The Indian Railways transports greater than 2.3 crore passengers day by day – roughly twice the projected inhabitants of Uttarakhand state in 2022. Catering to the well being wants of this inhabitants is its duty. The Balasore prepare accident in June 2023 raised vital issues about rail security, but it surely was largely about accident-related security.
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Because of its excessive passenger throughput, there is one other type of security the Railways is answerable for however which is typically neglected: medical emergencies.
In 2017, 1,076 medical emergencies have been reported at the Katpadi Junction railway station in Vellore, Tamil Nadu. 1 / 4 of those emergencies have been trauma-related; the remaining ranged from minor illnesses like fever to life-threatening situations like low blood sugar. Nearly 1 in each 10 emergencies reported at the station’s emergency assist desk, operated by Christian Medical College (CMC) Vellore, required pressing, life-saving intervention.
Non-communicable illnesses like diabetes and hypertension are on the rise in India. In the previous couple of years, the variety of deaths attributable to coronary heart assaults has additionally risen sharply. Is the Indian Railways ready to deal with medical emergencies that outcome?
Provision of emergency care
Medical care provision in Indian Railways has developed to handle emergency medical situations, not accident-related emergencies alone. In 1995, a ‘Special first aid box’ was supplied in long-distance superfast trains, Shatabdi and Rajdhani trains. This field consisted of 49 objects and was for use by a health care provider travelling on the prepare. An improved model of this equipment, known as the ‘Augmented first aid box’, containing 58 objects was supplied for particular long-distance trains.
In November 1996, as a part of a pilot venture, Railways stationed a medical group in two long-distance trains. This group consisted of a medical officer, a male nurse, and an attendant. In the subsequent 4 years, nonetheless, the Railways discovered the group was largely idle, with the physician attending solely to minor illnesses. Only 4 critically in poor health passengers have been recorded on this time, and none survived attributable to lack of enough sources within the (shifting) prepare. The Railways subsequently discontinued the service – however to make healthcare accessible, it determined to offer medical doctors travelling on trains a ten% low cost in the event that they have been prepared to supply medical providers en route.
These medical provisions have been discovered to be insufficient, nonetheless, once they failed to avoid wasting the lifetime of Netrapal Singh, the Chief Legal Assistant of Railways, who succumbed to a coronary heart assault whereas travelling from Jaipur to Kota in February 2004.
A petition filed in Rajasthan High Court in 1996, to enhance medical care provision in trains and railway stations, gained momentum after Mr. Singh’s demise. In a 2005 judgement, the Court discovered the explanation for the underutilisation of the medical group within the pilot section was a lack of expertise of the service. The Court directed Railways authorities to order 4 berths in long-distance trains to supply medical care and to have a medical group in trains travelling greater than 500 km. The Court additionally directed the authorities to adequately promote the presence of this medical facility in all prepare compartments and on platforms.
The Railways appealed this order in 2006 within the Supreme Court. During hearings, the Railways knowledgeable the apex courtroom {that a} pilot initiative – to have chemist’s stalls at stations and a health care provider in 9 choose stalls – had additionally failed. Similarly, it had reserved two berths for medical care, however since critically in poor health sufferers needed to be deboarded for care and the venture had a excessive price, the Railways stopped doing this as properly.
Finally, in 2017, the Supreme Court directed the Railways to arrange a committee consisting of consultants from the All India Institute of Medical Sciences (AIIMS), New Delhi, to suggest additional measures.
Based on the Court’s order and the committee’s suggestions, the Railways decided to switch the contents of the primary assist packing containers and supply them at all railway stations and in all passenger-carrying trains. It additionally mandated first-aid coaching for railway workers at the time of becoming a member of and as soon as each three years. The committee additionally advisable a evaluate of service utilisation each three years.
Status of medical care in trains
In 2018, in response to a query within the Lok Sabha, the Minister of State within the Ministry of Railways replied that every one suggestions of the AIIMS professional committee had been applied. In 2021, the Railways additionally launched an built-in helpline quantity – 139 – for all queries in regards to the railways, together with medical help.
In February 2023, Ashwini Vaishnaw, the Union Minister of Railways, stated in Lok Sabha that deputing a health care provider at each railway station had been deemed pointless. Yet in December, he stated all suggestions of the committee had been applied.
Even now, a search on X (Twitter) yields many posts of railway passengers complaining about poor medical providers on trains.
On December 23, 2023, one of many authors – Parth Sharma – was travelling from Delhi to Dehradun on a Vande Bharat specific. At one level, the prepare workers requested if there was a health care provider on board, and in that case, to come back to the C1 coach. Parth rushed to C1 and located a 60-year-old man had sudden onset sweating, giddiness, and higher stomach discomfort. His age, historical past of diabetes, hypertension, and medical signs all pointed to the potential of a coronary heart assault. The subsequent cease was half-hour away, so he wanted first assist.
Unfortunately, the emergency equipment on the prepare was insufficient. At first look, it lacked a blood strain monitor and a glucometer. Aspirin, a life-saving drug throughout a coronary heart assault, was accessible but it surely was only a week away from expiring. Nonetheless, Parth was in a position to present the very best first assist within the circumstances.
A later, nearer inspection of the equipment revealed much more quite a few inadequacies. In reality, it appeared the prepare was utilizing the 1995 48-item listing quite than the up to date 88-item listing from 2017.
The route forward
According to Okay.P.P. Abhilash, head of emergency medication at CMC Vellore, the 2017 listing is additionally wanting. Based on the circumstances recorded at the emergency care centre in Katpadi Railway station in Vellore, Dr Abhilash and his group ready a listing of important medical objects the station should inventory however didn’t. In addition to the objects within the listing by the AIIMS professional committee, this listing included private protecting gear for care suppliers and a pulse oximeter.
Recent developments in point-of-care diagnostics have revolutionised healthcare. According to Rajat Jain, founding father of Sunfox, a medical machine R&D organisation, moveable ECG units and fast diagnostic kits needs to be added to establish and deal with coronary heart assaults early.
A extra rapid step nonetheless is for the Railways to make sure the up to date 88-item listing is in place in all trains and that passengers are conscious of those providers. Periodic inspections are essential to keep up the standard of care as properly. Finally, the Railways wants to put in a system to seize information on the healthcare wants of individuals travelling on trains and use that to tell coverage.
Dr Parth Sharma is a public well being doctor, researcher, and founding father of Nivarana, a public well being advocacy and data platform. Vaishnavi Jayakumar is co-founder of The Banyan, member of the Disability Rights Alliance, and works at the intersections of incapacity, well being entry, homelessness, and human rights advocacy.
- The Indian Railways transports greater than 2.3 crore passengers day by day – roughly twice the projected inhabitants of Uttarakhand state in 2022
- In 1995, a ‘Special first aid box’ was supplied in long-distance superfast trains, Shatabdi and Rajdhani trains
- In 2021, the Railways launched an built-in helpline quantity – 139 – for all queries in regards to the railways, together with medical help
