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 accountability. The Balasore prepare accident in June 2023 raised necessary considerations about rail security, however it was largely about accident-related security.

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Because of its excessive passenger throughput, there’s one other sort of security the Railways is chargeable for however which is usually missed: medical emergencies.

In 2017, 1,076 medical emergencies had been reported on the Katpadi Junction railway station in Vellore, Tamil Nadu. 1 / 4 of those emergencies had 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 on 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 few years, the number of deaths attributable to coronary heart assaults has additionally risen sharply. Is the Indian Railways ready to deal with medical emergencies that consequence?

Provision of emergency care

Medical care provision in Indian Railways has advanced to deal with 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 gadgets and was for use by a physician travelling on the prepare. An improved model of this package, referred to as the ‘Augmented first aid box’, containing 58 gadgets was supplied for particular long-distance trains.

In November 1996, as a part of a pilot mission, 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, nevertheless, the Railways discovered the group was principally idle, with the physician attending solely to minor illnesses. Only 4 critically sick passengers had 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 provide medical doctors travelling on trains a ten% low cost in the event that they had been prepared to offer medical companies en route.

These medical provisions had been discovered to be insufficient, nevertheless, once they failed to save lots of 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 rationale for the underutilisation of the medical group within the pilot part was a lack of expertise of the service. The Court directed Railways authorities to order 4 berths in long-distance trains to offer 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 physician in 9 choose stalls – had additionally failed. Similarly, it had reserved two berths for medical care, however since critically sick sufferers needed to be deboarded for care and the mission had a excessive price, the Railways stopped doing this as nicely.

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 advocate additional measures.

Based on the Court’s order and the committee’s recommendations, the Railways decided to switch the contents of the primary support packing containers and supply them in any respect railway stations and in all passenger-carrying trains. It additionally mandated first-aid coaching for railway workers on the time of becoming a member of and as soon as each three years. The committee additionally beneficial a evaluation of service utilisation each three years.

Status of medical care in trains

In 2018, in response to a question 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 carried out. In 2021, the Railways additionally launched an built-in helpline quantity – 139 – for all queries regarding the railways, together with medical help.

In February 2023, Ashwini Vaishnaw, the Union Minister of Railways, stated in Lok Sabha that deputing a physician at each railway station had been deemed pointless. Yet in December, he stated all suggestions of the committee had been carried out.

Even now, a search on X (Twitter) yields many posts of railway passengers complaining about poor medical companies on trains.

On December 23, 2023, one of many authors – Parth Sharma – was travelling from Delhi to Dehradun on a Vande Bharat categorical. At one level, the prepare workers requested if there was a physician 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 scientific signs all pointed to the potential of a coronary heart assault. The subsequent cease was half-hour away, so he wanted first support.

Unfortunately, the emergency package on the prepare was insufficient. At first look, it lacked a blood stress monitor and a glucometer. Aspirin, a life-saving drug throughout a coronary heart assault, was out there however it was only a week away from expiring. Nonetheless, Parth was capable of present the very best first support within the circumstances.

A later, nearer inspection of the package revealed much more quite a few inadequacies. In reality, it appeared the prepare was utilizing the 1995 48-item checklist somewhat than the up to date 88-item list from 2017.

The route forward

According to Ok.P.P. Abhilash, head of emergency drugs at CMC Vellore, the 2017 checklist can be wanting. Based on the circumstances recorded on the emergency care centre in Katpadi Railway station in Vellore, Dr Abhilash and his group ready an inventory of important medical gadgets the station must inventory however didn’t. In addition to the gadgets within the checklist by the AIIMS professional committee, this checklist included private protecting tools 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 gadgets and speedy diagnostic kits needs to be added to establish and deal with coronary heart assaults early.

A extra quick step nevertheless is for the Railways to make sure the up to date 88-item checklist is in place in all trains and that passengers are conscious of those companies. Periodic inspections are essential to keep up the standard of care as nicely. 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 knowledge platform. Vaishnavi Jayakumar is co-founder of The Banyan, member of the Disability Rights Alliance, and works on 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 regarding the railways, together with medical help