Emergency response is a very important aspect of healthcare services. Ambulance services play a critical role in the delivery of emergency response services. What is the state of such services in India? Do we have adequate number of ambulances? What is the quality of such services? Here is a detailed story. It is well known that easy & timely availability of ambulances cansave a lot of lives, especially in case of emergencies. The state of emergencymedical transport i.e. ambulances is a vast issue. In this article, let’s lookat the number of operational ambulances across states and various studies thatevaluate the functioning of ambulance services with various parameters. To get an understanding of the total number of operational ambulances, we take stock of the state-run ambulances and commercial vehicles being used as ambulances. We gather data for state-run ambulances under National Rural Health Mission (NRHM) and state-run ambulances at Health Care Centers from Quarterly National Health Mission Report (June 2019 update). The data on commercial vehicles being used as ambulances has been gathered from Road Transport Year Book 2016-17. In understanding whether the operational number of ambulances across states meet established standards, we take World Health Organisation’s (WHO) benchmark of at least one ambulance (emergency response) per 1 lakh population in the plains and estimate the required number of ambulances based on mid-year population projection published in National Crime Records Bureau reports. It has to be noted that this benchmark refers to the number of ambulances in the centralized emergency response system like 108 in some states and not the total number of ambulances available in the country, which includes private ones as well. The Emergency Management and Research Institute (EMRI) which manages the 108 service also talks about roughly one such ambulance for every one lakh people. The National Health Mission website highlights that at the time of launch of NRHM in 2005, ambulance networks were non-existent. Now 33 States/UTs have the facility where people can Dial 108 or 102 for calling an ambulance. Dial 108 is predominantly an emergency response system, primarily designed to attend to patients of critical care, trauma and accident victims etc. Dial 102 services essentially consist of basic patient transport aimed to cater to the needs of pregnant women and children though other categories are also taking benefit and are not excluded. Do we have enough ambulances to meet the requires standards? Here is a comparison of the total number of ambulances operationalacross states and required number of ambulances as per WHO standards. It has tobe noted the WHO standard pertains to a centralized public emergency response systemand is not about private ambulances. On the other hand, the data on private ambulances is available only up to2016-17 and for several states, the data for commercial vehicles being used asambulances was not reported in the Road Transport Yearbook. Even the availabledata pertains to those commercial vehicles registered as ambulances. Therecould be other vehicles used as ambulances but are not registered asambulances. It is also surprising to note that in certain big states, there isnot a single commercial vehicle that is used as an ambulance. It could be acase a data gap and hence the total number of ambulances across the country couldbe much higher. Except for the state of Andhra Pradesh, all other states have reported a higher number of total ambulances as compared to the required number of ambulances as per WHO standards. This means, that the number of ambulances across states does not fall short of international standards set by WHO, at least in the reported figures. However, the reported number of operational ambulances do not necessarily signify their functionality, access & qualify of infrastructure among other things. Multiple studies across different states that have evaluated various aspects of the functionality of ambulance services have highlighted gaps in these services. Evaluation of ambulances services According to a study conducted by AIIMS in 2012, summarised in the Wall Street Journal, reports that Delhi had 152 state-run ambulances. Of the city’s state-run emergency vehicles, only 21 have advanced life-support facilities such as defibrillators, ventilators and drugs for use in critical or trauma-related cases. Ten vehicles have basic life support systems without drugs or ventilators and the rest are basically white vans with stretchers. It was found that 28% of the 70,768 emergency calls received between March 2009 and May 2010 in Delhi were refused because of the shortage of ambulances.