Central Armed Police Forces (CAPF) hospitals in India provide care to personnel, families, and in some places nearby communities. Many of these hospitals run low surgical volume but still face major emergencies such as trauma, obstetric crises, and acute abdominal conditions. This mix puts anaesthesia services under strain. Evidence from low- and middle-income countries (LMICs) and non operating room anaesthesia (NORA) shows that anaesthesia outside well-equipped operating theatres carries higher risk when basic equipment, monitoring, and staffing are weak.(Romero, 2024; Herman et al., 2021; Woodward, 2017; Kaye, 2025) CAPF hospitals share many of these features, including aging machines, limited monitoring, frequent referrals, and a shortage of trained staff. This article adapts lessons from NORA and LMIC perioperative safety literature to the specific context of low-volume CAPF hospitals, using five headings—technical, Organisational, economic, educational, and workforce—to describe key risks and propose practical system-level steps to restore safety. The central argument is that low case numbers are not the core problem; based on evidence from LMIC perioperative systems and our experience in CAPF hospitals, lack of steady investment and weak governance are likely to contribute more to risk than volume alone.
