Laws related to Ambulances in India

Editor’s Note: This article is written with the aim of explaining why the ambulances look the way they look, why does the siren sound the way it does and what all are the laws related to ambulances which you might be interested in knowing. This article has been written keeping in mind the needs of various NGOs, Trusts, body corporates and individuals who wish to register ambulances. This blog is supposed to give advocates a basic idea of laws relating to ambulances.

Table of Contents

1. What is an ambulance?
2. National Injury Surveillance Trauma and Registry and Capacity Building Centre (NISC)
3. Definition of Ambulances
4. Role of the Bureau of Indian Standards (BIS)
5. Conspicuity Code of the Ambulance
6. Registration of Ambulances
7. Different states have their own requirements for ambulance regulations. Delhi RTO needs the following requirement of ambulances for it to grant registration to them:
8. Punishment for those who obstruct ambulances

What is an ambulance?

Oxford dictionary provides a definition for ambulances as “a vehicle equipped for taking sick people to and from hospitals, especially during emergencies.”

An ambulance is well equipped with various tools to treat the patient during emergencies to help stabilize the person while taking them to the hospital. These include bag valve mask (oxygen supply), bandages, EG monitors, infection control, etc.

National Injury Surveillance Trauma and Registry and Capacity Building Centre (NISC)

NISC has been set up in Dr. RML Hospital New Delhi under the guidance of the Ministry of Health and Family Affairs government of India. The main objective of setting up this center was to provide efficient medical and paramedical training in the field of emergencies. Its purpose is the collection and analyzing injuries and trauma-related data to help policymakers in reducing deaths and disabilities during medical emergencies.^[1] The ambulance code published by NISC has specified that road ambulances have to be specifically designed and equipped for transporting patients.

Definition of Ambulances

The definition of Ambulance is provided in the National Ambulance Code, published by NISC, as –

“Road Ambulance or Ambulance is a specially equipped and ergonomically designed vehicle for transportation/emergent treatment of sick or injured people and capable of providing out of hospital medical care during transit/when stationary, commensurate with its designated level of care when appropriately staffed.”^[2]

Any vehicle suitable to carry a patient is called an ambulance without considering the overall design.^[3]

The Ministry of Road Transport and Highways, Govt. of India set up five Working Groups on 4Es of Road Safety i.e. Education, Engineering (Vehicles), Enforcement and Emergency Care on the recommendation of the National Road Safety Council (NRSC).^[4]

The working group recommended that there is a need to formulate the “National Ambulance Code” with necessary amendments in Central Motor Vehicle Rules, 1989 (CMVR) that defines the Constructional and Functional Requirements for Road Ambulances. In view of this, an Expert Committee was constituted with the approval of the Hon’ble Union Minister for Road Transport and Highways (in 2013) to formulate the “National Ambulance Code.”^[5]

The amendments in the CMVR were notified on 8th September, 2016.

Role of the Bureau of Indian Standards (BIS)

BIS is National Standards Body of India working under the Ministry of consumer affairs, food and public distribution, Government of India. Its headquarters is situated in Delhi. It was established through an act of parliament under the Bureau of Indian Standards Act, 1986.

Conspicuity Code of the Ambulance^[6]

For the clear visibility of the ambulance, the Constructive and functional requirements of the road ambulance, drafted under the Ministry of Road, Transport and Highways have given six important sections that should be in the construction all types of ambulances.

1. Color – the exterior color should be brilliant white (RAL code – 9010) withstanding regular cleaning and weather resistant.
2. Conspicuity Improvement Units – Markings made under this should be in brilliant red (RAL code 3024). No less than 50% of the front side of the vehicle should be sulfur yellow, RAL-Code 1016 in contrast to no less of 10% brilliant red, RAL Code 9010. The word “AMBULANCE” on yellow background, minimum of 65% of the hood width, shall be in mirror image (reverse reading) for mirror identification by drivers ahead.
3. Emblems – The emblems (every other sign, symbol or marking not referred under ‘conspicuity improvement units’) are only allowed in a non-reflecting manner and the size can’t be bigger than 60% of the “AMBULANCE” markings. Ambulance Calling Number (YYY) if available must be displayed on the side and back of the Road ambulance.
4. Warning lights – Type A and B road ambulances have flashers fitted at the appropriate locations as per the vehicle type.

Type C and D road ambulances should have warning lights as follows:

the blue and red lights will have a minimum intensity of 100cd at daylight and 200cd at night time. they shall be mounted rectangular to the horizontal ground minimum angle at 45 degrees. all lights must flash between 2Hz to 4Hz. Red during day and blue during the night time should be flashed.

1. Sirens – Sirens with loudspeakers should be mounted in all types of ambulances. The frequency range permitted for these sirens are 500 HZ to 2,000 Hz. Wail and yelp signals that cycle between 10 – 18 respectively 150 – 250 per minute at a sound pressure of 110db(A) – 120db(A) is permitted. A public address system working at all times from the driver’s seat. Also, the siren switch can only be used when the warning lights are on.
2. Recognition of personal – Safety garments for ambulance personnel should conform to at least ISO 14116:2008^[7]. These are protective clothing that gives protection against heat and flame.

Registration of Ambulances

Chapter VIII of the Motor Vehicles Act, 1988 is concerned with the control of traffic. Section 138 (2) (d) of the Motor Vehicle Act, 1988 empowers the State Government to make rules. These rules can provide exemption from all or any other provisions of Chapter VIII with respect to fire brigade, ambulances or any other special class vehicle subject to certain conditions. This implies that provisions can be made to prevent be restrictiction of Ambulances by general rules relating to speed limit, driving regulations, traffic signs, etc. if the State government publishes rules regarding those matters.

Chapter IV of the Motor Vehicle Act, 1988 deals with the registrations of motor vehicles. The chapter has exclusively mentioned about why, how and where the registrations of the vehicle should be made. Section 54 and 55 talks about suspension and cancellation of the vehicle by the authority if they have reason to believe that the vehicle does not follow the provisions provided under section 53 of the MV Act, 1988.^[8]

Different States and Union Territories have their own requirements for ambulance regulations. The documents required for Registration of Delhi RTO needs the following requirement of ambulances for it to grant registration to them.^[9] You shall visit the RTO of your area to understand the documentation required to register an Ambulance in your area.

Punishment for those who obstruct ambulances

As per Section 194E of the Motor Vehicles Act, 1988 a fine of INR 10,000 shall be imposed on anyone who obstructs the way of ambulance.

Edited by Srilakshmi G.

1. Ministry of Health and Family Welfare, About NISC, Capacity and Trauma Centre, National Injury Surveillance Trauma and Registry and Capacity Building Centre, http://www.nisc.gov.in/Default.aspx (2:00 PM 28 January, 2020). ↑
2. Ministry of Road Transport and Highways (Department of Road Transport and Highways), Constructive and functional requirements of road ambulances, National Injury and Surveillance Trauma Registry and Capacity Building Centre, http://www.nisc.gov.in/PDF/AIS_125.pdf (2:00 PM 28 January 2020). ↑
3. Dipak K Dash, Government sets new norms for ambulances, The Times of India, https://timesofindia.indiatimes.com/india/Government-sets-new-norms-for-ambulances/articleshow/54402610.cms (10:30 PM 28 January 2020). ↑
4. Ministry of Road Transport and Highways (Department of Road Transport and Highways), Constructive and functional requirements of road ambulances, National Injury Surveillance Trauma Registry and Capacity Building Center, http://www.nisc.gov.in/PDF/AIS_125.pdf (1:40 PM 28 January, 2019). ↑
5. Ministry of Road Transport and Highways (Department of Road Transport and Highways), Constructive and functional requirements of road ambulances, National Ambulance Code, National Injury and Surveillance Trauma Registry and Capacity Building Centre, http://www.nisc.gov.in/PDF/AIS_125.pdf (6:00 PM 29 January 2020). ↑
6. Ministry of Road Transport and Highways (Department of Road Transport and Highways), Constructive and functional requirements of road ambulances, National Injury and Surveillance Trauma Registry and Capacity Building Centre, http://www.nisc.gov.in/PDF/AIS_125.pdf (29 January 2020, 8:30 PM). ↑
7. The International Organization for Standardization, ISO 14116:2008, The International Organization for Standardization, https://www.iso.org/standard/37068.html (29 January 2020, 8:00 PM). ↑
8. Motor Vehicle Act, 1988 Chapter IV http://as2.ori.nic.in:8080/web/mva_ch4.jsp#sec_40. ↑
9. Department of Health and Family Welfare, Registration of Ambulances, Government of National Capital Territory of Delhi, http://health.delhigovt.nic.in/wps/wcm/connect/1c884d00406954a5b44dbc34262e20fd/cat.pdf?MOD=AJPERES&lmod=-288077341(30 January 2020, 08:00 PM). ↑