SC Notice Exposes a National Emergency in Emergency Care

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26 Nov 2025

ANUJ DWIVEDI The Supreme Court of India, by issuing notice to the Union Ministries on the alarming state of ambulance services across the nation, has reawakened a conversation India has postponed for far too long. In doing so, the Court has declared—quietly but unmistakably—that the right to life cannot be treated as an abstract constitutional artefact. It must be protected in every street, every district, and every ambulance that is summoned in a moment of fear and desperation. This judicial intervention was triggered by a tragedy that cuts deeply into the conscience of this nation. Dr. P. Venugopal—former Director of AIIMS, Padma Bhushan recipient, and the surgeon who performed India’s first heart transplant—was transported, in his final hour, in an ambulance that lacked even the most basic life-support facilities. Equipment that should have been standard—oxygen, a defibrillator, emergency drugs, trained personnel—was reportedly absent. He was declared “dead on arrival.” A man who spent decades saving lives was denied the rudimentary tools of survival in his own final emergency. His wife and daughter, who approached the Court, are not merely grieving; they are holding the nation accountable. The Bench of Chief Justice B. R. Gavai and Justice K. Vinod Chandran deserves unreserved commendation. With a single notice, it has reminded the government that constitutional obligations do not end at hospital gates—they begin the moment distress is reported. The judiciary has once again asserted its moral authority by refusing to allow preventable deaths to become accepted features of public life. The petitioners’ plea is supported by data that should shame a country of India’s stature. According to a study by the All India Institute of Medical Sciences (AIIMS) reviewing emergency and injury care across the country, over 90% of ambulances do not carry essential life-saving equipment, 95% of ambulance drivers have no paramedic training, and nearly 98.5% of ambulance runs are simply for transporting bodies rather than saving lives. A separate analysis reported in Medical Buyer echoed similar findings, noting that the vast majority of Indian ambulances function merely as glorified vans with sirens—vehicles that can move a patient from one place to another but cannot keep that patient alive. The gravity of the crisis is further underscored by utilisation data. A 2021 review published in the Journal of Emergency Medicine found that only about 30% of emergency patients in India arrive at hospitals by ambulance. The remainder reach by auto-rickshaws, motorcycles, private cars, or whatever transport is available. The reason is not cultural reluctance but practical distrust. People do not call ambulances because they do not believe the ambulances can save them. Meanwhile, the National Crime Records Bureau (NCRB) and Ministry of Road Transport figures have consistently shown that India records more than 150,000 road traffic deaths annually, among the highest in the world. The World Health Organization has repeatedly emphasised that most trauma deaths occur not on the road but in the absence of pre-hospital care. India’s own NITI Aayog has estimated that nearly 30% of critically ill patients die during transit due to the absence of basic life-support facilities. When such numbers are placed beside real-world tragedies, they paint a bleak but honest picture. That picture becomes painfully real in countless households. Consider the middle-aged man in Uttar Pradesh who collapsed due to sudden cardiac arrest. His family called the nearest ambulance service; the vehicle arrived with no oxygen cylinder, no defibrillator, and no trained personnel. The driver—a noble man, but wholly untrained—could only offer speed. By the time they reached the hospital, the man was beyond help. His wife was told “he did not make it.” The truth is harsher: he never stood a chance. In Rajasthan, a pregnant woman who began haemorrhaging was taken to a district hospital in an ambulance that lacked blood-pressure monitoring equipment, intravenous fluids, or any emergency drugs. She deteriorated during transit and died before arrival. Her death was quietly attributed to “complications,” but the real complication was the ambulance system itself. In tribal Maharashtra, a young farmer bitten by a venomous snake was placed in an “ambulance” that had no anti-venom, no monitoring equipment, and no paramedic. The 40-minute ride proved fatal. The bite did not kill him—the delay and the absence of care did. These are not isolated accounts; they are the lived experiences of millions. They reflect a structural truth: an alarming proportion of ambulances in India are not emergency care units. They are empty shells—vehicles that carry the sick but do not care for them. The paradox is glaring: India has world-class tertiary hospitals, advanced surgical units, and globally renowned doctors. But the bridge between the patient’s home and the hospital—the ambulance—remains fatally weak. A study published in Health Systems Review noted that between 2012 and 2022, the number of ambulances in India grew by 57%, yet only around 3,400 out of 17,000+ operational ambulances were classified as Advanced Life Support (ALS) units. In simple terms, more than 80% of ambulances lacked the capability to stabilise a patient in crisis. The question that arises is fundamental: What meaning does the right to life hold if the State cannot ensure life-support during the very minutes when life is slipping away? This is why the Supreme Court’s notice carries such profound significance. It is not merely an administrative step—it is a moral indictment of systemic neglect. It compels the government to confront a truth that has been avoided for decades: emergency medical transport must be an essential public service, held to enforceable national standards, and not left to the whims of private contractors or state-level improvisation. India urgently needs legally binding norms requiring every ambulance—private or public—to carry oxygen, defibrillators, vital-sign monitoring devices, emergency medicines, trained paramedics, and communication links with hospitals. Equipment must be inspected regularly. Response times must be measured. Performance must be audited. And most importantly, lives must be valued. If implemented with seriousness, such reforms could save thousands of lives every year. If ignored, the cycle of preventable loss will continue indefinitely. The death of Dr. P. Venugopal, a titan of Indian medicine, is a national tragedy. Yet if his passing becomes the catalyst for reforming emergency medical care, then his final journey may save countless others. His life exemplified medical excellence; his death now demands excellence in governance. The Supreme Court has lit the torch. It is now upon the executive to carry it forward with urgency, clarity, and conscience. India cannot aspire to global medical leadership while allowing ambulances to remain moving compartments of chance. No citizen—famous or unknown—should die because the ambulance that arrived carried everything except the means to save them. Let this be the moment when India finally resolves that emergency medical care is not to be left to providence. Let this be the moment when ambulances cease to be mere carriers of despair and become instruments of life. Only then will the constitutional promise of life truly find breath on the roads of this Republic. (Author is Advocate, Supreme Court of India)