulance
An ALS or advanced life support is an improvement over the BLS. It is particularly important in those scenarios where an FR or First Responder is not enough to provide the adequate level of medical support or in cases where a patient needs a higher level of medical support, say, of a paramedic. But it will be short-sighted to assume that ALS is the highest level of medical care in case of emergencies. If needed, a patient can be granted critical care medical help as well. Instead of FRs and paramedic, these are manned by an RN (registered nurse) or a specialized doctor. An ALS ambulance or personnel is trained and allowed to administer drugs as well (which can’t be done by a BLS ambulance or staff).
The main job of an ALS personnel and ambulance is to check the heart rate, apply defibrillation when necessary and provide appropriate medication. The procedure involved in most cases is guided by a 2005/2010 AHA ACLS guidelines, commonly known as 4H’s and 4T’s – an acronym for hypoxia, hypovolemia, hyper or hypokalemia, Hypo or hyperthermia, Tension pneumothorax, tamponade, toxic and thromboembolism. It will be worth mentioning that this guideline has been prescribed by the AHA and International Liaison Committee on Resuscitation. The Indian govt. guidelines may vary and indeed they do. The procedure too may vary as may be the requirement of must-have drugs and equipment on an ALS ambulance.
Basic life support (BLS) ambulance
A basic life support or BLS is the type of medical support provided to patients in the case of life-threatening emergencies or trauma until they reach the nearest medical support. While the exact meaning of the term may vary from country to country and even among states, the basic idea remains the same. It can be provided either by a trained First responder who can be a passerby or by trained staffs, but lower than a paramedic and an R.N. A BLS personnel is neither permitted nor prepared to administer drugs.
The basic philosophy is to maintain and improve the blood circulation, keep the airway clear and improve breathing. The procedure followed is generally abbreviated as CAB which stands for Circulation, Airway, and Breathing. While circulation can be restored by controlling bleeding or CPR, oral or nasal adjuncts are used to keep the patients’ airways open. To maintain and improve breathing, artificial breathing is provided.
Patient transport ambulance
The Committee of Health and Family Welfare Department of NCT of Delhi describes a patient transport ambulance as -
“A vehicle that is used for making non-emergency calls such as scheduled visits to a physician's office for treatment, routine physical examinations, x-rays or laboratory tests, or is used for transporting patients upon discharge from a hospital or nursing home to a hospital or nursing home or residence, or attending to other non- emergency calls.”
They are not usually equipped with life-support equipment and are manned by personnel with lower qualifications than ALS and BLS ambulance services. Now let us focus on the guidelines.
Color – the ambulance can be painted in any color. There’s absolutely no restriction. So, you don’t need to frown when you see an ambulance colored black as long as it follows other guidelines.
Emblems and markings – the guidelines are different for an ALS or BLS ambulance and patient transport ambulance. The guidelines are
- All items under this heading should be reflective quality and contrasting color to the exterior painted surface. If you choose to paint your ambulance black, the markings and emblems should in white and vice-versa. This is mandatory only for ALS and BLS ambulances. There’s no such restriction on the patient transport ambulance
- Star of life symbol – Blue for ALS, Green for BLS, no ‘star of life’ in the patient transport ambulance. Wherever applicable, there should be one star in the front at each end of word ‘ambulance’, one on each side, two in the rear and one on top. They should not be less than 30 cm in height.
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Star of life symbol. Credit: Wikimedia Commons and eBay.
- One ‘AMBULANCE’ in reverse in the front, one on each side and rear. The dimension should be 15x8 cm. This is only valid for ALS and BLS ambulance.
- A patient transport ambulance may not have this emergency signals etched on them. But they can write ‘patient transport ambulance’ and their license number on each side.
- Before selling the ambulance vehicle to the public, all emblems and markings have to be removed.
- While sirens and beacons will be mandatory in ALS and BLS, the same will be installed in patient transport ambulance as per the provisions of Center Motor Vehicles Rules under Motor Vehicles Act.
Interior patient space dimensions – for ALS and BLS, its 2700mm x1500mm x1500 mm and in the patient transport ambulance, the interior dimension has to be 1600mm x 940mm x 1000mm. The order of dimension is length x width x height (from floor to ceiling).
Minimum ambulance rescue equipment – Each BLS and ALS ambulance has to mandatorily carry these items –
- Hammer – one four pounds with a 15-inch handle.
- One ax
- Wrecking bar, minimum 24 inches
- Crowbar, minimum 48 inches with pinch point
Essential medical equipment and other items to be placed in an ambulance
Advanced life support ambulance (ALS) – an ALS ambulance is designed to provide a higher degree of medical support than a BLS ambulance. So, the list of items and equipment also vary accordingly. Below is the list of mandatory equipment for ALS
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List of essential items for ALS ambulance. Credit: Govt. of Delhi. If the image is not clear, visit https://imgur.com/63raNIE[/caption]Basic life support ambulance (BLS) – a BLS ambulance is designed to serve as the first point of medical support in case of emergencies. Though it is not equipped to administer drugs or possess any invasive skills, it is important to provide crucial first-aid relief.
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List of essential items for BLS ambulance. Source: GNCT of Delhi. Created by: AMB life. If the image is not clear, visit https://ufile.io/czm0n to see word file or https://imgur.com/XGjGNhY to see image
Patient transport ambulance – unlike ALS and BLS ambulance service, who pertain to emergency situations, patient transport is used for scheduled visits to a physician for treatment, physical examination, laboratory tests etc. Keeping this in mind, the requirement of items is rather frugal. Some of the essential medical pieces of equipment are -
- Resuscitation kit
- First aid box
- Ambulance Bag set Oropharyngeal airways
- Oxygen cylinder and accessories
List of consumable items – while it is not mandatory for a patient transport ambulance, it is must for an ALS and a BLS ambulance, especially for an ALS ambulance.
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List of essential consumable items. Source: Govt. of Delhi. If the image is not clear, visit https://imgur.com/c46ldzj[/caption]List of emergency drugs – apart from prescribing the list of essential equipment and consumable items, the guidelines also mention the names of some drugs which are to be mandatorily kept on every ALS ambulance. As you already know, BLS is not equipped to administer drugs so they need not stick to this list. They can keep it as a precautionary measure if they wish. Though nothing has been said about patient transport ambulances, it will do no harm if they carry these as well.
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Source: Govt. of Delhi. If the image is not clear, visit https://imgur.com/Mf02Y6u[/caption]BLS patient cabin specifications – Realizing the importance of medical support in ‘golden hours’, the guidelines specifically mention some of the specifications of cabins that is to be there in every basic life support ambulance. It is in line with the latest draft by the central government regarding the concept of the First responder. The central guidelines are expected to kick in starting 2018. Back to the list, these specs are –
- Proper ventilation
- Noise-free, comfortable ride
- Adequate power supply
- Adequate patient cabin space
- Complete flooring free of joints
- At least two superior quality fans, among others.
- Storage space, among others.
You can see the specifications in detail below.
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Source: Govt. of Delhi. If the image is not clear, visit https://imgur.com/mnDXus6[/caption]Some other important guidelines
Other than the points mentioned above, the regulations also lay down some guidelines regarding the new applicants and already certified ones. Let us have a look at them as well.
- Guidelines are applicable only to new applicants. Already certified ambulances not need to re-apply.
- The certificate, once granted, will be valid for five years. Within this period, the committee can inspect the ambulances for compliance and can revoke the certificates as well, in case of any negligence.
- Certified ambulances will have to obtain fitness certificate as per the guidelines of Center Motor Vehicles Act and Rules there-under from the department of transport, the government of Delhi.
- The certificate has to be revalidated on expiry to be able to continue the ambulance services.
- The committee has the right to revoke the certification at any time.
- The equipment should be in working condition.
Now, that you are aware of the registration guidelines, follow them. It’s the life of a patient which is on a ledger. Your actions can mean the difference between a life and death. Even after following this, if you are finding it difficult to make yourself accessible to your customers, then there’s a way out for you. AMB Life is inviting all private ambulance operators to register their main services like air ambulance, ground ambulance, ICU ambulance, motorcycle ambulance etc. with us. You can also register your ancillary services like hearse van, oxygen systems etc. If you are the one who excels in providing ambulance services for corporate events, film shootings, medical escorts etc., you are more than welcome to register with us.
Disclaimer: This article is based on the recent guidelines issued by Government of Delhi regarding ambulance regsitration and was originally written for AMB Life.
