After the crash: The race to care

Every Bengalurean has seen it, out of the corner of the eye, on a daily walk or commute. As we squeeze past, we glimpse a concerned crowd and an overturned two-wheeler: the scene of an accident. Somewhere there is an injured driver and/or a pedestrian in urgent need of help. We can only wonder what happened next – in the following hour, the next day, or, for that matter, for the rest of their lives.

To piece together this untold story of life after traumatic brain injury, the National Institute of Mental Health and Neurosciences (NIMHANS) recently conducted a comprehensive study of 1,500 brain trauma cases treated in 2025. The data reveal the depth of a public health crisis while also pointing the way towards innovative solutions.

Road accidents account for the lion’s share of brain injury cases treated at NIMHANS (65%). They occur almost equally on urban or rural roads, and nearly all (80%) involve two-wheelers. Eight out of 10 patients are men, and almost all come from households below the poverty line. 

The alarming truth is that medical care reaches accident victims far too slowly. On average, an injured patient travels five kilometres to reach any form of care—often long enough to lose what is known as the “golden hour” after injury, the most critical period for medical intervention. Only four of ten victims reach their first point of medical care by ambulance; almost all the rest travel in private or hired vehicles.

This first stop is rarely the end of the journey. Many hospitals lack the resources for trauma response or surgery or are unwilling to admit road trauma cases. Almost all patients who eventually reach the specialised facilities at NIMHANS have made not one but two or more transfers, losing precious time along the way. Nearly 20% require surgery at NIMHANS, where any delay can have grave consequences.

The most tragic finding of the study concerns long-run outcomes. Nine out of ten patients who reach NIMHANS survive. But the study showed that, among the survivors, more than half are unable to return to work even after three months, cutting off the sole income in households that are already poor. 

How can we do better? Some solutions lie squarely within our control. Helmet use remains worryingly low: only 23% of two-wheeler riders involved in accidents were wearing a helmet, and another 33% wore “half helmets” that offer little
or no protection. Proper helmet use remains the single simplest way to prevent these life-altering injuries. 

Bystanders, too, can save lives. The moments immediately after an accident are, by all expert accounts, the most crucial. Small actions make an enormous difference; even minutes can save lives. The “Good Samaritan”
law, which protects bystanders who provide medical assistance, is an important step, but it needs far wider publicity. The question is how bystanders can be
supported.

One clear need is for critical care ambulances, staffed with trained personnel, to be stationed near accident hotspots identified in the study. Bengaluru’s flagship IT companies may be well placed to step up to this community welfare challenge. Digital connectivity, combined with real-time data, could allow such services to be targeted precisely and effectively.

In the hospital system, much more could be done to ensure that accident victims receive the care they need in a timely fashion. It is an extraordinary tragedy for accident victims to lose their “golden hour” and chance for healthy survival in travelling to a hospital that cannot provide the required trauma care. In the long run, we need more and better trauma networks and stronger pre-hospital emergency systems. Even with the resources we currently have, we need to educate ambulance drivers and the general public about which hospitals have adequate facilities for frontline trauma care. Most importantly, the Government needs to step in and impose a trauma care admission requirement on a network of hospitals, with the reasonable costs taken by the Government for the critical period of intervention. This will also encourage Good Samaritans to do the right thing. 

For too long, we have let this crisis unfold before our eyes without serious or systematic investigation. This is a crisis of lifelong disability, broken families, and lost futures. Together, through steps small and large, we can try to do something about it. Bangalore intends to be a model city; the best way to show this is to develop a model trauma care network that makes the roads safe for its citizens and offers them a chance for survival, rather than living in constant fear of the roads.

(Dwarakanath is a professor of neurosurgery at NIMHANS, Bengaluru, and Anilkumar is a professor of mechanical and aerospace engineering at Vanderbilt University, US)