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Why India badly needs a trauma care ministry

Jan 23, 2025 08:17 PM IST

In its most common form, trauma is associated with road accidents but many other incidents and happenings in India lead to trauma of varying severity.

As we head into India’s annual Budget exercise, I have a suggestion for finance minister Nirmala Sitharaman. Even as she balances priorities and determines who gets how much out of the growing pie of tax money, can a new ministry (or department) for trauma care be considered?

Ambulances need to be well-equipped with trained paramedics adept at providing death-preventing treatment. (Photo by Idrees MOHAMMED / AFP) (AFP) PREMIUM
Ambulances need to be well-equipped with trained paramedics adept at providing death-preventing treatment. (Photo by Idrees MOHAMMED / AFP) (AFP)

Trauma is something Indians encounter on a daily basis. In its most common form, trauma is associated with road accidents but many other incidents and happenings in India lead to trauma of varying severity.

Here are a few instances. The pedestrian bridge collapse in Morbi, Gujarat, that caused 141 deaths and injuries to over 180 called for trauma care, as did the 200 consequential railway accidents reported across 17 railway zones in India. Over the last five years, these accidents led to the deaths of 350 people and caused injuries to close to 1,000 people.

Perhaps more than any other occurrence, rape, acid attack and domestic violence victims across India require consistent and intense trauma care. In a number of these cases, the mental trauma far exceeds the physical trauma but mental support in India remains virtually absent. Trauma is very much a part of the fabric of tourist destinations in India where those rescued from drownings on the beach or during adventure tourism-related accidents need urgent care.

The data on trauma-related deaths speaks for itself. Road accidents in India account for 200,000 deaths a year, and according to a 2020 report, approximately 45% of such registered deaths occurred without any medical attention. Add to these the fatalities that occur on account of other types of accidents (rail, fire, electrocutions, bridge collapses) and the numbers shoot up to almost 400,000 trauma deaths a year.

A recent Niti Aayog study titled Emergency and Injury Care at Secondary and Tertiary Level Centres in India reveals that although 91% of hospitals had in-house ambulances, only 34% of these ambulances had trained paramedics, and most hospitals lacked a pre-hospital arrival notification system.

In November 2024, SaveLIFE Foundation, a non-governmental organisation, moved the Supreme Court with a petition to ask the Union and the states to ensure comprehensive systems that guarantee a right to emergency trauma care. This would require the state to set up a seamless chain of survival response — within what is popularly termed as the Golden Hour — that ensures an interlinked delivery of services, from the time of a traumatic incident to at-scene-care, in-transit-care and at-facility treatment.

Hospitals, clinics and health care centres in India are not categorised by the level of care they can provide. As a result, ambulances take road accident victims to the nearest facility for care, rather than to where they can be provided the care required. In the September 2022 accident involving former Tata chairman Cyrus Mistry, he was taken by ambulance to a primary health care centre, which was in no position to provide the care his brain injury required. In a recent road accident, the body of the victim lay on the road for four hours as a jurisdiction dispute ensued between the police from two states Uttar Pradesh and Madhya Pradesh. The public responded by calling the police, but the latter failed in their duties abysmally. Had the victim been taken to a hospital immediately, a life might have been saved.

The chain of survival requires citizens at the scene of the accident to be trained and in a position to administer some basic care, which is taught in schools in many countries. There needs to be a universal access number that integrates all emergency services like police, fire, and ambulance (like 911 in the United States) that is known to all citizens. India attempted a similar service (112) — available in all states and Union territories barring Kerala — but it is not universally known and does not integrate all emergency services in all states yet.

Ambulances need to be well-equipped with trained paramedics adept at providing death-preventing treatment. There are wide state-wise variations in the quality of ambulances and paramedics. Last but not least, the ambulance needs to reach a facility certified to handle the type of injury or trauma the victim has undergone and, ideally, the hospital needs to have prior intimation of what to expect so the right treatment can be meted out almost instantly. For this, the hospitals and clinics need to be certified based on the level of care they are equipped to offer and this information needs to be handy with the ambulance services.

Even as the state governments begin work on the chain of survival, some level of basic trauma care training must be given at least to those who man petrol pumps, dhabas and small shops on the highways and those who man stalls and other services at railway stations. Anyone who is in a position to be a first responder needs to be given some basic training.

Readers may ask why, in this era of big government, we need yet another ministry for this. The answer is that trauma care is more specialised and time-sensitive than generalised medical care and is at present nobody’s baby. The ministry of health and family welfare is responsible for some aspects, but a lot falls outside its ambit. Countries like Japan and the United Kingdom have set up new ministries to tackle the menace of social isolation as they perceived this to be the need of the hour for their citizens. India needs to take a leaf out of their books and examine its own needs more closely.

Anjuli Bhargava writes about governance,infrastructure and the social sector.The views expressed are personal

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