When a vehicle called ambulance itself is a misnomer, its service beggars description. It is a wholesale racket that is going on in the name of private ambulance service in the city and elsewhere in the country. The very premise on which private ambulances operate, is reportedly faulty. First, ambulance operation under individual ownership is illegal. Second, most of the vehicles passed as ambulances are in fact makeshift ones converted from microbuses. Registered as microbuses, these vehicles do not have any approval for carrying patients, nor can they be used as hearse. 
The practice resorted to for conversion, is certainly illegal and punishable. When a microbus is locally tinkered with to give it a shape of an ambulance, it is only natural that most of the requisites go missing from such vehicles. The sliding door right in the middle of the vehicle is cut out in some cases but there are a few non-air-conditioned ones which do not even bother to have a properly locked door. An official of the Bangladesh Road Transport Authority (BRTA), according to the report carried in a Bangla contemporary, claims that an ambulance must have oxygen cylinder, mask, stretcher and seat for a physician. No seat for passengers should be there. When such conditions are fulfilled, only organisations not individuals are granted licences for carrying patients. 
In this context a look at the must-have-chart of equipment, system and arrangements in ambulances in the United States of America and Canada will expose how prehistoric the service here is. The Committee on Trauma of the American College of Surgeons, the American College of Emergency Physicians and the National Association of Emergency Medical Services Physicians have collaborated on devising a list of equipment and system an ambulance must have. Notably the list has been revised quite a few times to make it standardised in 2005. Also there is the Emergency Medical Services for Children and the Paediatric Equipment Guidelines Committee has worked out the supplies an ambulance must be equipped with for this purpose. Then again ambulances are categorised as those with basic equipment and supplies and others most advanced type.
The list is long and more importantly pre-hospital delivery care in an ambulance gives the impression that it is far better than a patient can expect in one of the most modern hospitals in Bangladesh. Beginning with a portable and fixed suction apparatus with a regulator, what is not there? Oxygen apparatus capable of metered flow, oxygen administration equipment, bag-valve mask, pulse oxymeter, saline drops, immobilisation devices, arterial tourniquet, nebuliser and many more medical apparatuses ought to be in place for a vehicle to operate as an ambulance. Then paramedics will be present on board to do the needful. They do maintain constant contact with hospitals to intervene on the advice of doctors. 
There is no question of comparison with the US or Canadian system of ambulance service. But at least the vehicles needed to be operated legally in this God-forsaken country. That an assistant of a so-called ambulance driver managed to kill four people including a pregnant woman at the main gate of the Dhaka Medical College Hospital no longer should cause many an eyebrow to raise when the makeshift method of conversion of microbuses into ambulance is known. How patients in such vehicles receive pre-hospital delivery care is anyone's guess. Many of the patients taking a rocky ride in such vehicles make it to the hospital by the grace of what some people believe as guardian angels. It is surprising they do. The majority of the critical patients were supposed to breathe their last on the way to hospital. 
Now this is not only disgraceful but also outrageous. If the private ambulances are like this, how the ambulances operated under the management of government hospitals are should be an interesting query. Do they follow some rudimentary guidelines in order to qualify as ambulances? There is hardly any reason to be optimistic about their capabilities. The list the BRTA official mentioned is nowhere near the basic requirement for taking care of a patient during transportation. 
Clearly, there is need for doing away with the deplorable system. Let there be a minimum decent transportation arrangement. Ambulances should not be in their name only, they should be real ones fitted with some basic equipment and supplies. Senior and expert surgeons, physicians and paediatricians should be involved with working out a list of 'must-have' equipment and apparatuses for ambulances. It has been unwise to leave the job to inept hands for so long. Ward boys, other low-ranked employees of government hospitals and political elements have taken advantage of the chaotic situation by pressing into service their own version of ambulance. 
An ambulance is a special type of vehicle that must not compromise on any of the required facilities inside. A siren and a stretcher are not all. Such a service has to be run by organisations that care for ailing humanity. Usually it is the critical patients who need the service most. So inadequacy in facilities or lapses in pre-hospital delivery inside an ambulance make a difference between life and death. Now that the ambulance scandal has become public, the job of streamlining the service has become an obligation for the nation. Patients are our near and dear ones and everyone may need such supportive intervention. So, the issue should be taken up in right earnest to get some standard ambulance services in the country.
nilratanhalder2000@yahoo.com
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Source: The Financial Express