Is Tamil Nadu’s ‘108’ Ambulance Service Failing the People It Vows to Save?

When the Lifeline Itself Needs Rescuing

The sight of a ‘108’ ambulance racing through Madurai’s streets used to reassure us — help was on the way. But today, that confidence is fading. Behind the flashing lights and sirens lies a troubling story of overworked drivers, underfunded operations, and a public-private partnership model that may be more broken than beneficial.

This isn’t just about poor working conditions. It’s about the erosion of public health infrastructure that Tamil Nadu once took pride in.

From Model System to Mounting Failures

Launched in 2008 under a PPP model between the Tamil Nadu government and EMRI Green Health Services, the ‘108’ ambulance system was once a textbook example of how the private sector could enhance public service delivery.

But fast-forward to today, and that narrative is unraveling. Drivers and paramedics are working continuous overnight shifts, vehicles reportedly go without proper maintenance, and promised salary increments have quietly disappeared. Protests, like the one recently staged in Madurai, are no longer rare — they’re routine.

How did a system built to save lives end up endangering both patients and the people hired to protect them?

A System Straining at Its Seams

According to field workers, the rot starts at the top. Ambulance drivers allege that:

• Routine vehicle maintenance is ignored, despite safety risks.
• Staff face delays in salary payments and are paid as little as ₹16,000/month.
• They are forced into double or triple shifts, risking not only their own lives but those of the patients they transport.
• The imposed speed cap of 80 kmph, while aimed at reducing accidents, can undermine golden-hour response times, especially in rural belts.

One driver in Theni, after a near-fatal accident, admitted to having driven straight for two nights. In his words: “We save lives, but we’re risking our own every day.”

How can a healthcare system claim to be efficient if its frontline responders are being pushed to the brink?

Unkept Promises and Shrinking Paychecks

The 2008 model promised fairness. The MoU included an annual 16% salary hike, meant to substitute for missing DA-linked increases. But workers allege they now receive only 10% — sometimes less. Even experienced drivers claim they’re earning far below what’s fair for a role that demands technical skill, composure under pressure, and literal life-and-death decision-making.

The company’s defense? “Veteran drivers make up to ₹45,000, equal to some doctors.”

Even if true, that doesn’t address the overwork, inconsistent policy implementation, or failure to upgrade working conditions for newer employees.

This isn’t just about pay — it’s about respect and recognition for essential service providers.

Golden Hour, Lost Opportunities

The much-celebrated “golden hour” — the critical window for saving trauma victims — becomes meaningless if ambulances are delayed due to faulty vehicles or insufficient staffing. Studies and CAG audits have long pointed to infrastructure gaps, driver fatigue, and poor vehicle upkeep as major barriers to effective EMS delivery.

So why hasn’t anyone fixed it?

PPP: Public-Private Promise or Policy Pitfall?

This crisis also exposes deeper questions about the Public-Private Partnership model in health. The idea was simple: let the government fund, and let the private partner manage. But what happens when profit begins to outweigh purpose?

The EMRI management claims protocols are followed and maintenance is in place. But when workers on the ground say otherwise, and ambulances are more often seen in protests than in active service, public trust erodes — fast.

This is no longer a contract dispute. It’s a public health emergency.

Who Holds the Accountability?

The Essential Services Maintenance Act (ESMA), 1980, applies to emergency healthcare workers. But for many ‘108’ drivers, the law is a paper tiger — offering no real protections when contractual violations, benefit denials, and management apathy are rampant.

So, who ensures accountability? The government, the contractor, the public? If no one takes responsibility, everyone will bear the cost.

Editorial Call to Action

This editorial is not a condemnation — it’s a plea. A plea to:

• The Government: Step in, review the MoU, and enforce worker protections. A functional EMS saves lives — but only when its workers are functional too.
• The Company: Prioritize safety and fairness over margins. You operate ambulances, not delivery vans.
• The Public: Demand better. These are your emergency services. Your tax money, your lives at stake.

Final Thought

A society is judged not by how it treats its wealthiest, but by how it protects its most vulnerable — especially in moments of crisis. Tamil Nadu’s ‘108’ ambulance service was once a beacon of responsive governance. Today, it’s dangerously close to burnout.

Let’s not wait for another crisis. Reform the system — before the system fails the very people it was built to save.

Additional Notes:

• Based on reporting from The Hindu newspaper, field interviews, and statements from union representatives and EMRI officials.
• Quotes from workers have been anonymized for their protection.
• Editorial viewpoint reflects the opinions of the MaduraiCity.co.in editorial team.