In India, first-aid training for bystanders attempts to fill emergency care gap

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KATHMANDU, Nepal — Globally, more than 1.3 million people die in road traffic accidents every year. But the vast majority of these deaths happen in low- and middle-income countries and 17 percent of these deaths occur in India alone.

“The primary reason why many people die on the side of the street waiting for help is because the pre-hospital aspect is not being addressed as effectively.”

— Piyush Tewari, founder and CEO, SaveLIFE Foundation

This means that every year in India, according to government figures, around 150,000 people die from road traffic accidents. According to the SaveLIFE Foundation, an NGO committed to improving road safety and emergency care across India, for every death attributable to road accident trauma, three patients survive but are left with permanent disabilities. In the past decade alone, more than 5 million Indians have been severely injured or are now living with a disability from road traffic accidents.

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Government data shows that 50 percent of road traffic deaths in India could have been prevented, had the injured received basic trauma care within the first hour after the accident. However, many accident victims are unable to access timely care and prevent further disability due to the lack of emergency medical services in many parts of the country.

Police and bystanders are often the first to respond to a road traffic accident and could play a vital role in supporting accident victims and fill the gap in India's emergency response system. But many of them lack the first-aid skills needed to stabilize a patient until an ambulance arrives.

“Emergency medical care is still evolving in India and there’s still a long way to go. The primary reason why many people die on the side of the street waiting for help is because the pre-hospital aspect is not being addressed as effectively,” said Piyush Tewari, founder and CEO at the SaveLIFE Foundation.

First aid training for bystanders

Together with a number of Indian hospitals, the SaveLIFE Foundation has trained 15,000 volunteers and members of the police force in basic trauma life support in 12 states over the last 10 years. The foundation's Jeevan Rakshak Training Program is funded by mandatory corporate social responsibility contributions from private companies under India’s Companies Act.

“We started the program with a simple [aim]: Let’s try to save those who are injured,” Tewari said.

With funding and know-how support from Bloomberg Philanthropies and the Global Road Safety Partnership, the program focuses on equipping policemen and members of the public, who live or work in accident-prone areas, with basic first-aid skills and teaches them how to transport crash victims safely to the nearest hospital as soon as possible after an accident.

“It’s really about having people with basic training to help the victim and making sure that people are interested to help. Even with the challenges in the health care system, this can have some significant impact,” said Taifur Rahman, senior officer at the Global Road Safety Partnership.

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According to Tewari, the Indian capital New Delhi is an example of how effective the model of trained bystander care can be. The SaveLIFE Foundation has been training police personnel there since 2010 and, despite a rise in the total in number traffic accidents, fatalities have reportedly dropped by 30 percent by 2016.

“This is primarily because victims are able to get immediate, trained care from the police or from bystanders. Over the last five years, more than 150,000 people have been rushed to hospitals by policemen trained by the SaveLIFE Foundation,” Tewari said.

Bystanders are not paid to complete training and they aren’t offered any financial incentives for assisting the injured. Instead, most volunteers are nominated by local police forces, which is seen as a token of respect and a sign of good standing with law enforcement. However, people in India who provide care to accident victims or bring them to the hospital are sequentially often detained and subjected to bureaucratic hassles by the police, which deters them from helping the injured.

In order to address this issue, the SaveLIFE Foundation successfully campaigned for the introduction of a federal Good Samaritans Law, which guarantees protection to first aiders.

However, the lack of awareness of the law among the population remains a huge issue. According to the foundation, only 16 percent of Indians are aware of its existence.

“It isn’t about how you enforce [the law], but rather how people know and get aware that they won’t be harassed anymore if they help a victim,” Rahman said.

Dr. Patanjali Dev Nayar, regional adviser for disability, injury prevention, and rehabilitation at the World Health Organization, agreed, noting that it’s equally important that the police is aware of the protection the Good Samaritans Law offers to bystanders.

Beyond first aid

Despite the success of the SaveLIFE Foundation’s interventions, there’s only so much that bystander care can accomplish. The sooner an injured person gets to hospital, the better the chance of survival and full recovery. Nayar warned that bystander care must not be seen as a panacea for the disabilities incurred by road traffic accidents.

“For the disabled people [in India] and their families, disability most of the time is a catastrophe.”

— Dr. Patanjali Dev Nayar, regional adviser for disability, injury prevention, and rehabilitation, WHO

“You can’t avert 100 percent disability. If there’s a crash injury, maybe the only way left for the doctors is to amputate the limb. A certain percentage of disability is simply built into trauma,” he said.

India has passed several pieces of legislation to increase the inclusion of people with disabilities and mitigate the impact of disability on people’s lives in recent years. But uptake has been slow.

“For the disabled people [in India] and their families, disability most of the time is a catastrophe,” Nayar said.

Nayar added that large numbers of people living with disabilities are excluded from participating in social life and the workforce and access to medical care is more limited.

“The data shows us that people suffering from any kind of disability seem to be disconnected in access and the utilization of medical services,” Nayar said.

He cautioned to not solely focus on reducing fatalities but to provide survivors of road traffic accidents with proper rehabilitation services.

“That’s equally important for society if we want to return these people to be [able to be] productive citizens,” he said.

report by the International Labour Organization from 2011 states that 73 percent of people with disabilities in India are out of the labor force. Since road traffic accidents are the number one cause for death and disability of people between 18-45 years in India, they mostly affect people who are productive members of the workforce.

The International Road Assessment Programme estimates that in terms of economic productivity alone, each road accident death in India costs the country 70 times the gross domestic product per capita, while every serious injury costs the country 17 times the GDP per capita.

For Tewari, these numbers illustrate how efficient bystander training can be when it comes to reducing the economic burden of road traffic accidents in India.

“If a bystander, trained at the cost of $20, can save a life, [while the loss of a life] will cost the country approximately $150,000, the math is very clear,” Tewari said.  

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    Martin Bader

    Martin Bader is a journalist based in South Asia focused on human rights and development. He was previously based in the Middle East and writes in English and German.