Wednesday, August 10, 2011
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India records one of the highest number of road accident deaths thanks to dismal trauma care
Around 14 people die every hour on Indian roads. Source: Biswarup Ganguly/Wikicommons

Roads are harbingers of progress and prosperity but in India, they seem to be bringing along the fatalities. Around 14 people die every hour on Indian roads with annual toll touching 1.27 lakh in 2009. This is nearly 80 per cent more than the road accident casualty toll of China where 70,000- odd people died during the corresponding period. Around 10 years ago a WHO report had stated that India will see an annual escalation of over 3 per cent in road accident deaths till 2040 unless emergency measures are taken. We have already surpassed the prediction with over 30 per cent escalation since 2005.

Around 10 years ago a WHO report had stated that India will see an annual escalation of over 3 per cent in road accident deaths till 2040 unless emergency measures are taken. We have already surpassed the prediction with over 30 per cent escalation since 2005.

Death rules the roads

Data from the National Crime Records Bureau (NCRB) shows if people meet with a road accident in India, there is an over 30 per cent chance of death. Poor management of roads, drunk driving, weak legal system and poor trauma care spell doom for accident victims. According to the WHO’s Global Status Report on Road Safety, around 70 per cent of those who die in India are males in the most productive age group of 20-50 years. This is the reason why every year road accident costs India about 3 per cent of its GDP. In comparison, China has been able to reduce deaths due to road accidents. While in 2008, the number was 73,484, it dropped down to 67,759 accident deaths in 2009. A major contributor to traffic accidents in India is the menace of drunk driving. Around 65 per cent of road accidents in Delhi were caused by drunk drivers in 2008, found a survey done by the Campaign Against Drunken Driving (CADD). 

Weak laws, lax enforcers

India has one of the most stringent legal limits towards drunk driving with just 0.03 per cent of blood alcohol content (BAC) allowed in the blood. But this doesn’t mean much, since very few drivers are put to the test and even when caught the penalty for drunk driving is only Rs 2,000 and the driver can be back on the road the very next day since it is a bailable offence. In comparison, drunk drivers in Canada and the US lose their licences in addition to the fine. In Sweden, driving with more than 0.02 per cent BAC can get you up to six months in jail and if you have as much as 0.10 per cent per cent of BAC you go to jail for two years. In Japan you cannot drink and drive at all.

While we are among the top countries with high road accident rates, the conviction rate for negligent driving here is the lowest. For instance, 214 criminal cases were lodged for causing death by negligent driving in Maharashtra in 2005, but the conviction rate was only 9 per cent. Off late, authorities in a few cities have turned stringent on drunk driving by handing out punishments varying from revocation of licence to imprisonment till rising of the court.

Delayed attention 

Legal system may be weak, but trauma care facilities for accident victims are pathetic. It’s always advisable that accident victim be given immediate basic care and shifted to a nearest health facility to increase chances of survival. Doctors swear by terms like “golden hour”, the crucial one hour after injury, and the “platinum 10 minutes”, the first 10 minutes for caregivers. However, these concepts are just a part of medical books in India.     

The main reasons for such a scenario include lack of well equipped ambulances to transport the victims and untrained staff. There are no standards on how to deliver a patient safely to the hospital. You don't even require a formal licence to run an ambulance service. A study published in the Indian Journal of Critical Medicine in 2004 (the most recent year for which research is available) found that 12 per cent of health facilities have a total absence of any ambulance service. In addition, only 4 per cent of the ambulance personnel have any certified formal training whereas one-third of ambulances serve only as transport vehicles with no paramedic staff. 

Around 12 per cent of health facilities have a total absence of any ambulance service. In addition, only 4 per cent of the ambulance personnel have any certified formal training whereas one-third of ambulances serve only as transport vehicles with no paramedic staff. 

No norms for trauma care

Even if you are able to arrive at the nearest hospital on time, it may not be equipped to treat you. You can count the number of good trauma centres in the country on your fingertips. Most of the so-called trauma centres lack expertise in treating complicated injuries and hence refer the patient to a bigger centre which leads to time wastage and high death rate.

The study found that there were no dedicated trauma surgeons and orthopaedicians led the trauma response in 50 per cent of hospitals. Only 54 per cent of the hospitals had set protocols to determine the priority of patients based on the severity of their condition. It’s difficult to define what a good trauma care facility means because there are no standards being followed in India. There is a law under which you establish a blood bank but no norms governing trauma centres and professionals.

Private hospitals in large cities are equipped with modern diagnostic and treatment facilities but they turn away patients who are unable to make immediate payment. In Europe and US, there is a law that trauma centres can’t refuse admission even if the mishap victim has no health insurance cover. However, in India, the concept of a dedicated trauma-response team is yet to percolate beyond tertiary-care hospitals. 

Till then, many would continue to die on the same roads which are meant to take them places.

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