<div>At the hospital’s casualty department, instead of rushing with instant medical help, documentation and police reporting takes precedence. There is an air of apathy, routine and disinterest everywhere. I have spent 30 years in surgery and these scenarios — as if asking, ‘Whose life is it anyway?’ — unnerve me. <br /><br />The answers lie not in medicine but in behavioural science. At the site of accident, there is fear, a sense of shock and disbelief, fear of the flowing blood... The scene may be ghastly and the injuries grievous. This itself drives people away from the scene. They don’t want to be a part of misery and evil in life, especially since it is not kith and kin. Hence, the reluctance to get involved.<br /><br />Scientific knowledge about the principles of triage to classify the victims on the basis of gravity of their injuries is lacking. There are instances when the good Samaritan act of transporting the victim has led to more damage than the accident itself. Transportation is a science and a pre-hospital transfer is not merely a physical transit but it also involves efforts to stabilise and assess a patient and inform the hospital to prepare for the victim’s arrival. <br /><br />Then, there is the police — they help, they interrogate, they detain, they document and they accuse. Sabari’s friend Shantam endured that as well. But the fear of unnecessary detention, involvement in documentation and endless trips to the police station and court is what deterred bystanders — that was Pahwa’s advise — keep out; albeit an expensive avoidance. It costs a life. <br /><br />Victim transfer involves money — bystanders also worry, if they helped, who is going to compensate them? <br />Hospital is always a busy place. Casualty is chaotic. There is nothing casual there. At any given time, you can have — all at the same time — a case of hit and run, stabbing, poisoning, asthma attack, a heart attack, a woman in labour, a child bleeding with a gash. We need to prioritise. A gash on the forehead, bleeding profusely looks ghastly but the intra cerebral occult bleed on the next bed is more dangerous and needs priority. All this becomes a routine for us in the hospital. Routine leads to mechanical behaviour. Excess of stress and routine lead to apathy. <br /><br />Medico-legal is a very critical part of hospital management. It may not be apparent today but it comes alive like a ghost six months down, in a court of law. Hence the documentation, search for the relatives, struggle to identify and need to be methodical and systematic<br />.<br /> The hospital does wish to decline but delays are inevitable for the want of protocols. Law has enforced a doctor’s duty to treat but it cannot ascertain its adherence. The relationship between clinical care and court may, at times, lead to tensions and while I agree that both sides are important, there can be no doubt that in the Casualty, it is the clinical domain that remains supreme. <br /><br />Victim is brought by unknown people. Family is not there, and hence, more details about the past history, ailments, any medications and allergies are not known. This leads to a cautious approach by the medical staff. <br />Often relatives arrive after the battle is lost, and thrash everybody around. The loss of property and unjustifiable violence has become an everyday affair. It is more the expression of anger, and grief due to an unexpected tragedy but yet it scars the medical profession. A young doctor, then starts thinking… why should I receive blows and brickbats; this may explain apathy in treating the next accident victim. <br /><br />There is a dire need for evolving a road safety culture that includes law, police, public and hospitals. School children can be the change agents in the behaviour of adults. Citizens need to be taught a documented process on the principles of transfer of victims. <br /><br />Police must adopt unintimidating attitude in accidents and their processes must become foolproof and simple. They must adopt documentation on video, and take statements in camera once only. Doctors and citizens should not to be called to court more than once and Samaritans must be compensated for costs.<br /><br />It’s time for all of us to wake up! The Good Samaritan Act needs to be approved and passed in the Parliament. <br /><br /><em>The writer is VC of DY Patil University, Navi Mumbai and an eminent paediatric surgeon. He is a prolific writer and has more than 200 scientific publications and 45 books to his credit</em><br /><br />(This story was published in BW | Businessworld Issue Dated 08-09-2014)</div>
