Prehospital care

Introduction

  • Trauma victims are evaluated at the site of injury, stabilised, and rapidly transported to the nearest medical facility by Emergency Medical Services (EMS).

  • Understanding the principles of pre-hospital care, triage, and trauma assessment is essential for effective casualty management.

  • Triage is a decision-making process that prioritises patients based on clinical urgency rather than diagnosis.

Pre-hospital care includes:

  • Organisation
  • Immediate actions and triage
  • Assessment and initial management
  • Extrication and immobilisation
  • Transfer to hospital

Organisation of pre-hospital care

Good Samaritan project

Definition

The Good Samaritan Project is a Kerala Government–supported initiative that protects and encourages bystanders to help road accident victims without fear of legal or police harassment.

Thrissur model of good samaritans

What it is

The Thrissur Model refers to a successful community-based Good Samaritan programme developed in Thrissur, Kerala, centered around a local voluntary organisation called the Accident Care and Transport Service (ACTS).

About acts

  • ACTS (Accident Care and Transport Service) is a voluntary organisation providing free emergency assistance to road accident victims in Thrissur city and district
  • Founded in May 2000 with support from civic leaders and the district administration
  • It has thousands of volunteers and multiple units with ambulances that respond to accidents

Why it’s important

The Supreme Court of India recognised the role of ACTS, and a committee appointed by the Court recommended the Thrissur Model of Good Samaritans as a guide for national Good Samaritan guidelines.

Impact

The model helped shape national Good Samaritan norms that encourage bystanders to help accident victims without fear of legal consequences.

Who is a good samaritan?

Any person who voluntarily and in good faith:

  • Calls 108 ambulance
  • Transports an accident victim to a hospital
  • Informs police or emergency services

Key provisions

  • No civil or criminal liability
  • Identity disclosure is voluntary
  • No compulsory or repeated police questioning
  • Court appearance only if absolutely necessary

Hospital provisions

  • Immediate emergency care must be provided
  • No demand for advance payment
  • Helper cannot be detained for medico-legal formalities

Police provisions

  • Minimal, respectful interaction
  • Statement can be given by phone or at residence

Awards and remuneration

  • Initially, the reward was fixed at Rs 5,000 along with a certificate
  • In April this year, the Centre revised the amount to Rs 25,000 per case
  • National awards of Rs 1 lakh each for 10 Good Samaritans annually

Objectives

  • Promote bystander assistance
  • Reduce delay in trauma care
  • Improve survival during the golden hour

108 emergency ambulance service: kaniv 108

  • 24×7 emergency service for medical, fire, and crime-related emergencies
  • Operated under Public–Private Partnership
  • Free of cost for all Indian citizens
  • Accessed by dialling toll-free number 108

Emergency response centre (ERC)

  • Receives emergency calls
  • Records nature and location of emergency
  • Dispatches ambulance, fire engine, or police assistance
  • Coordinates between dispatch officer, ERC physician, and emergency medical technician

Response time

  • Emergency help dispatched within 8–15 minutes depending on location
  • Pre-hospital care provided during transport

Care inside the ambulance

  • Dead patients and non-emergency cases are not transported
  • Spine board used for drowning, unconscious patients, or suspected spinal injury
  • Rapid head-to-toe examination performed
  • IV access, IV fluids, and oxygen support provided
  • Emergency drugs administered only under ERC physician supervision

Fracture management in ambulance

  • Assess neurovascular status (pulse, movement, sensation distal to injury)
  • Identify and dress external wounds
  • Immediate splinting of fractured limb
  • Rule of splinting: immobilise the joint above and below the fracture
Back to top