Sunday, June 15, 2008

Medical emergency ! What should I do ? A guide for Indians

Medical care during emergencies in India leaves a lot to be desired. Those of us who watch medical shows on TV ( such as ER) are very impressed with the high quality of care Emergency Rooms in the US provide. If there is an accident, someone phones 911, and within a few minutes an ambulance is promptly dispatched and succor provided. In India, unfortunately, the reality is far grimmer. If there is an accident, most of us prefer not to get involved and turn a blind eye. What’s worse, is that if we do try to help the victim by rushing them to the nearest local hospital, the doctor there may refuse to treat the patient – and tell us to transfer them to a government hospital. What is tragic is that many victims die because of simple medical problems ( such as bleeding) which could have been treated and their lives saved if medical care was provided to them promptly during the emergency.

Doctors know that during a medical emergency ( for example, a traffic accident or a heart attack), there is a “golden hour” which can literally spell the difference between life and death. If effective medical care is promptly delivered efficiently during this critical period, many lives could be saved. However, traffic accidents remain a distressingly common cause of preventable death in India. Given the state of our roads and our civic sense, this problem is going to keep on increasing unless we tackle it efficiently.

What should you do if you see an accident and the driver is bleeding profusely ? The first human instinct is to rush the patient to the local hospital for emergency medical care; or call for an ambulance. However, the nearest medical facility could be your local nursing home or hospital, many of which will refuse to admit these patients. Patients are then shunted off from pillar to post – losing valuable time – and possibly their lives, in the process. Not that large private hospitals are much better. Many do not even have a well-equipped Casualty ( ER): and even if they do, they refuse to take on the patient, until payment is made first.

It’s true that doctors have an ethical obligation to treat any patient – especially during an emergency. However, many refuse to do so. This is not because they are wicked or uncaring , but the sad truth is that many often don’t have the expertise or equipment to do so. What makes a bad situation worse, is that others refuse to do so because they are worried about the police hassles . Accident and emergency cases are often medicolegal cases , and these entail the burden of a lot of paperwork. While some are worried about who will pay for this medical care ( which can be expensive), others are fearful that if they try to help and the patient dies, the mob will vent their anger on the doctor and beat him up. It’s often much easier for the doctor not to do nothing, because they do not want to stick their neck out.

This is a sad situation , but it’s really no different from the approach most of us take when we see an accident. We prefer turning a blind eye and carrying on with our lives and are quite happy to let “someone else” provide succor because it’s not really our problem. Unfortunately, it is our problem. Ask not for whom the bell tolls – it tolls for thee ! Tomorrow , it could be your turn – or mine .

Shouldn’t doctors be held to a higher standard ? Haven’t they sworn a Hippocratic Oath to save lives ? Isn’t there a law which compels them to provide emergency assistance ? How can they refuse to help and transfer the patient ? Isn’t this illegal ?

The truth is that it’s impossible to compel doctors to provide emergency medical care. While most good doctors will do this on moral ground, they cannot be forced to do so – and in any case, this is hardly an effective solution. There are observations made by Supreme Court judges about the importance of doctors providing medical care expeditiously, but these are unlikely to be legally binding – and are very hard to implement in the absence of the needed infrastructure.

Following the Supreme Court Judgement in 1989 ( Pt. Parmanand Katara vs Union of India AIR 1989) , the Motor Vehicles Act was amended in 1994 and under section 134, it was made mandatory for the driver and the owner of the vehicle to take the accident victim to the nearest doctor and for the doctor to treat the victim without waiting for any formality. But, even after all this, the situation has not improved.

I think we cannot fix this problem on an individual basis – and passing a law is unlikely to help. “ Good samaritan” guidelines from the Mumbai Police encourage bystanders to provide assistance in an emergency by reassuring people that the police will not harass them. What can we do to improve the medical care provided during emergencies. ?

This is a societal problem , which needs to be addressed by the government. Unfortunately, there is no 911 service in Bombay – India’s prima urbis ! Most leading Mumbaikars are more focused on earning more money, rather than trying to improve these basic services. This is very short-sighted, as emergencies and accidents can strike anyone at any time !

The good news is that the EMRI ( Emergency Management and Research Institute,, a non-profit organization started by Mr.B.Ramalinga Raju (founder and Chairman, Satyam Computers) in Hyderabad, has implemented a very effective free medical emergency service in Andhra Pradesh called 108. This is a public-private partnership ; and is a shining example of what socially responsible Indians are capable of doing, when they put their mind to it.

We need similar services in Bombay and Maharashtra – and all over the country ! I do hope citizens will put pressure on the government to make this a reality. Once this happens, then we will no longer need to worry about proving effective emergency medical care !

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