TRIAGE
Emergency Medical Services: A Systems Study

The purpose of this research was to gain insight into the working of the Indian Emergency Medical Services (EMS) through a systems approach, thereby identifying the problem areas that may need improvement and change.

Process

The goal was to map the functioning of EMS in India.
This was done by:

1. Studying the existing EMS systems across the globe and in India.

2. Creating a benchmark for
comparison from the research findings.

3. Comparing the current state of
Indian EMS against the benchmark
to identify problem areas.

This process led to the finding that while there is a National policy on EMS in place, in reality the system is fragmented in its functioning.

A conceptual benchmark was developed using WHO guidelines on emergency care and research to compare the existing model against, identifying where the system is effective and where it falls short. Key system elements were identified and grouped by function, forming clear structural categories that help visualize their connections. This conceptual framework would rely on the interconnectedness of:

Health Service Delivery Model, trained EMS Workforce, well-functioning Communication Systems, Access to equipment, medicine, procedures, and transport, appropriate use of Technology by staff, Financing mechanisms to sustain EMS, Leadership and Governance to define policies

Systems Analysis

Map Breakdown

The ethical obligation of all stakeholders is to the user. Policies affect all system building blocks and drive the service forward. Better policies imply improvements in infrastructure and training capabilities, developing a more resilient EMS workforce. Additionally, better policies lead to standardisation across the country, making quality assessment more efficient, in turn generating more accurate insights and propelling policy improvement further. This reinforces the loop and ensures optimal patient-centric care.

The goal of the EMS system is to provide patient-centric care, and policies have the greatest effect on the system’s functioning. This is where the Indian EMS is currently lacking. Adoption of a joint centre-state legal and regulatory framework would reduce technical, legal, and administrative variations in the organisation and delivery of publicly financed EMS. There is no standardised practice amongst the services in each state, and this, paired with severe employee dissatisfaction, only results in a failing system.

There are gaps in the design and management of contracts of EMS due to the peculiar nature of EMS, poor contract design, and governance, leading to severe principal-agent problems. Currently, there is a pressing need for:

  • A centralised medical emergency authority

  • Standardised practice

  • Reduction of employee satisfaction

  • Changes at operational level

  • Health information gathering

  • Service Transparency

  • Facilities for EMS education

Insights

A.02 Triage, 2019
Reflections, 2025

This project assumed that mapping a system means understanding it, that restrained diagrams could translate complexity into clarity, and clarity into action. The benchmark built from WHO guidelines felt like an “objective” baseline: assuming a certain kind of body, a certain kind of access, certain infrastructures, and a certain kind of government that cares.

The real system, however held together through workarounds, quiet heroics, and people doing far more than they’re resourced for. Survival happened off-diagram. That sort of care isn’t reflected in any feedback loops.

The map focused on governance as the primary lever of change – just where it was structurally absent. In a field of political apathy, what can design do besides point at the gap? What would it mean to unpack the actual system, the one operating in the shadows of collapsing infrastructure and policies?

What if design supported the care already happening, instead of mapping the care that never arrives?