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Table of Contents
Year : 2019  |  Volume : 35  |  Issue : 3  |  Page : 401-402

The “critical” link in the transport of critically ill patients; role of the anesthesiologist and challenges in the Indian setup

Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Web Publication3-Sep-2019

Correspondence Address:
Dr. Sanjay Agrawal
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joacp.JOACP_6_19

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How to cite this article:
Dhar M, Agrawal S, Singh U, Agarwal R. The “critical” link in the transport of critically ill patients; role of the anesthesiologist and challenges in the Indian setup. J Anaesthesiol Clin Pharmacol 2019;35:401-2

How to cite this URL:
Dhar M, Agrawal S, Singh U, Agarwal R. The “critical” link in the transport of critically ill patients; role of the anesthesiologist and challenges in the Indian setup. J Anaesthesiol Clin Pharmacol [serial online] 2019 [cited 2021 May 17];35:401-2. Available from:


Inter-hospital transport (IHT) of critically ill patients and “transport medicine” are still finding their feet in developing countries such as India.[1],[2] In the context of appropriate personnel required to transfer patients, anesthesiology is one of the basic specialties where postgraduates get an abundant amount of exposure and training in resuscitation, airway management, and basic critical care. Residents are regularly involved in intra-hospital transfer of critical patients from intensive care unit (ICU) to other departments and are fairly familiar with basic transport protocols. Thus, on most occasions, during unavailability of specialist transferring personnel or intensivists, an anesthesiologist is generally the safest option. They are also better oriented with handling multiple organ systems including cardiovascular and respiratory systems, along with the use of ventilators.[1] Verma et al. in their study in a trauma center on referred patients from peripheral hospitals described that only 3.66% were accompanied by a paramedic or a nurse and none by a doctor.[2] Most remote areas having any kind of operative setup would have at least a surgeon and an anesthesiologist. Thus, until more formal training in transport medicine and specialist transport teams are established, anesthesiologists will perhaps be the go to option for such tasks and the “critical link” between the referring and receiving units.

India's ambulance dilemma: This is a unique and perhaps a socio-cultural problem related to “ambulance awareness” on Indian roads. The traffic patterns in most Indian cities on numerous occasions affect ambulance or critical care van movement from one unit to the other especially in absence of any external help or regulation from traffic control departments.[3] Sporadic incidents of “Green corridors” being created for transport of potential transplant organs have been seen on Indian roads. Perhaps similar initiatives could be taken for routine IHT of critically ill patients in the future, depending on the priority and severity of illness; with the collaboration of national and regional critical care societies, health ministry, and transport and traffic control departments.

Lack of appropriately trained drivers is another factor with incidents of ambulances getting into traffic accidents further aggravating an already critical situation. Most of the current ambulance network in India is run by the private sector and smaller unregulated ambulance services. Although the services including air ambulances are evolving and improving,[4] the cost factor is a major deterrent in context of accessibility to the masses. Government policies related to public–private partnerships and subsidized care to the underprivileged are the way ahead. GVK EMRI is such an initiative that has expanded its presence across numerous states and serves as an example on how to standardize and centralize ambulance services across the country.[5]

Long-distance IHT and adapting to local strengths: India is fortunate to have a fairly extensive and robust train network. In absence of air support or conditions unsuitable for air travel, this can be a viable option for long-distance IHT and a much more affordable option compared to air. Many hazards of air travel can also be avoided in these situations.[1] Army Medical Corps personnel of the Indian army are actively involved in rescue operations from remote locations and difficult terrain, including those for medical emergencies.[6] The technology and infrastructure of the armed forces and its presence in numerous remote, often troubled areas has been a continuous support to the civilian medical setup.

With the establishment of better central critical care services in India, referrals and IHT from peripheral hospitals is bound to increase. Due to the varied nature of topography and medical setup across the country, adapting to local conditions and resources at our disposal will be essential to maximize efficiency and conduct safe IHT of critical patients.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian J Anaesth 2016;60:451-7.  Back to cited text no. 1
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Verma V, Singh GK, Carvello EJ, Kumar S, Singh CM, Harjai M. Inter-hospital transfer of trauma patients in a developing country: A prospective descriptive study. Indian J Community Health 2013;25:309-15.  Back to cited text no. 2
The Wall Street Journal. India's Ambulance Emergency. Available from: [updated 2014 Oct 16, Cited 2018 Dec 25].  Back to cited text no. 3
Khurana H, Mehta Y, Dubey S. Air medical transportation in India: Our experience. J Anaesthesiol Clin Pharmacol 2016;32:359-63.  Back to cited text no. 4
[PUBMED]  [Full text]  
Kumutha J, Rao GR, Sridhar BN, Vidyasagar D. The GVK EMRI maternal and neonatal transport system in India: A mega plan for a mammoth problem. Semin Fetal Neonatal Med 2015;20:326-34.  Back to cited text no. 5
Ranjan CK, Renjhen P. Casualty air evacuation: Sine quo non of combat casualty. Med J Armed Forces India 2017;73:394-9.  Back to cited text no. 6


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