Study Finds Moderate Emergency And Critical Care Readiness In India With Notable Gaps At District And Secondary Levels

New Delhi: A national study on emergency and critical care (ECC) services in India indicated moderate ECC readiness across the country with notable gaps at district and secondary levels.

The study published in the International Journal of Emergency Medicine suggested strengthening workforce capacity, supply systems, and infrastructure to improve emergency care delivery.

It also emphasized the need for nationally representative assessments to guide policy and system-wide planning.

The survey was conducted between December 2024 and March 2025 across 50 hospitals representing tertiary, secondary, and district-level facilities in India.

Multiple healthcare providers and administrators from each hospital were interviewed to triangulate facility-level availability of ECC resources. The hospital was the primary unit of analysis. ECC readiness was assessed across four domains—staff, supplies & equipment, clinical services, and systems & space using the Hospital Emergency Unit Assessment Tool (HEAT) developed by the World Health Organization (WHO).

ECC readiness scores were calculated using WHO HEAT-based indicators across domains, including infrastructure, workforce, equipment, drugs, and clinical protocols. Readiness scores ranged from 0 to 1, with higher values indicating better preparedness.

Tertiary hospitals demonstrated higher overall readiness scores compared to secondary and district hospitals, particularly in the availability of specialist workforce, monitoring equipment, and critical care infrastructure. District hospitals showed greater variability in staffing, supply chain reliability, and availability of advanced life-support resources, the findings said.

“Tertiary hospitals demonstrated higher readiness scores across most domains, particularly in specialist workforce availability, monitoring equipment, and implementation of clinical protocols. In contrast, district and secondary hospitals showed gaps in trained personnel, infrastructure, and advanced life-support resources. Given that district hospitals serve as the first referral point for a large proportion of the population, especially in rural and semi-urban settings, these findings highlight critical areas for strengthening emergency care delivery at foundational levels of the health system,” the study highlighted.

Talking to ETV Bharat, Dr Tamorish Kole, past president of the Asian Society for Emergency Medicine, said that the findings shed an important light on a question that every healthcare leader in India should be asking: How ready are our hospitals to deliver emergency and critical care when it truly matters?

“The findings are both encouraging and concerning. Overall readiness was moderate, but the variation across levels of care was stark. Tertiary hospitals performed significantly better than secondary and district facilities, highlighting a structural imbalance in emergency care capacity. Clinical services were more consistently available than essential supplies and equipment—suggesting that while expertise may exist, systems and logistics often fail to support it. Workforce shortages, supply stock-outs, infrastructure gaps, and inconsistent training emerged as recurring barriers. Unsurprisingly, urban and private institutions generally outperformed rural and public facilities, reinforcing long-standing inequities in healthcare access and quality,” said Dr Kole.

According to Dr Kole, the message for policymakers, hospital administrators, and frontline clinicians is clear: emergency and critical care readiness cannot be assumed—it must be measured, strengthened, and continuously audited.

“Investments must go beyond infrastructure; they must address workforce development, supply chain resilience, standardized protocols, and accountability mechanisms. If district and secondary hospitals remain underprepared, the burden on tertiary centres will continue to grow, widening survival gaps for acute illnesses and trauma. This study is not just an academic exercise—it is a call to action to build a system where emergency care is dependable, equitable, and resilient across the entire healthcare network,” he said.

A Niti Aayog report earlier assessed the prevailing status of 100 emergency and injury care centres in government and private hospital settings, in addition to 34 District Hospitals.

The report highlighted the existing gaps in all domains of emergency care encompassing ambulance services, infrastructure, human resources, equipment status, essential medicines, definitive care and burden of various diseases.

According to the Niti Aayog study, even though 91 per cent of hospitals had in-house ambulances, trained paramedics needed to assist ambulance services were present only in 34 percent.

“Provision of specialised care during ambulance transport was largely poor. Only 19 percent hospitals had a mobile Stroke/ STEMI (for heart attack) program, with only 4 per cent having a mobile Stroke unit,” the report had stated.

Since it is essential to have the complete list of all recommended emergency medicines 24 by 7 in the emergency departments, assessment done for this aspect revealed that only 9 per cent of all hospitals fulfilled this criterion, the study found.