We need massive infrastructural changes to be able to save lives
In emergency medicine, the “golden hour” refers to a time period lasting for one hour following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment could prevent death.
The phrase was first introduced during emergency military medical aid at the close of World War II and the Korean conflict.
Emergency medical services regarding road crashes are similar, which has been found to be the case in many studies, indicating that the single most prevalent cause of death for injured road crash survivors was blood loss, mainly due to the failure to get these individuals into serious life-saving medical treatment quickly after being injured.
The world’s first road crash death was recorded back in 1896. After more than a century, WHO data shows that 1.25 million people are killed on the roads every year, and as many as 50 million are injured. Road crashes were ranked as the 11th leading cause of death, and account for 2.1% of all deaths globally, which is also the second leading cause of death among people aged five to 29 years, and leaving 20 million people in different forms of disability annually.
If coordinated and sustainable measures are not initiated now, WHO has predicted that road crashes will become the seventh leading cause of death by 2030. WHO data also shows that road crashes cost most countries 3% of their GDP and are increasingly putting a significant strain on the health care budget.
In Bangladesh, despite the high number of road crash casualties, the government is yet to develop an authentic coordinated mechanism to counter them.
Challenges of managing this “golden hour” are enormous, starting from getting timely information about the road crashes and responding to the emergency. Historically, both the private and public medical service providing agencies and institutions in South Asia, including Bangladesh, have been negligent in providing emergency medical services to road crash survivors.
In addition, “Good Samaritans” ie by-standers and passers-by who could provide help to the victims have the fear of legal consequences, harassment, and repeated police interrogation. Across the globe, there are practices of legislative protection for Good Samaritans, but we are yet to frame any institutional mechanism for their protection here.
Responding to a writ petition of BLAST, on February 10, 2016, the High Court also issued a rule nisi, asking the director general of health services and the secretary of the Ministry of Health, the Ministry of Road Transport and Bridges, and the Bangladesh Medical and Dental Council to pursue directions and frame guidelines which would make it mandatory for all public and private hospitals and clinics to provide emergency medical services to survivors of any road crash.
The High Court directive observed that “failure of the said agencies to ensure emergency medical services by hospitals and doctors for patients in a life threatening situation particularly following a road crash is a violation of fundamental rights guaranteed under the Article 27, 31, and 32 of the constitution, read with Articles 15(a) and 18 and 21.”
Though the responding parties were supposed to take initiatives within four weeks of the issuing of the directives, the concerned authorities are yet to finalize any of these regulations or guidelines.
The proposed Road Transport (draft) Act 2017 has made the owner or company or driver or any representative of the vehicles involved in the crash accountable with regards to transporting the injured to the nearby emergency medical service providing agency, including informing the nearby police station or fire services.
Representatives of the transport owners and workers are in disagreement with the proposed provisions, arguing that during most of the road crashes, operators -- drivers, conductors, and helpers -- also become victims of the crash and the owners stay away of the spot.
But road safety activists and experts have suggested transport owners should set up mechanisms to monitor road crashes round the clock, and inform all concerned to provide required support when any crash takes place, a prerequisite towards managing the “golden hour.”
Social attitudes around road crashes have greater influence over the non-responsive behaviour of the operators. After road crashes, they tend to fl ee the scene as quickly as possible to save themselves from the public’s wrath.
Professor Md Shamsul Hoque of the Department of Civil Engineering, BUET, who is also a road safety expert, has conducted research on a few road crashes in Bangladesh, eg the Manikganj crash which killed two boys, and the Mirsharai crash that killed 38 students, and showed that neither of the vehicles were solely responsible -- rather, there were other contributing factors.
So, to make operators accountable and provide mandatory support as stipulated in the proposed Road Transport (draft) Act 2017, changes in social attitudes are a must, which require a nationwide campaign engaging the community and all stake-holders.
While the transportation for crash survivors needs to be ensured, so does the skill and capacity of rendering emergency medical services.
To handle such emergencies, coordinated efforts of all concerned are required, but in the long term, separate legislation should address the issue.
Thus, to manage the “golden hour,” an institutional framework is required, which should include, among others, the following provisions:
Sadrul Hasan Mazumder is the Program Coordinator, Advocacy for Social Change, BRAC, and Coordinator, Safe Road and Transport Alliance (SROTA). He is can be reached at [email protected]