Are Train Passengers Safe? Examining Medical Care and Safety Mechanisms on Indian Railways

G AnanthakrishnanWhen an unoccupied middle berth on Chennai-Palakkad Express fell on a woman sleeping in the lower berth near Morappur in May this year, public attention focused on two things — the safety of the L clamp-type middle berth mechanism found in older ICF-design coaches, and the availability of efficacious emergency medical care on trains and in railway stations.

Given the state of public infrastructure, it is unsurprising that the first reaction of the Railway was to blame the passenger for failing to secure the middle berth properly. But as many travellers know, the L clamp lock mechanism often fails to fit into the slot under the berth properly on both ends, one of them often left dangling. A swaying train could dislodge it in a flash.Suria Murugan, the 39-year old woman who was injured by the falling berth complained that she got no first aid worth the name on the train, and was unwilling to alight at Morappur at night as she and her family had no idea of what facilities were available.

She exited the train at Salem an hour after suffering a bleeding head injury, and was taken to a govt hospital. She then opted to go to a private hospital.A year earlier, in June 2024, Ali Khan, 60, from Kerala died after a middle berth in the Millennium Express bound for New Delhi fell on him in Warangal district. Here too, the Railway said the middle berth had not been secured properly.The Railway Board told this writer in response to RTI petitions that upgraded first-aid kits, now called Medical Boxes as per AIIMS specifications, are to be made available in all trains carrying passengers and at all Railway Stations. This is in compliance with Supreme Court orders in Ram Dutt Sharma vs Union of India, 2006. A perusal of the Board’s order of March 2018 indicates that the designated medical box, containing the medical articles necessary to arrest bleeding, may not have been available on the Chennai-Palakkad Express, or at Morappur, or was not offered.

Southern Railway ordered inspection of L-clamp and eye-type locking mechanism for berths in all sleeper coaches of ICF design on May 12, the day of the Salem incident, and on May 17, extended it to AC coaches of ICF and LHB design. The review deadline ended May 26.What the Supreme Court wanted the Railways to tell passengers was that the medical boxes contain life-saving drugs and equipment among a total of 88 items, including a defibrillator with four pads and drugs for cardiac events (isosorbide nitrate), breathing difficulty (deriphyllin and portable oxygen), childbirth (drotaverine), blood pressure control (furosemide and amlodipine), poisoning (atropine), a local anaesthetic (xylocaine), pain management (ibuprofen, diclofenac, paracetamol), anxiety (diazepam), IV sets, and ambu bags.A defibrillator was seen recently at the Moore Market Complex building of Southern Railway in Chennai, although it is not clear whether sufficient numbers of qualified personnel are available with the necessary training for emergency response. There are anecdotal instances of passengers suffering a heart attack on a running train with no definite protocol followed by travelling ticket examiners or emergency helplines, leading to death.One of the interventions suggested by the Railway Board is the opening of an Emergency Medical Room (EMR) run by medical professional groups on the Central Railway Model, at each station and round the clock, under contractual agreement.A sample agreement in reply to the RTI petition for Vadala Road station in Mumbai showed that EMR facilities can serve passengers as well as nearby communities, especially in rural areas.

For a license fee of `2,300 a month, a qualified doctor with emergency drugs is stationed there. For treatments provided, the licensee is compensated at Central Govt Health Scheme rates in the case of passengers.To keep EMRs viable, their scope may need to go beyond railway passengers to serve nearby communities lacking emergency care. While agreements focus on rail accidents, EMRs could handle any emergency — heart attack, stroke, fever, poisoning, trauma, even a middle berth falling on a passenger.

Train service personnel may also require medical help.Supreme Court’s intent in ordering the publicising of medical facilities available to passengers has not been given due importance. Among the directions was to allocate a coupe of four berths in long distance trains marked medical facilities, with a Red Cross symbol outside and offering services of a medical officer, a male nurse and an attendant, posted on rotation basis.Travellers should be sensitised, the court said, through station displays, TV radio and other media. One aspect of the order, on opening a dispensing unit for medicines in stations (often run commercially), is increasingly visible. Where EMRs have been opened, it should be made clear through notices that the facility is free for passengers holding tickets.The Railways told the court in their arguments that a trial conducted on Rajdhani Express and Vaishali Express showed underutilisation of medical personnel after which the facility was discontinued.

Introducing fully resourced EMRs in all stations with life-saving training for paramedics and ambulance support could make them viable, rather than leaving the court’s order half-implemented.The IRCTC said in reply to a question under RTI, that where a passenger holding insurance purchased along with ticket (which costs less than a rupee and offers nomination facility) is involved in an accident on the journey, “If the cause of accident is confirmed to be within the purview of optional travel insurance policy issued, the insured can take treatment in any of the hospitals of his choice”.It says that the requirement of documents will remain the same as for any claim lodged under optional travel insurance: original treatment papers, bills, receipts and other reports confirming injuries. For accidental deaths, investigation, FIR and post-mortem reports are also needed.But this does not make clear whether the treatment is available in cashless mode, as it should be. Asked whether the middle berths on the Vande Bharat sleeper trains will be of a different design, and safer, ICF said, “Vande Bharat sleeper prototype is currently under validation and evaluation stage only.”(The writers is a Chennai-based journalist)Email your feedback to [email protected]