A large IIT Madras study analyzing Tamil Nadu’s eight-year Tamil Nadu 108 ambulance registry (2017–2024) shows that sustained investments in emergency medical services, maternal care infrastructure, and referral systems during and after the COVID-19 pandemic led to improved maternal and newborn outcomes across all 42 districts.

The analysis used real-world data from the 108 emergency response system spanning 2017 to 2024, led by P. Kandaswamy and Ashwin Prakash.

The study provides a multi-phase view of the pandemic's impact, assessing how EMS and maternal healthcare investments affected outcomes across both crisis and recovery periods.

During the resilient recovery period, non-inter-facility pregnancy emergency response times fell by more than 46%, with continued improvements in transfer and hospital handoff times through 2023–2024 thanks to fleet expansion, more personnel, and stronger referral networks.

The research covers 42 districts with a population of over 84 million, offering a system-wide perspective beyond hospital-level analyses.

Authors note that while associations between EMS enhancements and better outcomes are strong, the study identifies correlations rather than proving causation and acknowledges data and methodological limitations.

In the post-pandemic resilient phase, maternal and newborn indicators improved, with maternal mortality down 19% to 37 deaths per 100,000 live births (below the national average); home deliveries decreased by over 36%, miscarriages by 28%, and complicated vaginal births by over 19%, while neonatal and infant mortality declined by 17% and 19% respectively.

During the second COVID-19 wave, access to maternal healthcare was disrupted, leading to more home deliveries and a near doubling of maternal mortality compared with pre-pandemic levels, providing context for the observed improvements later.

The study employs an eight-phase pandemic analysis for granular evolution of healthcare delivery and presents EMS efficiency and population health outcomes as a dual-track evaluation with potential global relevance.

The findings suggest that sustained public investments in EMS infrastructure, workforce expansion, and targeted maternal health programs can improve outcomes during crises and even surpass pre-pandemic levels, offering a blueprint for other states.

Key EMS performance indicators—response time, transfer time, and hospital handoff time—improved after the first wave and remained efficient through 2023–2024, signaling enduring system resilience.

A tiered 108 ambulance referral network linking primary centers, district hospitals, and medical colleges helped ensure timely obstetric care and continuity of care during peak pandemic disruptions.