Shakari R had to take a private bus from Chennai to Bengaluru on a Saturday night. While she was on her way to the bus terminus along with her friend in a two-wheeler, they met with an accident on a road near Koyambedu market and bus stand.
“There was a big pothole on the road and it was not visible in the dark,” she says.
As soon as they fell from the bike, people gathered around them to help. But, no one was aware of where to go when such a medical emergency occurs at the Koyambedu bus stand.
Shankari ended up taking an auto to a private hospital nearby.
The Puratchi Thalaivar Dr M.G.R. Bus Terminus/ Chennai Mofussil Bus Terminus (CMBT) in Koyambedu is not only the hub for the MTC and State transport bus services but also the private buses plying to other districts and the Chennai Metro Rail service that connects to other parts of the city.
Being such an important multi-model transport hub that has a footfall of over one lakh people every day, it is vital to assess how equipped the bus terminus is with respect to handling medical emergencies.
Available medical emergency facilities in Chennai’s Koyambedu bus stand
Little did Shankari, her friend, or the people around them know that there is a ‘Free Emergency Care Centre on the premises of CMBT run by Apollo Hospitals that is close to the private bus stand.
According to the staff at the emergency centre, the centre has been operational for almost two decades now, long before such centres were established in Chennai Central and Egmore railway stations. Notably, the centre also has a pharmacy attached to it. This centre is not only the only medical emergency facility available for the MTC, state transport and private bus users including the drivers and conductors, but also for those vendors and the public who use the Koyambedu Market.
Dr J Ajay, one of the three doctors at the centre, says that the Emergency Care Centre in CMBT deals only with emergency care for health issues related to heart, lungs, respiratory issues and certain neurological issues in addition to providing first-aid to other trauma cases. The centre is also equipped with oxygen cylinders and other such emergency equipment needed for the treatment.
There are as many as 10 staff including three doctors and seven paramedical staff. This includes the three staff at the feeding centre on the campus of the bus terminus. Further, a 108 ambulance is also stationed near the Emergency Care Centre to take the patients to the referral hospitals.
Though there is no battery-operated ambulance stationed at the centre to transport the patients from within the Koyambedu bus stand to the medical emergency care centre like the ones in Chennai Central and Egmore railway station, staff at the emergency care centre say that the security guards at the bus terminus campus usually alert the centre when there is any medical emergency and use the wheelchairs in the campus to bring the patients to the centre.
Notably, unlike the medical emergency centres in the railway stations mentioned above that have a helpline number to reach out to the paramedical staff, the centre at the CMBT campus does not have a dedicated helpline number.
Challenges in handling medical emergency cases in Koyambedu bus stand
The footfall at the emergency care centre depends on the footfall at the bus terminus.
“We will start receiving more cases a week before any festivals or holidays in general. Otherwise, on average we receive 30 to 40 cases. Of these, five to six cases will be emergency cases like cardiac issues, trauma, renal stone issues and abdominal problems. Many patients who travel by bus tend to come with complaints of vomiting. Vomiting once or twice during travel is not a problem but vomiting 10 or 15 times becomes a medical emergency,” explains Dr Ajay.
From his experience, he observes that they have not received many cardiac cases in recent times. “There have been only three instances of death, all due to critical cardiac cases, in the past six months. In recent times, we have been receiving only seasonal conditions. Paediatric age group patients with fever and other seasons conditions are more these days,” he notes.
Focus needed on the health issues of the drivers and conductors
Apart from the passengers, the Emergency Care Centre is of great help to the drivers, conductors, and other such staff at the transport department.
Sharing his observations on treating the transport staff, Dr Ajay says that the drivers and conductors are overworked.
Even when they have chest pain, they tend to drive the bus. Since they are sitting near the engine of the bus throughout the day, they end up getting heat boils and skin infections in the body. Many conductors also have conditions of Varicose veins. Most of the government drivers and conductors also have hypertension and diabetes.
“The problem with them is that they neither take the food nor the medicines properly on time. They neither come for follow-up medical check-ups even if we insist,” he observes.
Commenting on this, Kumar*, an MTC bus driver notes that there are no toilets exclusively for the staff at the bus stand campus. They neither have drinking water facilities nor a room to rest in between their travel.
“If I must report to duty for an 8-hour shift at 4 am, I will have to start from my house in Kannagi Nagar as early as 2 am. How can I break my fast that early? Besides, during the shift, we keep driving the bus and there will be no time to have the food or medicines on time. It is just the nature of our job,” he says.
Kumar has gone to the Emergency Care Centre multiple times for complaints of hypertension.
“The blood pressure shoots up occasionally due to work pressure and insufficient sleep. I get back to work after getting treated at the emergency centre at the CMBT bus stand,” he says.
He, along with other staff, also sought the government to ensure basic amenities and to conduct monthly medical camps for the transport department staff.
Other factors contributing to medical emergencies in Koyambedu bus stand
Kavya, an IT employee who works in Chennai, reached the Puratchi Thalaivar Dr M.G.R. Bus Terminus at 3 am from her hometown on a Monday. She was waiting for her cab for more than 30 minutes at the bus terminus.
“I felt very unsafe to wait at the bus stand. A couple of drunk men kept watching me and were also following me. I kept moving and finally reached the police station. Only then they went away,” she says.
She also notes, unlike daytime, the bus stand looks more unsafe during the night as many people are seen sleeping on the walkway. “I was scared even to walk near those who were sleeping,” she says.
According to security personnel at the bus stand, the people who work in the market stay in the hall of the Koyambedu bus stand during the night.
After a daylong of labour at the market, they end up at the wine shop near the private bus stand and get back to the open hall in the Koyambedu bus stand to rest during the night.
Dr Ajay says, “We get many trauma cases with severe injuries during the evenings. Most of these are trauma cases with multiple injuries. There have also been instances of assault due to drunken brawls and assault during robbery during the night times. In such cases, we will provide first aid, inform the nearby police station, and refer the patients to a government hospital.”
He also adds that the wineshop near the bus stand was a major cause of such trauma-related injuries.
Scope for improvement in emergency response
The problem in dealing with the people who stay inside the Koyambedu bus stand campus (with respect to medical care) is that they come to the Emergency Care Centre even for non-emergency cases.
“We cannot refer a normal asthma patient to a different hospital in an ambulance. We can only give them first aid and ask them to go to a hospital on their own. But there have been instances where the same patient comes thrice a day with the same complaint,” says Dr Ajay.
At a time when the government planning to set up a new bus stand at Kilambakkam aiming to decongest the city traffic, it is also important for the government to ensure the bus stands, both Koyambedu and Kilambakkam, are well-equipped to handle the medical emergencies. At the same time, it is also important to address some of the important social issues caused by the existence of a TASMAC near the Koyambedu bus stands that leads to medical emergencies.
- Improve awareness about the existing medical emergency facilities as not many are aware of it
- Introduce a helpline number to reach out to the Emergency Care Centre
- Conduct monthly health camps for the transport staff (both MTC and state transport stand)
- Shut down the wine shop
- Ensure safety in the bus stand campus
What bystanders can do in case of medical emergencies
“Irrespective of what is the next best available medical facility be it the availability of a clinic or an ambulance, the critical first few minutes influence the patient’s survival. It can be an emergency as simple as someone having a fall or a cardiac arrest. There is a scope for the layperson, who is around the patient when they face such an emergency, to do the right few things that will have a major impact on their survival. Even if it is not a life-threatening emergency, this immediate response will have an impact on how soon the person can come back to normal,” says Rajesh R Trivedi, the Co-Founder and Managing Trustee of Alert, a not-for-profit organization working to ensure the ‘Right to Life’ a reality in India by bettering the emergency response ecosystem.
“It starts from the ability to read the emergency scene where one knows if the medical emergency of the person suffering is life-threatening or not and how much time they have before the professional help arrives. With that knowledge, they can do a range of help from tying a bandage if someone is bleeding or putting a person in a simple recovery position depending on the case-to-case basis. Any layperson can do this and it does not require a paramedic or a doctor,” adds Rajesh.
Many people have the hesitation of coming forward to help people primarily for two reasons. First is the lack of confidence that arises because of a lack of awareness of the first response. Second, is the inhibition that arises out of fear of dealing with the police or court at a later point in time if something goes wrong.
There is something called a Good Samaritan Law which protects the citizens who come forward with good intentions to help during such emergency situations. It clearly gives total protection from the police, the provisions to not disclose the identity, and free from any civil or criminal liability even if something goes wrong.
Awareness of these laws will help the common person to come forward with more confidence to help those in need of help during medical emergencies. However, it also requires proper awareness of the fundamentals of first responses.
Things to consider during a medical emergency:
Are you dealing with a victim who is conscious or unconscious? A simple way to ascertain this is by tapping the shoulders of the victim and shouting something loud. This will help to see if the persons respond to stimuli of touch or sound. If there is a response from the person, then they are in a less life-threatening situation but you have to be around to keep them engaged.
If someone collapses, the first respondent should check if the person is breathing or not. A quick way to check whether the person is breathing or not is by placing a tissue paper (though unscientific, it is an easy way) near the nose or by placing two fingers near the nose.
If the person is breathing, then the immediate thing to do is to put them in a recovery position In a layperson’s terms, it is to put the person in a sideways sleeping position without a pillow. This is extremely helpful to deal with patients who are breathing but are unconscious. Irrespective of the cause of unconsciousness, the recovery position helps to get the blood to the brain. many a time, when the person is put in a recovery position for five to seven minutes, they will come around immediately.
Another common mistake that we tend to do is to provide the unconscious person with water, soda or juice. If a person is unconscious and is not responding to basic stimuli, do not offer anything to drink (even water). That will only aggravate the situation. When a person is unconscious and is not in a position to swallow their own saliva, it means that the food pipe is closed and the windpipe is open. When we offer water, soda or any such liquid, the chances of it getting into the person’s lungs are more. This is something we all should be completely aware of ‘what not to do’ when a person is unconscious.
Alert also provides a basic program online on first response during medical emergencies every Saturday which is free for anyone to join – https://alert.ngo/savioursaturdays/
They also have youtube videos of some of the basic first responses that we should be aware of – https://youtube.com/playlist?list=PL0IvZh9fuI9ToFWFbDbz849-uCKQAzZ-K