Global comparative study highlights the need for a national law on trauma care

Calls for establishment of the Right to Emergency Medical Care, with a special focus on trauma care, to save lives of trauma patients

A 2020 report by the Ministry of Home Affairs, Government of India states that well-established trauma care systems greatly help to reduce such deaths by nearly 20-25 per cent and serious disabilities by more than half. This help though, is hard to come by as highlighted by multiple assessments of different components of the emergency medical care system in India. For instance, the 2020 Vital Statistics of India data released by the Ministry of Home Affairs, Government of India, states that approximately 45 percent of the total fatalities registered during the year, amounting to 36.5 lakh people, died without receiving any medical attention. As per the Emergency and Injury Care at District Hospitals in India report by NITI Aayog and AIIMS published in 2021, compliance with availability of overall recommended biomedical equipment and critical equipment was largely deficient in district hospitals, to the tune of 45-60 per cent. The report also revealed that none of the district hospitals studied had all of the essential emergency medicines recommended for emergency departments.

To gauge where the gap lies with regard to the available emergency medical care in India, both in terms of written statutes and systems available, SaveLIFE Foundation, in collaboration with the Thomson Reuters Foundation’s TrustLaw Network has undertaken a global study to report on the prevalence of legal statutes to guarantee emergency medical care as a Statutory Right and the subsequent availability of commensurate systems in the studied countries. The selected countries include a mix of both developing and developed nations, including the USA, Germany, England and Wales, Malaysia, Australia, Brazil, Japan, Pakistan and South Africa. The prevalence of such legal guarantees and grassroots systems in India has also been studied and included in the report.

The study investigated five distinct aspects of emergency medical care in these countries:

Availability of guaranteed/statutory right to emergency medical care

• Existence of separate federal and state laws and/or guidelines on the right and access to emergency medical care, and the ways in which they are harmonised and enforced
• Status of emergency medical care funding, including state, insurance and privately-sourced funding
• Mechanisms at the Federal and State level to regulate referrals at hospitals/trauma care centres, and established protocols
• Specific guidelines/regulations to address traumatic injuries on highways

The legal comparative research for the report has been prepared by SaveLIFE Foundation with support from four international law firms’ part of the TrustLaw network including Dechert LLP, Latham & Watkins, White & Case and Norton Rose Fulbright.

As per the report, while high-income countries such as Australia and Japan have partial written statutes guaranteeing right to emergency medical care, their strong, well-established universal trauma care access systems ensure that a robust emergency response framework is available to the citizens. In fact, the United States of America and England and Wales, also have written statues to ensure universal access to trauma care for their respective citizens. Most developing countries covered in this report have enshrined trauma care in their statutory provisions even as they continue to build the mechanisms required to implement care systems on the ground. Though India doesn’t have legislative statutes guaranteeing emergency medical care as a right, court judgments have sought to interpret emergency medical care as a right. The said judgements, however, neither prescribe basic minimum standards for various facets of emergency medical care nor outline punitive measures for violation of such a right.

Despite landmark judgments like Parmanand Katara v. Union of India and Paschim Banga Khet Mazdoor Samithi v. State of West Bengal by the honourable Supreme Court of India that highlight the importance of inclusion of emergency medical care in Article 21 of Indian Constitution, emergency medical care has not as yet been standardised across the country.

The 2021 report published by NITI Aayog and AIIMS highlights the state of emergency medical care with alarming numbers such as 98.5 per cent of ambulance runs transporting only dead bodies; 90 per cent of ambulances functioning without any equipment including oxygen; 95 per cent of ambulances having untrained personnel; most emergency department (ED) doctors having no formal training in trauma care and 30 per cent mortality due to delay in emergency care.

Commenting on the report, Piyush Tewari, CEO and Founder, SaveLIFE Foundation said, “Trauma care helps preserve our fundamental right to life, but delivery of such care requires a system with interlinked sub-systems and uniform standards. Such standards can very well be established without an explicit “Right to Trauma Care” law but a legislation would ensure that a framework to establish such standards and systems exist with appropriate authority, accountability, and long-term sustainability. The “Right to Education Act, 2009” is a classic example of how legislation can spur the creation of systems to ensure that the country progresses ahead. This report documents the precedent of such actions taken by high as well as low- and middle-income countries. We hope that it will motivate a much-needed discourse amongst all stakeholders, with saving lives being at the front and centre of all discussions.”