India records among the highest numbers of road traffic deaths in the world, and a substantial share of those deaths occur before the person reaches hospital.
Bystanders are almost always first on the scene. What they do, and equally what they avoid doing, changes outcomes considerably.
Your Own Safety First
A rescuer who becomes a casualty helps nobody, and secondary collisions at accident scenes are common.
- Check for oncoming traffic before approaching
- Park safely with hazard lights on, well before the scene
- Set up a warning triangle or ask someone to direct traffic
- Watch for fuel leaks, fire risk and downed electrical cables
- Do not enter a vehicle that is unstable or smoking
- Wear gloves if available, given the blood exposure risk
Only after the scene is reasonably safe should you approach the casualty.
The Good Samaritan Protection
Fear of police involvement and legal harassment is the main reason bystanders in India do not help. That fear is now largely unfounded.
Supreme Court guidelines and subsequent legislation protect bystanders who assist accident victims. A good samaritan cannot be forced to disclose personal details, cannot be compelled to be a witness, and cannot be held liable for the outcome.
Hospitals are required to provide immediate treatment to accident victims regardless of ability to pay, and cannot refuse or delay care pending payment or police formalities.
Knowing this matters, because hesitation costs lives at the roadside.
The Priorities in Order
Assess in a fixed sequence, since the most rapidly fatal problems come first.
- Response: speak loudly and tap the shoulder. Do not shake
- Airway: if unconscious, open the airway using a jaw thrust rather than tilting the head, since the neck may be injured
- Breathing: look, listen and feel for up to ten seconds. If absent, begin CPR
- Circulation: control obvious severe bleeding with firm direct pressure
- Disability: note their level of alertness and whether they can move their limbs
- Exposure: look for other injuries, and keep them warm
Severe external bleeding is the one thing a bystander can definitively fix, and it should be addressed immediately alongside the airway.
Do Not Move the Person Unnecessarily
This is the most common and most damaging mistake at Indian accident scenes. Casualties are routinely dragged into vehicles by their arms and legs.
Spinal injury is common in road trauma, and moving someone incorrectly can convert a recoverable injury into permanent paralysis.
Move them only if there is immediate danger from fire, traffic or fuel, or if the airway cannot be maintained where they are.
If you must move them, support the head and neck in line with the body, use as many people as possible, and move them as a single unit without twisting the spine.
Otherwise, leave them where they are, maintain the airway, control bleeding, and wait for trained help with proper equipment.
Helmets and Motorcyclists
Motorcyclists make up a large proportion of Indian road casualties, and helmet removal is a specific area where bystanders cause harm.
Do not remove a helmet unless the person is not breathing and you cannot manage the airway with it in place, or unless the helmet is causing an obstruction.
If removal is unavoidable, it requires two people: one holding the head and neck steady from below while the other carefully eases the helmet off, spreading it slightly at the sides and tilting it to clear the nose.
A single person pulling a helmet off a casualty is a well recognised cause of additional spinal injury.
The Golden Hour
The first hour after major trauma is when definitive treatment has the greatest effect on survival. Internal bleeding, airway compromise and head injury all progress rapidly during this period.
The practical implication is to prioritise getting the person to an appropriate hospital rather than to the nearest one. A facility with surgical capability, imaging, blood availability and critical care is what a major trauma patient needs.
Call ahead if possible so the hospital can prepare. Our trauma service and polytrauma team mobilise before arrival when notified.
Where an ambulance will take considerably longer than private transport, transport is reasonable, but only with proper attention to the spine and airway.
Information That Helps the Hospital
Details from the scene genuinely change medical decisions, and once you leave, they are lost.
- The mechanism: speed, type of collision, whether the person was thrown or trapped
- Whether a helmet or seatbelt was worn
- Whether the person was ever unconscious, and for how long
- Whether they were talking initially and then deteriorated, which suggests bleeding inside the skull
- Approximate blood loss at the scene
- Time of the accident
- Any known medical conditions or medications, if a relative is present
The pattern of talking and then deteriorating is particularly important, as it points to an expanding intracranial bleed requiring urgent surgery.
Head Injury Warning Signs
Many people involved in accidents walk away and are told to go home. These features require assessment or return to hospital.
- Any period of unconsciousness, however brief
- Repeated vomiting
- Worsening headache
- Confusion, drowsiness or difficulty waking
- Seizure
- Weakness or numbness in any limb
- Unequal pupil sizes
- Clear fluid or blood from the nose or ears
- Slurred speech or visual disturbance
Anyone on blood thinning medication who sustains a head injury, even a minor one, should be assessed regardless of how well they feel, since bleeding can be delayed. Our emergency department assesses head injuries at any hour.
At an accident scene: make it safe, check breathing, control bleeding with firm pressure, do not move the person or remove a helmet unnecessarily, and get them to a hospital equipped for trauma rather than the closest clinic. Legal protection for helping is now clear.
Our emergency department and trauma surgery team at T. Nagar receive trauma patients around the clock.
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