11 Jan 2025 : The Indian Express

Editorial 1 : Symptom of a Larger Malady 

Context: BlinkIt’s ‘10-minute’ ambulances and the spectre of a larger malady.

Introduction: An increase in chronic diseases and road accidents has spurred the demand for emergency services and hospitalisation. Ambulance services are an important link for transporting patients who require emergency care.

Evolution of Ambulance Services in India

• For a long time, ambulances were available only at a hospital.
• In the 1980s, non-government organisations stepped in, particularly in southern India, to provide voluntary and free ambulance services.
• State governments introduced services targeted at:
  • Women of reproductive age.
  • Children under five years.
• National Rural Health Mission (NRHM)
  • Introduced public-private partnership (PPP) ambulance models.
  • Focused on increasing institutional deliveries, primarily in urban areas.
• Private Sector Involvement
  • Recent growth in private ambulance services by corporate hospitals and standalone companies.
  • Example: Blinkit launched a “10-minute” ambulance service in Gurugram.

Current Landscape of Ambulance Services

• Market Overview
  • Indian ambulance market valued at $1.5 billion in 2022.
  • Expected growth: Over 5% CAGR from 2024-2028.
  • Out of 17,495 ambulances, only 3,441 have Advanced Life Support (ALS) units.
• Regional Disparities
  • Western and southern states dominate the market. Examples: Maharashtra, Gujarat, Rajasthan, and Goa.
  • Significant shortages in northeastern states.
• Types of Ambulances
  • Patient transport facilities (no medical support).
  • Basic Life Support (BLS): CPR, oxygen therapy.
  • Advanced Life Support (ALS): Cardiac monitors, defibrillators, ventilators.
  • Specialised services
    • Air ambulances for long-distance transport.
    • ICU ambulances for critical care during transit.
• Infrastructure and Workforce Challenges: According to a NITI Aayog study
  • 88% of hospitals have in-house ambulances, but only 3% employ Emergency Medical Technicians (EMTs).
  • Only 12% offer specialised care during transportation.

Challenges

• Operational Barriers
  • Traffic congestion and poor road planning hinder emergency response.
  • Fragmented regulatory landscape:
    • Central and state-level inconsistencies.
    • Bureaucratic hurdles and corruption in licensing.
• Quality and Regulation
  • Lack of standardised protocols for ambulance services.
  • Deficiencies in trained staff and equipment availability, and Monitoring and accountability mechanisms.
  • Absence of a unified pan-India toll-free number for emergency services.
• Private Sector Concerns
  • Unregulated growth leads to disparities in service standards.
  • High costs limit accessibility for low-income populations.

Way Forward: Recommendations

• Policy Interventions
  • Develop standard protocols for general and specialised ambulance services.
  • Establish a unified toll-free emergency number across the country.
• Skilling and Certification: Train and certify paramedics and EMTs for efficient emergency care.
• Infrastructure Development: Improve road connectivity and traffic management for faster ambulance transit.
• Regulatory Measures
  • Streamline central and state-level regulations to reduce inconsistencies.
  • Introduce stringent licensing requirements to ensure service quality.
• Strengthening Public-Private Partnerships
  • Encourage collaborations between government, private entities, and NGOs.
  • Focus on affordable and accessible ambulance services for underserved regions.

Conclusion

Given increased longevity, contributing to the need for elder care, as well as increasing incidence of health emergencies, the provisioning of efficient and modern ambulance services will remain an attractive field for private investment. Publicly-funded services, public-private partnerships and civil society sponsored services have a critical role to offset the high cost of private services.

Editorial 2 : What breaching 1.5°C means

Context: 2024 was the first year to breach the 1.5^oCelsius threshold.

Introduction: The year 2024 has now been confirmed to have breached the 1.5^oCelsius global warming threshold, becoming the first calendar year to do so.

1.5^o Celsius: An arbitrary mark

• The 1.5-degree mark is an arbitrarily decided threshold. In terms of climate change impacts, there is nothing new that will begin to happen once this threshold is crossed.
• Paris Target: The 2024 breach does not mean that the 1.5-degree target is over. This target, mentioned in the 2015 Paris Agreement, refers to long-term temperature trends, usually over two to three decades, not annual or monthly averages.
• Emission Cut Targets: Global emissions are still on the rise, and the 2030 emission cut targets are almost certain to be missed. Therefore, there is every likelihood that the breach that has happened in 2024 would become a norm within the next decade.

2023, 2024 Exceptionally Warm

• The year 2024 has now become the warmest year ever, taking over from 2023 which was 1.45 degrees Celsius warmer than pre-industrial levels.
• Every month since July 2023, with the exception of July 2024, has been more than 1.5^oCelsius warmer than the corresponding monthly average of pre-industrial times.
• El Niño, a periodic oceanic phenomenon in the eastern Pacific Ocean that has a big impact on global weather. El Niño has a general warming effect, while its opposite phenomenon, called La Niña, has a cooling effect.
  • There was an El Niño prevailing during 2023 and 2024.
• Other Factors
  • Unprecedented El Niño-like systems in multiple other ocean regions.
  • An underwater volcanic eruption near Tonga in the southern Pacific Ocean in January 2022.
  • Lower sulphur dioxide emissions from the shipping industry in 2024 could also have contributed to the warming.
    • Sulphur dioxide in the atmosphere reflects some solar radiation, thus preventing it from reaching Earth.
  • The unusual warming could also be because of the Sun, which was in its solar maximum phase in 2024 during its routine 11-year solar cycle.
    • During the cycle, the magnetic poles of the Sun flip from one end to the other. Increase in the solar energy reaching the Earth during the solar maximum phase could have contributed to the warming.

Looking at 2025 and beyond

• The exceptional trends seen in 2023 and 2024 are unlikely to continue in 2025.
• In the last decade, annual temperatures have been between 1.1 and 1.4^oCelsius higher than pre-industrial levels, and this year is expected to fall in the same bracket.
• According to a WMO report, there is a possibility of annual average temperatures reaching as high as 1.9^oCelsius above pre-industrial levels in one of the years before 2028.
  • There is a 50% chance of the five-year average of annual temperatures up to 2028 exceeding the 1.5^oCelsius threshold.

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