In 2022, India recorded 461,312 road accidents, resulting in 168,491 fatalities and leaving 443,366 people injured, marking notable increases of 11.9%, 9.4%, and 15.3% respectively compared to the previous year. This alarming rise—translating to one crash every 68 seconds and a death every three minutes—underscores the critical urgency of implementing robust, fast, and well-coordinated emergency medical care systems for accident victims across the country (MoRTH, 2022). The same report also paints a grim picture of the situation in Tamil Nadu, with the state recording the highest number of road accidents (64,105 accidents - 13.9% of all road accidents recorded in India) and 17,884 fatalities (10.6% of all road fatalities recorded in India). India is responsible for 13% of total road crashes all over the world, highlighting the country’s significant challenges in addressing its road safety record.
India has not remained passive in the face of its road fatality crisis. In recent years, the country has progressively rolled out a series of initiatives to strengthen road safety and reduce preventable deaths. These efforts range from stricter enforcement of traffic laws—including higher penalties for violations—to mandatory use of helmets and seat belts, sustained public awareness campaigns, improved data collection, comprehensive road safety action plans, and the upgrading of critical road infrastructure. While these measures focus primarily on prevention, ensuring timely and effective emergency medical care is equally vital once a crash occurs. This is where the concept of the ‘golden hour’ becomes crucial—the critical first hour following a traumatic injury, during which prompt medical intervention can significantly improve the chances of survival and minimize long-term harm.
A road crash can occur anywhere—not just in urban or residential areas where medical care is more accessible. Accidents on remote roads or highways, far from hospitals or trauma centres, can significantly strain emergency response times. The high-impact nature of such crashes often leads to complex, multi-system injuries that demand advanced skills and training from first responders. Moreover, the anonymity of many crash victims means that emergency care systems must be designed to provide equitable, life-saving treatment to all—regardless of a person’s ability to pay.
Building on this need for accessible and equitable emergency care, Tamil Nadu has long been a pioneer in delivering inclusive health services. Schemes like Makalai Thedi Maruthuvam and the state’s extensive network of Primary Health Centres have set national benchmarks in reaching underserved populations. Extending this commitment to emergency care, initiatives such as the 108 ambulance service and the Innuyir Kappom scheme aim to reduce preventable deaths by ensuring timely medical response and offering financial protection to accident victims—regardless of their socio-economic background or location.
Life saving schemes
In 2009, Tamil Nadu launched the Chief Minister Comprehensive Health Insurance Scheme (CMCHIS) to reduce the financial burden on economically disadvantaged families, should they face unexpected medical care. This initiative offers cashless hospitalization for certain procedures, covering up to ₹5 lakh per family each year.
To cater specifically to the needs of road accident victims, in 2021, the Tamil Nadu government also introduced the Innuyir Kappom - Nammai Kakkum 48 scheme. Under the provisions of this scheme, all road accident victims are provided free emergency treatment for the first 48 hours following a crash. The scheme has enlisted nearly 609 hospitals across the state, including 405 private facilities, significantly expanding access to trauma care. By eliminating cost-related delays and facilitating timely treatment during the golden hour, the scheme holds immense potential to improve survival rates and reduce long-term disability.
Building on similar principles at the national level, the central government recently introduced the Cashless Treatment of Road Accident Victims Scheme, 2025, which offers cashless treatment of up to ₹1.5 lakh per individual per accident, aiming to standardize and strengthen emergency care across India.
Life saving response times
Rapid access to emergency care is essential for saving lives, and conversely, delays in response time can lead to significant complications that could even result in death.
In 2008, the TN government introduced a free, 24/7 emergency medical transportation system via the 108 number. In the years since its inception, the service has grown significantly in fleet size, coverage and efficiency. Ambulances are equipped with basic life support units as well as advanced life support with ventilators. The fleet also includes neonatal ambulances for high risk infants. To further improve access, bike ambulances were introduced in 2016 for use in congested urban areas.
Over the years, Tamil Nadu has also improved the average response time of its ambulances, from 18:09 minutes in 2017 to 14:48 minutes in 2021. Data gathering such as the mapping of road accidents hotspots has helped achieve this, with more ambulances being stationed in accident prone areas.
Life saving law
The Good Samaritan Law was introduced in 2016 to reduce the widespread reluctance among bystanders to assist victims of road accidents and other emergencies, a hesitation rooted in fear of harassment by the police, and long legal procedures. The law is designed to protect those who come forward to provide assistance to road accident victims, by granting several specific rights and immunities to the person offering assistance namely:
- They are not liable for any civil or criminal consequences of their actions
- They can leave the hospital immediately after bringing the victim
- They are not obligated to provide personal details
- They cannot be compelled to pay for the victim’s treatment
- Hospitals are required to acknowledge their assistance.
- They should be suitably rewarded to encourage other citizens and so on.
Awareness of the Good Samaritan Law is crucial, as timely assistance during the ‘golden hour’ often depends on the willingness of bystanders to intervene. However, a staggering three out of four people nationwide remain hesitant to help road accident victims—largely due to a lack of awareness about their legal protections and lingering fears of police harassment or legal complications. A survey in Chennai identified that only 7% of respondents were aware of the law. This highlights an urgent need for targeted public awareness campaigns to build trust, dispel misconceptions, and empower citizens to act without fear when every second counts.
Progress Made, But Gaps Remain
While these advances are not insignificant, there is still room for improvement as captured in the TN State Health Policy Vision 2030 report. The report indicates a high inter-facility transfer rate of 41% suggesting that many patients are initially taken to hospitals that cannot provide full emergency care, requiring them to be shifted later and therefore costing crucial hours; inconsistent triage practices in both pre-hospital and hospital settings that do not consistently reflect standard protocols; and the absence of a trauma registry hampering effective data collection and management.
A study conducted by NITI Ayog across India (in 2018 ) shows that, even though 91% of hospitals have an in house ambulance service, only 34% of the ambulances have trained paramedics. In addition, 82% of the hospitals surveyed did not have a pre-hospital arrival notification system. This study also revealed the need for a National Emergency Department Information Systems (EDIS) to continuously monitor and collect data related to emergency and trauma care, thus helping to measure initiative outcomes, inform future research and lead to more scientific interventions.
Further advances can be made by addressing disparities. Rural areas are still facing long ambulance wait times due to remoteness, road conditions, and a lack of awareness among the rural population about emergency services. This needs to be addressed via policies and education.
Conclusion
Tamil Nadu has created a multi-layered, responsive, and largely free emergency care infrastructure that offers valuable lessons to other Indian states. Unfortunately, it also has some of the highest road accident and fatality rates. However, with consistent investment in quality improvements, better coordination between first responders and hospitals, and stronger protocols Tamil Nadu can close the remaining gaps in its system and set a new national benchmark for equitable, timely, and life-saving trauma care.
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