Medical care on India’s trains is running late, with passengers at risk | Explained Premium

The Indian Railways must address medical emergencies for its high passenger throughput, but current provisions are inadequate. Importantly, the medical kits onboard many moving trains still contain items defined by a 1995 standard, rather than the latest 2017 standard.

The Indian Railways transports more than 2.3 crore passengers daily – roughly twice the projected population of Uttarakhand state in 2022. Catering to the health needs of this population is its responsibility. The Balasore train accident in June 2023 raised important concerns about rail safety, but it was largely about accident-related safety.

Because of its high passenger throughput, there is another kind of safety the Railways is responsible for but which is often overlooked: medical emergencies.

In 2017, 1,076 medical emergencies were reported at the Katpadi Junction railway station in Vellore, Tamil Nadu. A quarter of these emergencies were trauma-related; the remaining ranged from minor ailments like fever to life-threatening conditions like low blood sugar. Nearly 1 in every 10 emergencies reported at the station’s emergency help desk, operated by Christian Medical College (CMC) Vellore, required urgent, life-saving intervention.

Non-communicable diseases like diabetes and hypertension are on the rise in India. In the last few years, the number of deaths due to heart attacks has also risen sharply. Is the Indian Railways prepared to handle medical emergencies that result?

Medical care provision in Indian Railways has evolved to address emergency medical conditions, not accident-related emergencies alone. In 1995, a ‘Special first aid box’ was provided in long-distance superfast trains, Shatabdi and Rajdhani trains. This box consisted of 49 items and was to be used by a doctor travelling on the train. An improved version of this kit, called the ‘Augmented first aid box’, containing 58 items was provided for specific long-distance trains.

In November 1996, as part of a pilot project, Railways stationed a medical team in two long-distance trains. This team consisted of a medical officer, a male nurse, and an attendant. In the next four years, however, the Railways found the team was mostly idle, with the doctor attending only to minor ailments. Only four critically ill passengers were recorded in this time, and none survived due to lack of adequate resources in the (moving) train. The Railways subsequently discontinued the service – but to make healthcare accessible, it decided to give doctors travelling on trains a 10% discount if they were willing to provide medical services en route.

These medical provisions were found to be inadequate, however, when they failed to save the life of Netrapal Singh, the Chief Legal Assistant of Railways, who succumbed to a heart attack while travelling from Jaipur to Kota in February 2004.