News excerpt:

The Indian Railways transports more than 2.3 crore passengers daily. Catering to the health needs of this population is its responsibility. 

Evolution of medical services in trains In India:

• Medical care provision in Indian Railways has evolved to address emergency medical conditions, not accident-related emergencies alone. 
• In 1995, a ‘Special first aid box’ was provided in long-distance superfast trains, Shatabdi and Rajdhani trains. 
• This box consisted of 49 items and was to be used by a doctor travelling on the train. 
• An improved version of this kit, called the ‘Augmented first aid box’, containing 58 items was provided for specific long-distance trains.
• In 1996, as part of a pilot project, Railways stationed a medical team in two long-distance trains. This team consisted of a medical officer, a male nurse, and an attendant. 
•  
• The Railways subsequently discontinued the service – but to make healthcare accessible, it decided to give doctors travelling on trains a 10% discount if they were willing to provide medical services en route.
• A petition filed in Rajasthan High Court in 1996, to improve medical care provision in trains and railway stations. 
• In a 2005 judgement, the Court found the reason for the underutilisation of the medical team in the pilot phase was a lack of awareness of the service. 
• The Court directed Railways authorities to reserve four berths in long-distance trains to provide medical care and to have a medical team in trains travelling more than 500 km. 
• The Court also directed the authorities to adequately advertise the presence of this medical facility in all train compartments and on platforms.

• The Railways appealed this order in 2006 in the Supreme Court. During hearings, the Railways informed the apex court that a pilot initiative – to have chemist’s stalls at stations and a doctor in nine select stalls, had also failed. 
• Similarly, it had reserved two berths for medical care, but since critically ill patients had to be deboarded for care and the project had a high cost, the Railways stopped doing this as well.

• In 2017, the Supreme Court directed the Railways to set up a committee consisting of experts from the All India Institute of Medical Sciences (AIIMS), New Delhi, to recommend further measures.
  • Based on the Court’s order and the committee’s recommendations, the Railways determined to modify the contents of the first aid boxes and provide them at all railway stations and in all passenger-carrying trains. 
  • It also mandated first-aid training for railway staff at the time of joining and once every three years. The committee also recommended a review of service utilisation every three years.

Present status of medical care in trains in India:

• In 2018, the Minister of State in the Ministry of Railways, said in lok sabha that all recommendations of the AIIMS expert committee had been implemented. 
• In 2021, the Railways also launched an integrated helpline number 139 for all queries concerning the railways, including medical assistance.
• In February 2023, the Union Minister of Railways, said in Lok Sabha that deputing a doctor at every railway station had been deemed unnecessary. Yet in December, he said all recommendations of the committee had been implemented.
• There is also a concern about trains using the 1995’s 48-item list rather than the updated 88-item list from 2017.

Way forward:

• In addition to the items in the list by the AIIMS expert committee, this list should also include more necessary equipment like personal protective equipment for care providers and a pulse oximeter, portable ECG devices and rapid diagnostic kits should be added to identify and treat heart attacks early.
• Railways should ensure the updated 88-item list is in place in all trains and that passengers are aware of these services. 
• Periodic inspections are necessary to maintain the quality of care and railways must install a system to capture data on the healthcare needs of people travelling on trains and use that to inform policy.