Understanding Bystanders’ role in an Emergency Ecosystem.
On the last day of our stay, Saturday, August 21, 1999, we were heading back to our home in Bangalore. I was sitting beside my friend Mahesh, who was driving the car. Few of our friends were in the back seat. It was a rainy night, and we were going faster than we should have on a gravel road, lost control, and the car went up an incline.
We hit a tree and rolled, throwing me out through the passenger window, and others were thrown into the front–middle of the car.
I quickly pulled my friends out as I could see smoke coming out of the car and was concerned about their safety. I was the one who could move around a bit and tried to flag a vehicle down.
Unfortunately, there were limited vehicles during that time, and people who passed by did not choose to stop. We were stranded there for more than 4 hours as we did not have mobile phones or GPS systems during that time. Without losing hope, we fought for our own lives. At around dawn, we finally managed to get some help.
What would be your thoughts after going through this life-threatening situation?
Would you have ignored this situation on destiny and moved on?
It was a fictional story loosely based on a real-life incident narrated by Ms. Sushmita Das and her husband, Dr. Subroto Das (a Padma Shri Awardee). These might be the questions the couple would have asked themselves.
“We were lucky to be alive! Let us ensure others do not die on the highways. — Ms. Sushmita Das and Dr. Subroto Das.”
It was the first time a singular thought of two ordinary individuals introduced a ground-breaking initiative that changed the emergency operations handled in India. They went through many struggles and bureaucracy to establish Highway Trauma Care.
The couple implemented the idea of an integrated and centralised network of ambulances and other rescue utilities in some of the states in India. They introduced a toll-free number, 98250 26000, which became the lifeline for all highway users in Gujarat and later spread across India. They continue to contribute to improving emergency medical services in India.
Two ordinary citizens could change the face of an emergency in India, then what stops us?
It was not before our most loved and admired former President A. P. J. Abdul Kalam started expressing concern over the increasing number of road accidents in India. There was an urgent need to form a national emergency management mission to handle emergencies and save lives.
“Delhi government had set up a Centralised Accidents and Trauma Services (CATS) in the early 1990s. The same service later expanded throughout the country. Unfortunately, it did not succeed despite having a toll-free number (102) available through various media. — Prasanthi Potluri”
In 2005, the government and corporate leaders, Mr. Ramalinga Raju, Founder and Chairman of the erstwhile Satyam, led to the birth of 108 services in India. It originated under a public-private partnership through joint efforts of the Central and State governments.
It has proven to be one of the biggest challenges to implement one unified approach across the second most populous country in the world.
Fragmented and Disconnected
Emergency Medical Services in India are still in their infancy and very fragmented. An organised EMS system could play a significant role in saving lives.
Possible Solution
The entire system must work together and let go of bureaucracy to save lives, for example — EMS agencies, government, police and fire departments, private hospitals, and the community. It takes the whole system to work in harmony to save a life, rightfully mentioned in a LinkedIn article — Let’s Rise to Save a Life…!!!
Absence of Triage System
Triage systems closely analyse the emergency data and systematically prioritise patient treatment based on the urgency of care. The triage results influence the order and priority of emergency treatment, emergency transport, or the transport destination for the patient.
Due to various EMS models in the country, there have been different processes and practices followed across states. It becomes more difficult to trace the efficiency and effectiveness of the process and far more challenging to build a single triage system with many variations.
Possible Solution
It has been a global problem in EMS across the world. There is an urgent need for a common legal framework and best practices. It will define and regulate the roles and liabilities of various stakeholders (like ambulance operators, emergency technicians, etc.) and provide further clarity/transparency, standardisation, and enforcement across the states.
Improvements in Infrastructure
EMS and Hospital infrastructure, especially in public hospitals, for treating and managing medical emergencies needs further strengthening. It is also a challenge to receive basic health care facilities in the rural parts of India.
Possible Solution
It could be one of the most complex and time-consuming initiatives in a country like India. The COVID 19 pandemic has shown us the reality of our healthcare in India. The government has to take the necessary steps to ensure we do not repeat the same mistakes.
Some of the measures could be:
- Introduce dedicated lanes for ambulances in the urban areas.
- Improve the quality of out-of-hospital and in-hospital care facilities in public or government-driven entities.
- Push towards the integrated medical system (with privacy at the core)
- Bring better first-mile connectivity and facilities to rural areas. (the government has been putting a lot of effort here)
Lack of Proper Training / Curriculum
Lack of training and infrastructure for training health staff (public or private) and other stakeholders in medical emergency management/first aid.
Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS.
Possible Solution
There is a need for a single source of truth and a possible body to bring consistency and regulate the EMS education system in India. We also need to focus on simulation training, building high-quality training centres, and training the best of class instructors and facilitators.
We have to introduce emergency-related courses in the early education system. It will help introduce early concepts and training at an early age. It might provide us a chance to build emergency-ready citizens.
Multiple Emergency Numbers
There are different emergency numbers in the country’s 28 states and seven Union Territories. Hospitals in the country provide various telephone numbers for ambulance services.
Most people do not know the number to call in cases of emergency services as Dial 108/102/1298. Ambulances, Centralised Accident and Trauma Service (CATS), and private ambulance models operate with wide variability in their dispatch and transport capabilities.
Possible Solution
The citizens do not have to remember various numbers to call in case of any emergency. The government has taken proactive measures by introducing the National Emergency Number. We need to provide some time to evaluate the effectiveness and improvements in the coming days.
An Emergency Response Support System (ERSS) is a Pan-India single number (112) based emergency response system for citizens in emergencies. The number is also integrated seamlessly into every mobile phone within India. (Please note: THIS IS AN EMERGENCY FACILITY. USERS ARE ADVISED TO USE THIS SERVICE CAREFULLY.)
We might not be able to solve the above challenges, but we citizens and the community can contribute and support.
84% of people are not aware of the Good Samaritan Law. 77% of people reported hospitals unnecessarily detained Good Samaritans and asked them to pay hospital registration fees and other charges. Less than 1% of bystanders in India are willing to come forward to help any victim.
Be Aware
No one can harass any good samaritan who is helping any victim in any circumstances. Refer to the link from the Ministry of Road Transport and Highways and Gazette in the references.
Every doctor has a professional obligation to extend services to protect life. All Government hospitals/Medical institutions to provide immediate medical aid in all cases. Constitution of India, 1950: Article 21-Obligation on the state to preserve life, Indian Medical Council Act, 1860: Section 33.
Secondly, conducting awareness campaigns at the national level is the key to onboarding people with similar interests and missions. These sessions should aim to increase the awareness and importance of bystanders in out-of-hospital care. Boost the confidence to rescue victims by providing all the (legal and psychological) support to the bystanders while saving lives.
“SaveLIFE Foundation (SLF) is an independent non-profit, non-governmental organisation committed to improving road safety and emergency medical care across India.”
Be Prepared
We should make an effort to take up Basic life support courses. It includes core knowledge in providing quality CPR for adults and infants, learning first aid skills, ventilation, and usage of AED. It also covers enhancing soft skills like team coordination, trust, and confidence among individuals during an event of an emergency. These skills might help save your family along with the people in need.
Secondly, we could take simple steps like carrying a basic first-aid kit with gauze, tape, bandages, antibiotic ointment, etc. Essential survival equipment like a tool kit or a multipurpose utility tool, flashlight and extra batteries, reflective triangles to make your vehicle more visible, a compass, and drinking water.
Be Available
We need the right mindset and willingness to help anyone in need. An individual with no prior skills can also help in an emergency. Assist the emergency team in retrieving required equipment (AED, First Aid Kit). Moving the victims based on provided instructions. Assisting in crowd control until police or firefighters arrive at the location.
Be Cynic
Do not leave the scene of the accident site before looking at the victim’s face, as stated by Dr. Subroto Das. He narrated a story that changed my thought process.
An individual was driving through an area and saw a lot of crowds. He ignored it as a normal phenomenon in the city. Later, he got the news that his in-law was involved in a motor accident at the very spot. He bled to death as no one helped him.
Be Responsible
Will we continue to blame the government and local authorities? Do we always need to take the easy route and forget the victim and their family, or will we step up and take responsibility as citizens and help in an emergency?
We (ordinary individuals like you and me) are one of the most crucial pieces of the entire emergency ecosystem. We could contribute immensely and be most valuable during the golden hours and platinum minutes, even before the out-of-hospital care is triggered and during the rescue.
What would you prefer? Watch your close ones or unknown victims (someone’s wife, son, father, or friend) die, or Step up and do whatever possible and save lives?
References:
Emergency Medical Services in India: The Present and Future — by Mohit Sharma, MBBS; Ethan S. Brandler, MD, MPH, FACEP
EMERGENCY MEDICAL SERVICE (EMS) IN INDIA: A CONCEPT PAPER — by National Health Systems Resource Centre
EMS India — by Lifeline Foundation
Triage systems for pre-hospital emergency medical services — a systematic review — by Ingeborg Beate Lidal, Hilde H Holte and Gunn Elisabeth Vist
Safe India — Website
Indian Kanoon — Website
Ministry of Road Transport and Highways — Government of India
Gazette — Government of India
Ted talk — by Dr. Subroto Das (a Padma Shri Awardee)
National Emergency Number (112) — Ministry of Home Affairs
