Health Empirics

Counts of ambulances and trauma buildings say little about whether injured people receive timely care. We assessed where Karnataka’s post-crash pathway converted public spending into operational emergency care, and where it failed. We analysed three state performance audits and two departmental annual reports (2014–15 to January 2025), benchmarked against national road-crash statistics. Sixty-five observations were coded across ten links of a service-production chain; published distributions were recomputed and the principal timeliness estimate was tested for sensitivity. Results of 599,417 road-crash responses, 52.40% reached the scene within 15 minutes. Half of 637,437 trauma despatches (49.7%) reached hospital beyond the golden hour. Handover exceeded 15 minutes in 39% of 7.25 million trips as audited, but in 56.37% once an anomalous 2020–21 return was excluded. Delayed de-assignment cost 2.94 million ambulance hours. All seven trauma care centres lay in two of four revenue divisions. The ₹500.07 crore service was free at the point of use, yet 15% of traced patients reached fee-charging private hospitals. Readiness failed link by link, so input counts overstated capacity. Financing and audit should follow the chain, not the purchase.