Quality pre-hospital emergency care is not available in India, despite it being the most important ingredient of emergency services

Emergency protocols followed in most medical institutes, including top institutes are outdated and no effort has been made to modernize the systems. Most emergency rooms (casualties) in India are nothing but traffic islands where the emergency physician does nothing more than directing incoming patients to different specialties and wards. Trained manpower in terms of Emergency Physicians and Emergency Technicians are a sparse commodity.

Accessibility in an emergency is of paramount importance as a patient is rushed to the nearest medical facility irrespective of the quality of services provided by that facility. Although cost of healthcare often decides the destination of a patient, in an emergency a patient is willing to spend any amount just to save his life. However nobody, not even the rich are prepared to pay a large sum as advance in an emergency. Under these circumstances they tend to stay away from medical facilities which require payment of large sums as advances. 

Society does not digest financial considerations while a patient is in a life and death situation and expects the doctor to proceed with life saving measures, irrespective of affordability. Any doctor or institute which does not honor this sentiment is often condemned by the society and this reflects not just on emergency services but on overall services. Despite these sentiments of the society, the fact is that quality emergency care costs money and there is no way in which it could be provided free of cost. Therefore a system that balances the costs and human sentiment needs to be developed and this is the only system that is likely to succeed in India. 

Our society is ill informed about requirements for quality emergency care. If one intends to provide this care, public education is critical.