By Palanivel Rajan

Copyright thehindu

The ‘108’ emergency ambulance services were started in 2008 in Tamil Nadu as a Public Private Partnership and which received accolades for their rapid and prompt response system initially, alleged irregularities that have been surfacing for the last few years have put their working model in question.

Akin to other States, the non-profit joint initiative between the Tamil Nadu government and EMRI Green Health Services (formerly known as GVK EMRI) reportedly enabled a service model combining public funding with technological support and managerial competencies from the private entities, with a common goal of achieving safe and timely transportation.

The answer to whether the goal has been achieved or not, according to researchers and health professionals, should be that the ‘108’ emergency services enhanced the otherwise dormant Emergency Medical Service (EMS) into a more active one.

They clarified that with the establishment of an integrated network of trauma centres through Government Taluk Hospitals, Primary Health Centres and Urban Primary Health Centres, Tamil Nadu Accident and Emergency Care Initiative (TAEI), the EMS too had evolved to adhere to the need of emerging population.

But, along with the evolution of the medical health services came the unavoidable aspect of profit-seeking.

The PPP method which functions under an ‘operate and maintain’ basis involves the initial investment by the respective State governments with the support of the Union government.

As the responsibility of the contract company lies in effectively operating the service with the fund provided by the State governments, going by what the ‘108’ ambulance drivers says, the contract company EMRI Green Health Services has been barely putting any effort to subject the vehicles to routine services and maintenance check.

In addition to the other basic problems – delay in salary payment, work overload, among others – the workers face, they are also made to fear for their life while delivering the essential and noble duty of saving people’s life, the drivers say.

An ambulance driver in Theni, recalling a recent event, says, “On board a person with severe injuries sustained in a road accident, when I was rushing from Kottaipatti to a nearby hospital, I ended up veering the van into a tree on the roadside.”

Expressing a sigh of relief over coming out of the incident with no injuries to the passengers or any damage to the vehicle, the driver, seeking anonymity, adds that it was the result of two-day continuous overnight shifts.

“While the Theni district alone has 27 ‘108’ ambulances, there are close to 130 to 140 drivers/pilots. This may seem to be enough, but with two to three shifts in the round the operation, the number is not even remotely close to enough,” he notes.

Activists flag the issue that when contracted EMS employees are overworked and can’t get proper rest, it’s more likely they’ll make medical errors, putting patients and clinical quality at risk.

This is just one of the issues which has surfaced around the organisation and delivery of the ‘108’ services in recent years.

Another major issue which plagues the smooth functioning of the service is the frequent unrest among the contract employees to earn their rights lost to the contract company’s complacent and self-indulgent policies.

R. Rajendran, State general secretary, ‘108’ Ambulance Workers Union – COITU, says, the company, as opposed to the initial contract which mandated 16% increase in the salary of the workers, often provides just 10% increment and sometimes even less.

“As their salary structure is not based on the Dearness Allowance system, which automatically guarantees yearly hike, a mandate was made to make a 16% increment every year,” he states.

“The abrupt cut in salary increment came as a blow to the workers who were preparing to demand for a 30% hike. With the excess work they are forced to do the current salary which is around ₹16,000 for a fresher is not even close to sufficient,” he points out.

“Though the emergency ambulance service comes under the Essential Services Maintenance Act, 1980, the contracted drivers and paramedical staff of 108 services have to jump into protest to draw the attention. As the law remains only on paper, the violation of contractual labour norms, denial of benefits and pay as mentioned in the contract have led to conflicts between the employees and the company,” Mr. Rajendran says.

Another driver based in Kanniyakumari, Lokesh (name changed), says the company in a bid to reduce their maintenance cost and to increase the mileage of the vehicles has limited the vehicles’ speed limit to 80 kmph.

Though it was not followed earlier, the new system often puts them in a spot as they could steer their vehicle above the speed limit to reach their destination.

“Ours is not a school bus or public auto to be forced to stick to the speed limit. Without crossing the speed limit, we cannot save lives within the golden hour,” he adds.

Even though the difference in survival rate is attributed to access to quality treatment during golden hour, several studies and CAG reports have pointed out the various hindrances like of lack of properly maintained vehicles, quality drivers, among others, which severely affected getting treatment within the golden hour.

Despite this, neither the company nor the government has made any effort to improve the quality of emergency service being delivered, the driver alleges.

An official of the EMRI Green Health Services says that since they (company) decided that the drivers/pilots have attained an adequate salary which is around ₹45,000 for those joined in 2008, they reduced the increment rate to 10%.

“As the Tamil Nadu government commending the work and efforts of the drivers and Emergency Medical Technicians (EMT) granted the 16% hike about five years ago, now they receive enough salary which is even equal to most of the doctors who are employed under EMRI,” he adds.

As per the Memorandum of Understanding (MoU) with the government the hike was only 10% and if the government steps forward to increase it, he states that they are ready to make the change.

Regarding limiting the vehicle speed limit to 80 kmph, he says that was done to prevent accidents caused due to ambulances.

“As they are not going to exceed the 80 kmph speed limit in both city and rural areas this rule was mandated,” he adds.

Refuting the workers’ accusation that the vehicles were not being serviced properly and not maintained periodically, he says they have a protocol and system to maintain the vehicles and as per that they undertake the works.