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Golden Hour: The Importance of Emergency Medical Care In Motor Vehicular Accidents

Road accidents occur due to multiple causes such as rash and negligent driving, the use of mobile phones on the go, drunken driving / consumption of alcohol / drugs, overloaded vehicles, poor light conditions, jumping red light, over speeding, overtaking, negligence of civil bodies characterized by unfinished civil work such as flyovers, adhoc digging etc. India is an unfortunate victim of a large number of road crash fatalities.

As per reports, road crashes claim more than 2, 00, 000 lives in India out of which nearly 50% victims succumb to the injuries because they dont receive immediate medical attention within the Golden Hour. When it comes to a traumatic injury, especially if an emergency surgery needs to be performed to save life the first few minutes or hours can be very crucial and become a vital determinant of the patients well being and the clinical outcome of any emergency procedure conducted. This period is more popularly termed as the Golden Hour - In emergency care, this aptly named Golden Hour may mean a difference between survival & death.

The concept of Golden Hour refers to the window of opportunity right after the injury when an intervention is made at the earliest to could impact the survival of the patient. It has been observed that the sooner a trauma victim reaches the Emergency Care Unit, the better their chance of their survival. In fact, several studies have shown how Golden Hour interventions have a considerable impact in terms of trauma mortality.

World Health Organization report on pre-hospital trauma care system says Even the most sophisticated and well-equipped pre-hospital trauma care system can do little if bystanders fail to recognize the seriousness of a situation, call for help, and provide basic care until help arrives. WHO report further says, Bystanders must feel both empowered to act and confident that they will not suffer adverse consequences, such as legal liability, as a result of aiding someone who has been injured.

The Golden Hour � the first sixty minutes of the care the patient receives directly affects the outcome. It is very important especially in cases of traumatic injuries as this Golden Hour plays an important role in deciding the morbidity and mortality of the patient. If the victim can be stabilized and transported safely to a hospital in this time frame, his or her chances of survival increase significantly. According to experts, right care during Golden Hour increases the chances of survival as well as reduces the after effects of the trauma.

R. Adams Cowley, founder of Shock Trauma Institute, Baltimore came up with the term Golden Hour in the year 1975. He called this time as the time between life and death. According to him, if a person is critically injured, rather than dying right away, that person might have less than sixty minutes for any chance of survival. However, this isnt a statement or theory that is proved yet. But the concept of Golden Hour plays an important role even in the current situation as this spreads the importance of seeking urgent medical treatments in cases of traumas.

However, Golden Hour is not always a pre-defined time period. Sometimes, according to the severity of the situation the Golden Hour can range from a few minutes to several hours. Golden Hour is aimed at saving the lives of patients who underwent major trauma from early deaths mostly caused due to haemorrhage. Although it isnt proved that the survival rates drop after 60 minutes, it is always advisable to receive the best care. Also, in some cases, the patient might experience shock due to delayed treatments which can lead to death. Trauma is one of the leading causes of death in India.

Golden Hour voices the necessity of rushing a trauma patient to the nearest Health Care Centre in the least possible time because this Golden Hour is the time that decides the life of a person post this trauma. The medical literature on the subject states that the Golden Hour is the first hour immediately after the accident in which emergency medical care is necessary and most victims die if no such care is available or is not given soon after the accident. The purpose of emergency medical care is to stabilize the patient and this, unfortunately, is not done.

In the Public Interest case filed in the Supreme Court on the need for emergency care of victims of accident, the Supreme Court of India stated in [Parmand Katra Vs Union of India, AIR 1989 SC 2039] as follows:
Every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter the procedural criminal law should be allowed to operate in order to avoid negligent death. There is no legal impediment for a medical professional when he is called upon or requested to attend to an injured person needing his medical assistance immediately. The effort to save the person should be the top priority not only of the medical professional but even of the police or any other citizen who happens to be connected with the matter or who happens to notice such an incident or a situation.

Preservation of human life is of paramount importance. That is so on account of the fact that once life is lost, the status quo ante cannot be restored as resurrection is beyond the capacity of man. The patient whether he be an innocent person or be a criminal liable to punishment under the laws of the society, it is the obligation of those who are incharge of the health of the community to preserve life so that the innocent may be protected and the guilty may be punished. Social laws do not contemplate death by negligence to tantamount to legal punishment.

A doctor at the Government hospital positioned to meet the States obligation is, therefore, duty bound to extend medical assistance for preserving life. Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. No law or State action can intervene to avoid/delay the discharge of the paramount obligation cast upon members of the medical profession.

The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way. Every doctor should be reminded of his total obligation and be assured of the position that he does not contravene the law of the land by proceeding to treat the injured victim on his appearance before him either by himself or being carried by others.

Zonal regulations and classifications cannot also operate as fetters in the process of discharge of the obligation and irrespective of the fact whether under instructions or rules, the victim has to be sent elsewhere or how the police shall be contacted, the guideline indicated in the 1985 decision of the Committee on Forensic Medicine (set up by the Ministry of Home Affairs of the Government of India) is to become operative.

It is expected of the members of the legal profession which is the other honourable profession to honour the persons in the medical profession and see that they are not called to give evidence so long as it is not necessary. It is also expected that where the facts are so clear it is expected that unnecessary harassment of the members of the medical profession either by way of requests for adjournment or by cross examination should be avoided so that the apprehension that the men in the medical profession have which prevents them from discharging their duty to a suffering person who needs their assistance utmost is removed and a citizen needing the assistance of a man in the medical profession receives it.

The ground reality that in spite of the observations of the Supreme Court and certain provisions of the Motor Vehicles Act, 1988, it is a fact of life that there is no proper pre-hospital medical care and that private hospitals and medical practitioners who are nearest to the place of accident refuse to admit victims even for emergency medical care, on the plea that the cases are medico-legal cases and they direct the victims to go to Government Hospitals, howsoever far they may be. Some private hospitals refuse purely on monetary grounds, if the victim is either poor or is not immediately in possession of funds.

Scheme For Cashless Treatment Of The Accident Victim During The Golden Hour

Section 162 of Motor Vehicles (Amendment) Act, 2019 provides a Scheme for Golden Hour which lays down that notwithstanding anything contained in the General Insurance Companies (Nationalization) Act, 1972 or any other law for the time being in force or any instrument having the force of law, the Insurance Companies for the time being carrying on general insurance business in India shall provide in accordance with provisions of this Act and the Schemes made under this Act for treatment of road accident victims, including during the Golden Hour. The Central Government shall make a Scheme for the cashless treatment of victims of the accident during the Golden Hour and such Scheme may contain provisions for creation of a fund for such treatment.

Duty Of Driver Of Motor Vehicle Causing Injuries To Person

When a person is injured in case of an accident by a motor vehicle, it is the incumbent duty of the driver or any other person in charge of the motor vehicle to take all reasonable steps to secure medical attention for the injured person by conveying him/her to the nearest medical practitioner or hospital. The driver may be excused from doing so if it is not practicable to do so on account of mob fury or any other reason beyond his/her control or if the injured person or his/her guardian doesnt desire to go to the hospital.

When demanded by the Police Officer, the driver is bound to give any information required by him. Suppose if no Police Officer is present, then the driver or any other person-in-charge of the Offending Vehicle must report the circumstances of the occurrence and in case, he/she has not taken any reasonable steps to secure medical attention as is required, then he/she must also report the circumstance if any, for not doing so at the nearest Police Station as soon as possible, and in any case within twenty-four hours of the occurrence.

Referring to Section 134 of the Motor Vehicles Act, 1988 the driver or any other person-in-charge of the Vehicle is bound to give the following information in writing to the insurer, who has issued the Certificates of Insurance, about the occurrence of the accident, namely:
  1. Insurance Policy Number and period of its validity;
  2. Date, time and place of accident;
  3. Particulars of the persons injured or killed in the accident;
  4. Name of the driver and the particulars of his driving license.
For the purposes of this law, the expression driver includes the owner of the vehicle.

Mandatory Duty Of Doctor To Provide First Aid To Accident Victim

It is the mandatory duty of the doctor on duty in the hospital to immediately attend to the injured person and render medical aid or treatment without waiting for any procedural formalities. The treatment of the patients should not wait for the arrival of the police or completion of legal formalities.

The Supreme Court had long back stressed in case of Parmanand Katara (spra) observed that every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter the procedural criminal law should be allowed to operate in order to avoid negligent death. There is no legal impediment for a medical professional when he is called upon and requested to attend to an injured person needing his medical assistance immediately.

The effort to save the person should be a top priority not only of the medical professional but of the police and other citizens. There are no provisions in the Indian Penal Code/Code of Criminal Procedure/Motor Vehicles Act which prevents doctors from promptly attending to seriously injured persons and accident cases before the arrival of the police and taking into cognizance of such cases, preparation of FIR and other formalities by Police.

Duty Of Driver To Stop In Certain Cases

According to Section 132 of Motor Vehicles Act, 1988 it is the duty of a motor vehicle to stop and co-operate as long as it is necessary. He is supposed to give his/her name and address as well as the name and address of the Owner of the vehicle to the victim of the accident.

Laws Encouraging Samaritans To Help Accident Victims

Three out of four people in the country are hesitant to help the injured accident victims on roads due to fear of police harassment, detention at hospitals and prolonged legal formalities.
Even if someone desires to help these factors stop them from doing so. However, a Good Samaritan is a person who in good faith, voluntarily and without expectation of any reward or compensation renders emergency medical or non-medical care or assistance at the scene of an accident to the victim or transports such victim to the hospital.

Supreme Court in [Savelife Foundation & Anr. Vs Union of India & Anr., Savelife Foundation VS Union of India, 2016 (7) SCC 194] emphasized the need for establishing legal framework for protection of Good Samaritan so that he/she is empowered to act without any fear of adverse consequences or harassment was emphasized. The Supreme Court in this Judgment approved guidelines issued by the Centre for the protection of Good Samaritans at the hands of the police or any other authority.
  • A Good Samaritan will not be liable for any civil or criminal action for any injury or death of the victim.
  • A Good Samaritan who informs police or emergency service on coming upon an injured person is not to be compelled to reveal his personal details.
  • Disciplinary action will be initiated against public officials who coerce Good Samaritan to reveal his personal details.
  • A Good Samaritan is not to be forced to reveal his/her personal details; disclosure of personal information including for the Medico-Legal Case Form will be optional and voluntary.
  • Good Samaritans are not to be forced to bear the initial cost of treatment. No public or private hospital can demand payment for registration and admissions costs from any bystander who brings an injured to the hospital.
  • Hospitals cannot refuse treatment to a victim; Lack of response by a doctor in an emergency situation shall be considered as Professional Misconduct and disciplinary action shall be taken against such a doctor (as per Indian Medical Council Regulations, 2002).

Section 134 (A) was inserted by Act 32 of 2019 w. e. f 01.09.2019 in Motor Vehicles (Amendment) Act, 2019 which lays down protection of Good Samaritans shall not be liable for any civil or criminal action for any injury to or death of the victim of an accident involving a motor vehicle, where such injury or death resulted from the Good Samaritans negligence in acting or failing to act while rendering emergency medical or non-medical care or assistance.

The Central Government may, by rules, provide for the procedure for questioning or examination of the Good Samaritan, disclosure of personal information of the Good Samaritan and such other related matters. There is also a proposal dt. 27.10.2020 for giving away awards to the Good Samaritans and other stakeholders working in the field of Road-Safety.

Golden Hour means the time period lasting one hour following a traumatic injury which there is highest likelihood of preventing death by providing prompt medical care. We repeatedly come across instances of road mishaps where victims sustain injuries and at times, the victim succumbs to injuries.

There are many instances where the driver of the Offending Vehicle responsible for the incident flees from the spot abandoning the injured victim leading to the loss of the Golden Hour which has a larger probability of saving the injured persons life. The first sixty minutes of such an emergency, often called the Golden Hour is widely regarded as the most critical for saving lives. In case of severely injured victims, this is the time after which the chances of morbidity and mortality significantly increase. If the victim can be stabilized and transported safely to a hospital in this time frame, his or her chances of survival increase significantly.

With regard to emergency trauma care, a few minutes can mean the difference between life and death. This first hour of definitive medical care is called the Golden Hour. It is usually this first hour where the patients medical fate is sealed. In general, the faster that medical care is rendered, the better the medical outcome will be. The Supreme Court emphasized the need for making it obligatory for hospitals and medical practitioners to provide Emergency Medical Care. This is not the only reason for not attending on injured person or persons in a Medical Emergency, for sometimes such persons are turned out on the ground that they are not in a position to make payment immediately or that they have no insurance or that they are not members of any scheme which entitles them to medical reimbursement.

Written By: Dinesh Singh Chauhan, Advocate - High Court of Judicature, J&K, Jammu.
Email: [email protected]; [email protected].

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