New Delhi: Help is on the way for patients facing long delays during medical emergencies. India is set to overhaul its National Health Mission (NHM) ambulance network by introducing strict response-time penalties, mandatory fleet retirement, and electric vehicles, according to a senior government official and a document reviewed by Mint.
The new rules cover 28,472 ambulances funded under the ₹39,390-crore scheme. Under a new accountability matrix, operators will be fined ₹20 for every minute they exceed agreed-upon response times.
The new rules also introduce strict penalties for operational shortfalls. Ambulance operators must cover minimum daily travel thresholds—120 km in the plains and 80 km in hilly regions—or face fines of ₹20 and ₹25 per missing kilometer, respectively. Additionally, operating without a functional air conditioner or essential medical supplies will cost vendors ₹5,000 per vehicle each day, while unannounced GPS failures or deliberate tampering carry a ₹25,000 fine.
Failing to deploy a qualified emergency medical technician (EMT) and driver on shift will draw a ₹10,000 penalty per instance. To ensure constant tracking, all ambulances must maintain 100% functional GPS connectivity linked in real time to the 112 emergency helpline, with telecom providers automatically sharing caller location data. Overall, fleet availability must stay at 95% daily, requiring each vehicle to operate at least 28.5 days a month.
The framework was jointly developed by the Union Ministry of Health and Family Welfare and the National Health Systems Resource Centre to enforce commercial and operational accountability nationwide.
Plugging system gaps
The stringent guidelines aim to fix systemic vulnerabilities that have long plagued India's emergency medical transport network. Currently, response delays remain common due to poor vehicle placement, unmonitored routes, and ageing fleets that frequently break down or sit idle for extended maintenance.
Service quality is further compromised by training gaps among drivers and EMTs, who often operate without standardized, skill-based instruction. Onboard, vehicles frequently lack life-saving medicines and functional equipment, leaving patients vulnerable during transit.
Compounding these issues, weak GPS compliance and lax triage protocols have allowed private operators to mask vehicle downtime and delay dispatch operations without penalty.
Dr Sonia Lal Gupta, a neurologist and joint managing director at the Metro Group of Hospitals, said prompt ambulance services are essential for conditions such as stroke, cardiac arrest, trauma, and respiratory distress because time is a crucial factor. "Imposing fines for late arrivals, malfunctioning ambulances, and a lack of medication and qualified staff will increase responsibility and efficiency of the service. Real-time GPS integration will help reduce response times and improve co-ordination between ambulances and hospitals.”
Queries sent to the health ministry spokesperson remained unanswered at the time of publishing.
GPS tracking and more
Standardising fleet performance across states, the new rules state, "A structured service level agreement (SLA) framework shall be implemented to hold service providers accountable for operational, clinical, and maintenance defaults".
On financial penalties, the guidelines say, "Non-compliance with operational availability, staffing requirements, or essential equipment standards shall result in financial deductions calculated directly from monthly operational payments.”
To prevent vendors from masking equipment failures, the guidelines say, "Any deliberate tampering with GPS tracking devices, unannounced signal outages, or failure to maintain functional air conditioning units shall attract severe commercial penalties per vehicle per day."
The new rules link these penalties directly to vehicle retirement and fleet uptime obligations. Addressing aging infrastructure, the guidelines state that "all government and public fleet ambulances completing 15 years from the date of registration shall be mandatorily scrapped through registered vehicle scrapping facilities (RVSFs) in compliance with the voluntary vehicle-fleet modernisation program".
The document also notes that "no extension of registration or operational deployment shall be granted to ambulances exceeding the 15-year operational age limit under the National Health Mission". To support vehicle retirement without compromising coverage, the guidelines outline transition provisions under the PM E-DRIVE scheme, noting that "a budgetary incentive outlay of ₹500 crore is allocated to accelerate the deployment of 3,800 electric ambulances across public health transport networks".
On daily fleet availability, the new rules specify that "service providers must maintain a minimum threshold of 95% daily fleet uptime across the sanctioned strength, ensuring each vehicle remains active for at least 28.5 days per month". Any vehicle remaining off-road without prior administrative clearance "shall forfeit operational disbursements for the period and face SLA-based financial penalties".