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Where There Are No Emergency Medical Services—Prehospital Care for the Injured in Mumbai, India

  • Nobhojit Roy (a1), V. Murlidhar (a2), Ritam Chowdhury (a2) (a3), Sandeep B. Patil (a2) (a4), Priyanka A. Supe (a2) (a3), Poonam D. Vaishnav (a2) (a3) and Arvind Vatkar (a2) (a3)...



In a populous city like Mumbai, which lacks an organized pre-hospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai.


A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July–August 2005) at a Level-I, urban, trauma center.


The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0 .41) and those who came by taxi (OR = 0.54).


Currently, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries and the insufficient evidence that prehospital field interventions by the EMS actually have improved outcomes, Mumbai must proceed with caution when implementing advanced EMS systems into its congested urban traffic. Similar cities, such as Mexico City and Jakarta, have had limited success with implementing EMS systems. Perhaps reinforcing the existing network of informal providers of taxi drivers and police and with training, funding quick transport with taxes on roads and automobile fuels and regulating the private ambulance providers, could be more cost-effective in a culture in which sharing and helping others is not just desirable, but is necessary for overall economic survival.


Corresponding author

Jamshedji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Deonar, Mumbai, 400088 India E-mail:


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1.Mock, CN, Jurkovich, GJ, nii-Amon-Kotei, D, Arreola-Risa, C, Maier, RV: Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development. J Trauma 1998;44(5):804812; discussion 812-814.
2.Ali, J, Adam, R, Stedman, M, Howard, M, Williams, JI: Advanced trauma life support program increases emergency room application of trauma resuscitative procedures in a developing country. J Trauma 1994;36(3):391394.
3.Ali, J, Adam, RU, Gana, TJ, Williams, JI: Trauma patient outcome after the prehospital trauma life support program. J Trauma 1997;42(6):10181021;discussion 1021-1022.
4.Marson, AC, Thomson, JC: The influence of prehospital trauma care on motor vehicle crash mortality. J Trauma 2001;50(5):917920; discussion 920-921.
5.Mock, CN, Denno, D, Adzotor, ES: Paediatric trauma in the rural developing world: low cost measures to improve outcome. Injury 1993;24(5):291296.
6.Pitt, E, Pusponegoro, A: Prehospital care in Indonesia. Emerg Med J 2005;22(2):144147.
7.Roberts, I, Li, L, Barker, M: Trends in intentional injury deaths in children and teenagers (1980-1995). J Public Health Med 1998;20(4):463466.
8.Nantulya, VM, Reich, MR: The neglected epidemic: Road traffic injuries in developing countries. BMJ 2002;324(7346):11391141.
9.Rafei, UM: Role of Private Hospitals in Health Care, in Regional Health Forum WHO South-East Asia Region. WHO-SEARO, 2006.
10.Kwan, I, Bunn, F, Roberts, I: Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2003;3:CD002245.
11.Kwan, I., Bunn, F, Roberts, I: Spinal immobilisation for trauma patients. Cochrane Database Syst Rev 2001;2:CD002803.
12.The list. Available at Accessed 08 March 2010.
13.Cropper, M, Bhattacharya, S: Public Transport Subsidies and Affordability in Mumbai, India. World Bank Policy Research Working Paper Series, 2007.
14.Murlidhar, V, Roy, N: Measuring trauma outcomes in India: An analysis based on TRISS methodology in a Mumbai university hospital. Injury 2004;35(4):386390.
15.Mohan, D: Road safety in less-motorized environments: Future concerns. Int J Epidemiol 2002;31(3):527532.
16.The British Broadcasting Corporation: Mumbai's valued railway lifeline 2006. Available at Accessed 06 April 2009.
17.Joshipura, MK, Shah, HS, Patel, RP, Divatia, PA, Desai PM.: Trauma care systems in India. Injury 2003;34(9):686692.
18.Gumber, A: Burden of Injury in India—Utilization and expenditure pattern. Available at Accessed 05 April 2009.
19.Parmar, HR: Private intensive care units in Mumbai. Indian Journal of Medical Ethics 1999;7(2):1.
20.Stout, JL: The EMS subsidy/price tradeoff. JEMS 1988;13(8):7476.
21.Colohan, AR, Alves, WM, Gross, CR, Torner, JC, Mehta, VS, Tandon, PN, Jane, JA: Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 1989;71(2):202207.
22.Callaham, M: Quantifying the scanty science of prehospital emergency care. Ann Emerg Med 1997;30(6):785790.
23.Eastman, BA: Strengthening Prehospital and Emergency Trauma Care Systems. In: National Consultation on Human Capacity Building in Emergency, Trauma & Disaster Management. Pune: Maharashtra, 2009.
24.Jayaraman, S, Sethi, D: Advanced trauma life support training for ambulance crews. Cochrane Database Syst Rev 2001;2:CD003109.
25.Soberon, G, Frenk, J, Sepulveda, J: The health care reform in Mexico: Before and after the 1985 earthquakes. Am J Public Health 1986;76(6):673680.
26.Mock, CN, Forjuoh, SN, Rivara, FP: Epidemiology of transport-related injuries in Ghana. Accid Anal Prev 1999;31(4):359370.
27.Peralta, LM: The prehospital emergency care system in Mexico City: A system's performance evaluation. Prehosp Disaster Med 2006;21(Suppl 2):104111.
28.Devadasan, N, Ranson, K, Van Damme, W, Acharya, A, Crielet, B: The landscape of community health insurance in India: An overview based on 10 case studies. Health Policy 2006;78(2-3):224234.


Where There Are No Emergency Medical Services—Prehospital Care for the Injured in Mumbai, India

  • Nobhojit Roy (a1), V. Murlidhar (a2), Ritam Chowdhury (a2) (a3), Sandeep B. Patil (a2) (a4), Priyanka A. Supe (a2) (a3), Poonam D. Vaishnav (a2) (a3) and Arvind Vatkar (a2) (a3)...


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