I use to wonder why onomatopoeic representation of a siren is similar to wailing? Why a siren wails, why doesn’t it rings like a bell or honks like a horn? I got the answer when I heard the siren of an ambulance or more precisely when I heard the siren of the ambulance which had my grandfather’s corpse. The wailing of siren totally justifies when the siren is of an ambulance. I was too upset to realize anything at that moment, but days after a thought struck me like a sharp object and ached me awfully. The time I spent in that ambulance was terribly difficult for me, I couldn’t bear the fact that my grandfather is lying in front of me; inert and inanimate. How people who had been with there loved one alive but gravely-injured or critically-sick, would have borne that time, how the victim themselves would have endured that misery of being in that vehicle; let alone that vehicle being stuck in traffic… I never realized that ambulance is not an ordinary transportation vehicle, it doesn’t transport just a human like others, it transports “life”, it transports “hope” and how often we turn that hope into a lifetime despair, how often we turn a life into death!
Have we ever realized that a family might have mourned because of us, a person might have been disabled for lifetime because of us? Not that we were directly involved in physical damage, but we might have hindered the way of an ambulance, we might have hampered it from reaching the hospital earlier. NO, I’m not accusing you; you definitely haven’t done that deliberately, but we are not free from the guilt of carelessness and irresponsibility.
This isn’t mere emotional paronomasia; this is statistically proven. Injuries make up almost 16% of Global burden of disease. About 973 million individuals got injured in 2013 and 4.8 million injured succumbed to injuries (Haagsma et al., 2016; Mock, 2004). The underdeveloped and developing countries lead when it comes to the rate of death in accidents (London, Mock, Quansah, Abantanga, & Jurkovich, 2001). Talking about the indigenous scenario, as per data available at Pakistan Bureau of Statistics’ website, 13 valuable lives are lost every day in the country solely because of traffic accidents. Amongst four provinces Punjab comes first in terms of numbers of accidents and causalities, KPK comes next then Sindh and Finally Baluchistan. Data so given reflects horrible stats, in 91933 accidents that struck the roads of Pakistan, 108616 injured lost their lives and 47925 were injured (PBS, 2017). that means more than half injured never return to life. Figures depict in detail the number of accidents, causalities and injuries over the period of last ten years.
The number of ambulances available to cater the emergency situations is below the desired level. In addition, traffic load, improper traffic regulation and then irresponsible drivers make it even difficult to rescue the victims. Plus, road accidents are not the only emergency where ambulance service is required; there are numerous crisis conditions heralding for emergency service. Medical emergency, gravidity, fire, building collapse, crime incidents, drowning, blast, explosions, etc. too demand emergency response thus intensifying the need and importance of ambulance service.
The following pictorial depiction of data as obtained from rescue 1122 from 10th October 2004 to 5th May, 2017, highlights high ratio of various emergency situations, keep in mind that Rescue 1122 is emergency service of Punjab, data so shown pertains to Punjab only, stat will surge enormously when emergencies of all provinces are consolidated. In these mind boggling numbers of emergencies depicted below, Rescue 1122 successfully rescued 4880595 people (PES, 2017).
Evidence supports the conjecture that causalities can be precluded and permanent impairments can be obviated in emergency situations e.g. trauma, gravidity, cardiac arrest, toxaemia/ pyemia and heat stroke by elevating and improving emergency response and care (Mock et al., 2006; Varghese, Sasser, Kellermann, Lormand, & Organization, 2005). Trunkey devised a trimodal distribution of death centered on entr’acte from injury to death. The model categorizes death into three phases:
|Trunkey 1983: Trimodal Distribution of Death*|
|Immediate||Minutes||Scene||Nonsurvivable injuries||Injury prevention|
|Early||Hours||Hospital||Grave injuries, survivable with optimal care||Improved entrée to trauma center|
|Late||Weeks||Hospital||organ failure, septic poisoning||Enhanced resuscitation/Intensive Care|
*(Trauma Trunkey, 1983)
According to common understanding, patients have more chances to recover if medical care is provided within sixty minutes of the happening of injury, this is truer in trauma emergency. These valuable sixty minutes are often referred to as Golden Hour. Apropos proviso of care is positively capable of circumscribing or halting the cases, which under other conditions speedily direct to demise or permanent disability (Sasser, Varghese, Joshipura, & Kellermann, 2006; Sasser, Varghese, Joshipura, & Kellermann, 2014). Individuals having bright possibilities of survival may go the way of all flesh either on the spot or while making headway towards the hospital, only because of the absence of appropriate and timely pre-hospital care. Deaths in early hours following accidental injury are mostly caused by airway obstruction, hypoxemia or rampant blood loss (De Knegt, Meylaerts, & Leenen, 2008; Demetriades et al., 2005; Trauma Trunkey, 1983). However, these three causes of demise can be controlled with an imminent response and standard care. Research studies substantiate the importance of pre-hospital care in case of myocardial infarction too. Ting et al. (2008) and Mathews et al. (2011) have identified better survival chances among patients of acute cardiac-arrest who received some pre-hospital care as compared to those who received no preliminary care and were treated at the trauma center. The American Heart Association advocates the use of cardiograms in pre-hospital care to improve the quality of care given to patients (O’Riordan & Lie, 2008). The trimodal of death can be reduced to bimodal by eliminating the second phase and that’s possible only when the Golden Hour is utilized with high efficiency. There are two ways to take benefit of these treasured sixty minutes. Either provide pre-hospital care to the victim on site or take them to the hospital as early as possible.
Importance of Pre-hospital care is evident from researches and here it ignites our level of worry. Let’s bear in mind that ambulances in Pakistan do not live up to the definition of Ambulance i.e. “a vehicle equipped for taking sick or injured people to and from hospital, especially in emergencies” (Stevenson, 2010). With the exception of precious few, ambulance here in our country are merely vehicles and they are not outfitted with any sort of pre hospital medical equipment or drugs. That shows the severity of the issue, how desperately urgent it is for an ambulance to reach the hospital. Here very scant number of victims get some intervention on the spot, scantier can expect to be carried to the hospital in ambulance and scantiest can hope to reach the hospital right in time.
Edhi Foundation and St. John Association is working from a long time to bear the burden of such emergencies, Chippa welfare Association, Aman Foundation, Red Crescent 1030, Rescue 1122 have also joined hands to alleviate the burden, some hospitals and trusts also offer ambulance services. Safely said the most of the ambulance services are merely transportations, with little or no rescue equipment or paramedic. Pilot project of Rescue 1122started like other ambulances in 2004 at that time it wasn’t an actual emergency service. However, it developed and is now working as true emergency service with efficiently trained crew and well outfitted equipment and a response time of 7 minutes on an average. Rescue 1122 has now become groundbreakers and train the similar formations who want to effectuate similar facility. In Karachi Aman Foundation is pioneer in introducing state of the art ambulance service, equipped with all necessary pre-hospital care kit and a trained paramedic and in some ambulances a doctor too, with 10-minute response time in dense traffic of Karachi. Red Crescent have done the same quality arrangements for ambulances in Islamabad. Although the services given by these institutes are highly valuable and precious still it’s not sufficient for the entire population of the country. Rescue 1122 website states that 97 percent of the emergency calls they receive relate to “Emergency Ambulance Service”. The heavy requirement of ambulance makes it impossible to believe that all the victims will receive some preliminary aid on spot and thus the need to reach hospital early will become less grave. Thus our golden hour is valuable only if patient is moved to hospital within time, smoothly without any hindrance or traffic jams. CEO Aman Foundation said on a TV show that 82 bundles of joy opened eyes in the ambulance as the ambulances got stuck in traffic with the parturient women inside. (Aired on ARY Digital as on 31 May, 2017).
Delay in ambulance arrivals is caused by multiple reasons e.g. delayed response, long-distance, traffic snarl-ups, inadequate infrastructure and poor public cooperation etc. There is a lot to be done when it comes to perfecting the system of first-aid and emergency transportation, but not every factor is controllable and not every controllable factor comes under control of public and not everything will be reformed overnight. We can minimize the chance of accidents in first place, and health emergency can be minimized with better precautions, still emergencies will occur. We cannot do anything about the distance, it cannot be shrunk. Infrastructure is the responsibility of state so does traffic jams, though we can help by following traffic rules. However, the public cooperation is fully under our control, we being the public can completely eliminate this hindrance and nothing much is required just a heart that can feel, a sense of responsibility and a living conscience.
It’s not a vacuous allegation or a common observation, research studies have found that people generally don’t bother to give way to ambulance. Pitt and Pusponegoro (2005) quote in their article, “There is rarely any effort by traffic to pull over or give way to ambulances”. Chandran et al. (2013) have observed similar attitude in Karachi where traffic rarely sheds to make way for an ambulance. But The question remains, why people don’t give way to ambulance? It would be a complete injustice to say that people simply don’t bother, cause number of citizens do care for “right of way”. Whatever the reason maybe lives remain endanger unless we learn to give way to the emergency vehicle.
Following steps are recommended to improve level of awareness in public.
WHAT GOVERNMENT CAN DO?
Government has most power and most resources in this regard, though some restraints may hold them for putting all the plans into actions it still can do a lot of things to meliorate the situation of traffic in general and ambulance in particular. However, red-tapism and procedural delays make it difficult to improve the scenario promptly.
- Dedicated Traffic Lanes: To avoid all the hassle in the first place, it is advised to make dedicated lanes for the ambulances and emergency vehicles, this proposal is simple to implement on highways and motorways imminently; conversely, its challenging to do the same in the cities. It’s difficult to do the same in densely populated cities and roads bulging with traffic, nevertheless where there is will there is way.
- Traffic Laws: The first recommendation in this regard is simply an iteration of a general pleading. Implement the rules, traffic rules if followed with true spirit; can be extremely beneficial in many ways e.g. avoiding accidents chiefly, smooth flow of traffic etc.
- Traffic Officer with an ambulance: If viable, a traffic warden may accompany ambulance in emergency just like it happens in VIP Protocols. An officer on motorcycle might drive in front of vehicle to get the way.
- Traffic Laws for Ambulance: As per a press release, “there are no legal provisions or administrative arrangements that would make it compulsory for drivers to get out of the way of an ambulance on an emergency run” (Khatri, 2016). Make it a law to give way to an ambulance and make public aware of this law. Make it a vital stipulation for drivers to learn rules to obtain driving license.
- Frequency Siren: Ambulance network can be interconnected with traffic department; frequency signals can be transmitted through radio to vacate the road before ambulance approaches the next signal on its way.
- Advanced Technology: Advanced technology can be adopted to assist smooth flow of traffic and ambulance. Such systems can be borrowed from developed nations or can be devised and tested in Pakistan. For example, Germany is using highly sophisticated system to regulate traffic and avoiding accidents at Autobahn even when there is no speed limit. Encourage teletraffic and civil engineers to devise new systems etc.
- Penalties: Carrots and stick approach is essential to obtain the desired results. Rule breakers must be imposed monetary fines or when found deliberately hindering the way ambulance cancel the driving license. It may seem severe, but desperate situation needs desperate measures.
- Part of Curriculum: Include traffic laws, particularly rules regarding ambulances and emergency vehicles in primary and secondary school curriculum. It’s easy to teach the minds of young and shape constructive behaviors.
WHAT PHILANTHROPISTS CAN DO?
Welfare organizations and foundations have done much work for the prosperity of humanity in Pakistan. The largest network of ambulance in the world is in Pakistan, thanks to Edhi foundation. There are many such organizations and philanthropic wings of corporate sectors that can help in spreading awareness. Government can do the same either alone or in collaboration with such organizations.
Full fledge campaigns are advised e.g. from TVCs to print advertisement, billboards to pamphlets, social media talks to seminars in school, colleges and universities. The aim should be one, teach the importance of giving way and how it should it be given. Various techniques and maneuvers can be employed in such campaigns. “La Paz’s cebritas program” can serve as a precedent, volunteers appareled in zebra costumes, direct the traffic in Bolivia, to improve traffic sense in citizens (Ajplus, 2017; Henderson, 2017). Interesting, attractive, creative, emotional, statistical all sort of appeals should be made to teach the right of way to masses. TVC may cast celebrities as celebrity endorsements are more impactful (Ahmed, Seedani, Ahuja, & Paryani, 2015; Gupta, 2007), better story, better appeal, better execution and marketing etc. will make it work.
WHAT AN INDIVIDUAL CAN DO?
On Individual level we all should make an effort to learn the rules regarding ambulances and emergency vehicles, whether we drive or not, whether we travel in public transport or private. The laws are simple enough to be learned by anyone.
- Move to Left: It’s as simple as, move to left. Yes, that’s it. Move to left vacate the right most lane for the ambulance. Do not wait for the ambulance to approach your head, start making way as soon as you hear the siren.
- Stop the Traffic: Traffic must stop for a while, wait on the left side till the ambulance slides by. Don’t hasten to be on left, move steadily clearing the way for ambulance. Avoid frenzy, do not cause more people to be in the ambulance while making way for one.
- Do Not Park on Roads: Do not park on roadsides. It constricts the lanes causing traffic blockage which obstructs the passageway of ambulance even when other automobilists try to cooperate.
- Break the Signal: Ambulance drivers have liberty to break the signal and drive in the wrong lane. All motorists should be aware of this privilege even motorists are allowed to jump up the red signal if and only if an ambulance is behind, waiting for you to clear the way. However, instead of going straight thru the red light in front of it, drag to the right into the crossroad seeing that you do not intervene with traffic coming in.
- Respect the Ambulance Drivers: There have been many cases where ambulance drivers or paramedics have been mistreated by public or the relatives of victim (Khatri, 2016). Control your frantic emotions, they are helpers, do not abuse them. They deserve appreciation and respect, not abusive language and harassment.
- Teach Others: Learn these rules by heart and follow them, teach them to others in pleasant way whenever possible. If you are not driving yourself ask the driver to pull at left side, if you are in public transport urge the driver to make way for the ambulance. Use social media for spreading awareness or whatever medium you like, collaborate with friends and community, do volunteer work to help organizations, government and traffic departments in this movement. Use your pen, your camera, whatever skill you have, every single person can make a difference.
I don’t trust a human is stone-hearted that it wouldn’t let an ambulance pass, I contemplate that we never understood what ambulance actually is. We never emphasized that a minute or two means entirety to the riders of an ambulance, we never inferred that a minute is of no significance to us but for some injured a minute means hope, hope of being saved, hope to be rescued. With proper guidance and education and facilities of course, we will learn to give way to all emergency vehicles may it be an ambulance, fire brigade or bomb disposal squad etc. Someone might in midst of flames is waiting to be saved, think about misery of being burnt alive, think of misery of waiting for death on roadside with critical injuries causing severe pain. Give way to an emergency vehicle some of your loved one might be in it and you may cause them to die unintentionally, give way to emergency vehicle it might be on its way to rescue your dear one who is in agony, somewhere in eye of a misfortune incident. And give way even when you are sure your loved ones are safe and secure, it’s your moral obligation, you will not save one life you’ll save families, you’ll save a mother form the ache of losing her son, you will save children from being orphan, you will save a woman form being a widow, you will save a sister’s brother, you will save a father, a mother, a sister, a brother, a wife, a husband, a friend, you’ll save as many relations you may think of. Do it for others and others will do it for you, save someone’s loved one and your loved one might be saved as well. Above all remember
“And whoever saves one – it is as if he had saved mankind entirely”
Zufishan Ahmad took third position in the ICRC’s essay writing competition.