Emergency Medicine (EM) is a relatively new specialty in developing countries and it is still in its infancy.

Transportation of patients is undergoing a facelift, where it is being conducted by trained EM physicians with the help of trained Emergency Medical Services (EMS) staffs. This branch of highly skilled transportation comes under the division of transport medicine under the department of Emergency Medicine.

This Branch of Emergency Medicine deals with not just transportation but also pre transport / en-route stabilization of patients. It also involves comprehensive retrieval/transfer system.

Ambulances were first used for emergency transport in 15th century in Spain. Initially even hot air balloons were used for transportation. In this era of transport medicine which began to develop in the early 20th century, we have established various modes of transportation.

There are various modes of transportations viz: -

• Ground transport (Road Ambulance)
• Water Transport (Water Ambulance)
• Air transport (Air Ambulance)
  • Rotor-wing vehicle (helicopter)
  • Fixed-wing vehicle (airplane).

Transportation of critically ill patients is a challenging task. There is an increased risk of morbidity and mortality. Indication for transportation are many. But always consider the Risk vs Benefit before transporting any patient.

Few of the indications of transportation are as follows:

• Referral to higher centers for expert care
• Therapeutic purpose – surgical / image guided procedures.
• Diagnostic – MRI, CT, Angiography
• Specialized care – tertiary hospital
• Lack of ICU Beds/ Specialists.

Types of transportation available are:

• Interhospital transport – Hospital to hospital transport, also include field retrieval.
• Intrahospital transport – Within the hospital transport.

In India, the National Ambulance Code AIS:125 (Automotive Industry Standard) is being introduced, to improve the quality and safety of ambulances.

This code is Recommended by the Central Motor Vehicles Rules-Technical Standing Committee (CMVR-TSC) and approved by the Union Ministry of Road Transport and Highways (MoRTH).

The code classifies road ambulances into four - A, B, C, and D - on the level of service they render to the sick and the injured.

• Type A: First Responder
• Type B: Patient Transport
• Type C: Basic Life Support
  • Non-invasive airway management and basic monitoring.
• Type D: Advanced Life Support
  • Emergency patients requiring invasive airway management / intensive monitoring.

The various stages of interhospital transport include:

• Pre-transport
• During transport (en route)
• Post-transport

We at Caritas Hospitalhave the state-of-the-art level D ambulances which caters to all types of patients from neonatal age group to geriatric age group. It is equipped with all equipment’s & facilities required for all critical patient transportation including ventilator.

Caritas Hospital and Institute of Health Sciences, Kottayam, Kerala launched India’s first Telemedic AI ED on wheels – C RATS AI (Caritas Remote Ambulance Telemetry Services) along with Caritas RATS AI app on October 28, 2023. With this artificial intelligence (AI) supported Telemedic service, the Caritas team aims to provide continuous expert care to the patients while on their way to the hospital. For this noble venture, Caritas Hospital has obtained a National Record as First AI integrated Telemedic Advanced Ambulance Service & ED on Wheels by the Best of India Records. Since its inception in 2023, we have successfully completed over 1000 such transportations.

A toll-free number has been provided for all ambulance service at Caritas Hospital – 9496555200. A separate division of transport medicine has been formulated under the emergency medicine department to provide 24 x 7 ambulance services along with trained emergency medical technicians.

Even though the system of transport medicine in our country has improved over the last decade, we still have lots of concerns like heavy road traffic, no separate ambulance line, lack of separate toll free number, deficiency of specific guidelines for ambulance transport, lack of clearance for air ambulance transport for helicopter retrieval, lack of training for ambulance drivers and crew.

Ambulance transportation has gone into a totally different level in our country. It’s the responsibility of everyone to support the government officials in formulating a better transport medicine system in our country so that the expert care can be provided right from the incident site to the hospital.

Dr. Ajith Venugopalan
MBBS, MD(EM), MBA (HA&HCM), PGDMLE, DHQM, FACEE, FICM
Chief Operating Officer & Group Head (Sr Consultant – EM & TC),
Caritas Hospital & Institute of Health Sciences, Kottayam, Kerala.