Fewer people used state’s free ambulance service in pandemic year of 2020
Despite an acute shortage of ambulances being reported from across Maharashtra in the first wave of Covid-19 in 2020, fewer people availed of the state government’s free ambulance service 108
Despite an acute shortage of ambulances being reported from across Maharashtra in the first wave of Covid-19 in 2020, fewer people availed of the state government’s free ambulance service 108. Data from the Maharashtra Emergency Medical Services (MEMS) shows its fleet of 937 ambulances ferried over 9,18,778 patients with various health emergencies in 2020, nearly 12% lower than over one million patients transported in the pre-pandemic year of 2019.
However, in 2021, when the second wave struck, use of 108 service saw a drastic rise as more than 1.2 million people sought the free facility. It was a 33% jump from the 2020 figure and an 18% increase from the number in the pre-pandemic year. The MEMS numbers show the use was higher in the rural and tribal areas (together 80%) compared to urban areas.
Multiple reasons have contributed to the lower uptake in 2020, according to MEMS officials.
“Cases of road accidents and other traumas came down because of the lockdown in the first wave, which led to a drop in such type of emergency calls,” Dr Dnyaneshwar Shelke, chief operating officer of MEMS, said. “On the other hand, many people simply avoided availing of medical services due to the fear of Covid-19, and conversion of health facilities into fully Covid-19 care centres. These aspects impacted the overall statistics.”
A scarcity of ambulances was reported from all over the state because of the pandemic and the ensuing lockdown when public transport services were unavailable. Covid-19 patients, and others like pregnant women and those on dialysis and chemotherapy, struggled to get to hospitals. On the other hand, many ambulances stayed off the road as drivers feared the infection or were down with the virus.
In Mumbai, the civic body converted private vehicles and BEST (Brihanmumbai Electric Supply and Transport) buses into ambulances to ferry Covid-19 and other patients. “It is hard to pinpoint why the overall uptake reduced in the first wave, but people with other medical issues largely refrained from availing of health services fearing Covid-19,” Shelke said.
Between March 2020 and December 2021, the 108 ambulances served 5,926,49 Covid-19 patients across the state, the MEMS data reveals.
The fleet of 937 ambulances comprise 704 with basic life support and 233 with advanced life support. While there are over 10,000 other ambulances registered with the transport department, the MEMS fleet is a government-run service offered free of cost. The service was started in 2014 and can be availed of by dialling the toll-free number 108.
“The MEMS has managed to make access to the free ambulance service easier. Since it is a toll-free number, even someone who does not have balance on their mobile phone can reach out to us,” Shelke said.
According to Shelke, almost 70% of the emergencies that the MEMS has handled have been home emergencies, on-road emergencies, or mass casualties and 30% are referrals from smaller medical facilities to higher centres.
“Commonly, the referrals that we have are from smaller sub-centres or rural hospitals to higher centres such as district hospitals and tertiary care hospitals that are attached to medical colleges. A large number of these referrals are for pregnant women and those with serious ailments who need specialised surgical, medical, or intensive care,” he said.
Data collated by the MEMS shows the maximum number of emergencies fall under the ‘medical’ category which includes general ailments such as abdominal pain, headache, sprain, fever etc. Since 2019, nearly 64% of the emergencies handled by the ambulance service have come under this category. While pregnancy and labour have accounted for nearly 13% of the emergencies, vehicular accidents have made up only 4.5% of the emergencies attended to.
The higher number of calls in the ‘medical’ category may not seem like true emergencies compared to vehicular accidents for instance. However, MEMS authorities say when a patient or a relative calls for an ambulance, it should be assumed an emergency.
“Someone may have an acute headache, which may not seem very serious, but it may turn out to be a heat stroke which is a life-threatening circumstance,” said Prashant Ghate, zonal manager of MEMS for Nagpur and Akola divisions. “We get many such calls from the Marathwada and Vidarbha regions. For us, when a patient or a relative thinks it is an emergency, we treat it as an emergency,” he said, adding in some cases, people from the rural or tribal areas of Maharashtra call when they don’t have access to a vehicle, or the access roads to their home is very bad. “Difficulty in access also becomes an emergency situation.”
80% from rural areas
The MEMS data shows nearly 80% of the emergencies that have been handled over the recent years are from rural and tribal areas. “Only about 20% of the calls were from urban parts of the state,” said Shelke, adding they are spreading awareness of the ambulance service and defining emergencies.
Since its inception, the MEMS has held nearly 6,800 school awareness programmes and over 33,800 general public awareness events. “We plan to step up the awareness drive in order to increase the reach and also ensure that people know what an emergency can be and that they can call 108 for help,” he said.
The fleet of 937 was planned based on the 2001 census when Maharashtra’s population was around 9 crore and 37 lakh, which comes to one ambulance per one lakh population. However, the recommended ratio in low- and middle-income countries is one ambulance per 50,000 population and the response time should be as low as four to six minutes. The MEMS response time is on the higher side - an average of 30 minutes in rural and tribal areas and 20 minutes in urban areas.
“The access roads in rural areas are difficult and traffic is a big issue in urban areas for us,” Shelke said. “There is no plan to increase the fleet at the moment, but we are constantly working to improve our response time.”
Public health researcher and activist Ravi Duggal said it is a good sign if the 108 ambulance service has increased its reach in the remote areas of Maharashtra. “Golden hour is extremely important when it comes to emergency services,” he said.