MUMBAI’S ‘JUGAD’ EMERGENCY CARE Porters to pick up the injured, medical aid kit with aspirins and band-aids, ambulances with no drivers

Yogesh Sadhwani, Virat Singh and Lata Mishra 

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    Of the 108 stations on Mumbai’s suburban network, that carries nearly 75 lakh commuters every day, only Dadar could have managed to save Monica More’s arms. 
    A test-drive of stations across Western, Central, and Harbour lines carried out by this newspaper on Wednesday revealed that not one of them, with the exception of Dadar, is equipped to handle victims of serious accidents. 
    Monica, who fell off a crowded train in Ghatkopar last Saturday, lost her arms for two main reasons: one, there was an inordinate delay in taking her to KEM Hospital, where doctors tried unsuccessfully to reattach her arms; two, in absence of any emergency medical care, she was carried to the nearest hospital in an auto by two young men, who wrapped her severed arm in a piece cloth borrowed from a fellow commuter. 
    The scary reality is that Monica would have got the same care at any other station, small or big. Only Dadar has a trauma care centre and doctor on duty round-the-clock. But even Dadardoesnotstockonice,criticalintransporting severed limbs to a hospital. 
    The test-drive revealed that whatever emergency care facilities have been created at stations are not aimed at helping accident victims. They are aimed at complying with a 2004 Bombay High Court ruling, which put the onusofprovidingmedicalaidtoaperson injured in a train accident on the concerned station master. In Mumbaiya, it’s called ‘jugad’. 
    Other than first-aid kits with 66 items, many of them of no use in the sort of injuries that train accidents throw up, all stations across the city now have stretchers and wheelchairs. But the problemisthatnoneofthem have trained staff. Every time an accident is reported, the station master must beg, plead and bribe hamaals (casual labourers) to rush to the spot, pick up the victim. 
    The world over, extreme care is advised in handling accident victims as untrained hands can aggravate injuries. But on Mumbai’s stations, it’s the baggage handlers that are sent to take care of the injured. 
    And it doesn’t end here. Only six stations of the 108 have dedicated ambulances. All other stations must call for an ambulance. On Wednesday at Parel station, it took an ambulance half an hour to reach the spot after S K Patil, 50, a railway employee on his way home, fell off the train (see picture on page 1). 
    Thankfully, he had not suffered any serious injuries. 
Not that the situation is any better at those handful of stations where there are ambulances. A railway officer, who did not wish to be identified, said while the ambulances are parked at the station, their drivers are never around. “It can take anything between 20 minutes to an hour to trace the driver and get him to the ambulance,” he said. 
Theproblemisthatmostoftheseambulances are donations from social groups. Thus, their drivers are not accountable to the railways. “TheygettheirsalariesfromtheNGOsthatown the vehicles, they don’t need to report to us,” the railway officer said. 
At Airoli, which caters to over 50,000 season ticket travellers and another 25,000 ticket buyers each day, every timethereisanaccident,the station master calls porters from Thane or Vashi to attend to the victim. That itself takes half an hour. 
Doctors say that the first 45 minutes after an accident are critical in saving an accident victim’slife.“Theinjured must be attended to by paramedics and stabilized in the first45minutes,”saidaKEMdoctor. 
But forget paramedics, the station masters are not given enough money to even pay the porters. Each station master has a budget of Rs 1150 to attend to an accident victim -- Rs 400 to pay porters to pick the injured, and rest for the ambulance.“Tryaskingfourporterstopickupa bleeding man off the track for around Rs 100 each. At many suburban stations there are no porters, so we end up asking drug addicts languishing around to help,” said another station master. For a rail network that earns Rs 1225 crore annually, it’s clearly the passengers that are important, not their lives.

SK Patil, 50, fell into the gap between the platform and the tracks at Parel on Wednesday. After commuters pulled him out, it took 30 minutes to take him to a hospital

THANE STATION Though almost all stations have stretchers, wheelchairs and first-aid kits with 66 items, they are of no use when it comes to major medical emergencies

Consumer court can hold railways guilty of negligence Teen Who Lost Arms Entitled To Damages

Rebecca Samervel TNN 

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    Consumer law experts say Monika More has a more than even chance of making the railways eat its words (calling her accident a case of trespassing) if she approaches the consumer court. The 16-year-old college student lost her arms under a train after falling into a gap on platform No 2at Ghatkopar station on Saturday. 
    As a service provider, the railways are in a consumer relationship with commuters and so Monika’s case has valid ingredients for admission in a consumer forum, said consumer activist M S Kamath. “All she needs is a valid daily or season ticket. This will prove that she is aconsumer. If a gap on the platform was the reason she fell on tracks, the railways can be held guilty for deficiency in service,” he said. 
    Kamath said that in recent cases of theft and dacoity, consumer commissions have held the railways guilty of negligence and not providing adequate security on trains. 
    In a landmark case, the National Consumer Disputes Redressal Commission in 1995 upheld a state commission order and directed the railways to pay Rs 2.25 lakh to the parents of a 21-year-old, Kabita Hansaria, who died in 1990 while passing through interconnecting compartments on a long-distance train. The Hansarias told the commission that the vestibule connecting the compartments did not have safety grills. The railways had contended that according to the provisions of the Railway Claims Tribunal, the complaint was not tenable before the commission. But the commission made a clear distinction between a train accident and accidental death, and observing that Kabita's death was the latter case. “The state commission is right in pointing out that a railway passenger is a consumer,” the national commission had said. 
    Consumer lawyer Uday Wavikar said cases like Monika’s fell under the purview of the Consumer Protection Act. ‘‘There are instances when the national commission awarded compensation to people injured after falling off railway bridges. In a recent order, an airliner was ordered to pay compensation to a passenger who died in an escalator mishap.” 
    In 2011, the national commission ruled in favour of a woman whose husband was run over by a goods train in 2003 while he was crossing tracks at a spot where there was no railway bridge. The commission rejected the railways’ defence that such cases fell under the provisions of the Railway Claims Tribunal Act and that consumer fora did not have jurisdiction. 
COMPENSATION 
POSSIBILITIES RAILWAY CLAIMS TRIBUNAL Compensation for accident victims 4 LAKH | Death, loss of both hands or legs, deafness, disfiguring of face 
32,000 TO 3.6 LAKH | Other injuries 
Interim Relief | Pending settlement of claim, the railways are required to meet victim’s emergent expenses and afford her immediate relief. The amount is adjusted against final settlement CONSUMER COURT A complaint can be filed in any of six ‘district consumer disputes redressal’ forums in the Mumbai Metropolitan Region | South Mumbai, Central Mumbai, Mumbai Suburban, Mumbai Additional (suburban), Thane, Thane Additional (Navi Mumbai) 
Forum admits complaint within 21 days and issues notice to the service provider (in Monika More’s case, the railways), who must reply in 30 days. Grace period of 15 days can be given. If there is no reply, forum can hear matter ex parte and pass order If order is unsatisfactory, file appeal at state and then national commission LEVELS AS PER COMPENSATION 
Above 1 crore Complaint heard by national commission 
20 lakh to 1 crore 
Complaint heard by 
state commission 
Below 20 lakh Complaint heard 
by district forum HIGH COURT To expedite hearing at Railway Claims Tribunal, the high court can be approached PROSTHETIC ARMS Bebionic 3 | Most advanced myoelectric arm. Controlled by electrical impulses from amputee’s stump muscles. Can perform complex tasks like tying shoe laces and holding heavy objects Cost of arm | 50L Cost of fitting and follow-ups 
| 30-50L

CCTV footage of Monika More (circled) on the platform, seconds before her accident at Ghatkopar station on Saturday

Ambernath platforms pose daily risk for commuters Uneven surfaces, craters and inconsistent height of platforms have made boarding and alighting from suburban trains in the township difficult as well as dangerous

Virat A Singh virat.singh@timesgroup.com TWEETS @singhvirat246 

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    If the hazard of gaps between footboards of local trains and platforms across the city was not enough, commuters at Ambernath are risking their lives every day due to uneven surfaces, inconsistent height, as well as huge craters on all three platforms there. 
    Almost daily, several commuters trip and fall while boarding or alighting from trains, some narrowly escaping landing on the tracks. 
    At platform No 2 for instance, a part of the platform is paved and is ata proper height to the foot board of trains. But a section of the platform, spanning over two compartments, has not been paved. When the height of platforms was raised a couple of years ago, the contractor did not care to install tiles but simply paved the surface with cement. This has resulted in the cemented stretch being at least two inches lower than the tiled portion. 
    The situation is no different on platform No 1, where a long stretch has not been tiled and is a few inches lower than the rest of the platform. Even in the section where tiles have been laid, the flooring is uneven at certain spots. 
    With the population of Ambernath rising sharply over the years, a lot more commuters travel by locals each day. A decade ago, the population of the township was around 1.5 lakh, but it has risen to well over 3.5 lakh today. On an average, one member from each family travels by train everyday. 
    “The situation is so bad that everyday somebody or the other fallsdue to the uneven platforms. The gaps and unevenness has made alighting difficult and dangerous,” said S Murughan, a daily traveller. 
    Satyajit Burman, a regular commuter, said, “We have made several complaints to the station officials, but there’s been no action. Platform No 3 does not even have anti-skid tiles. Will the authorities wake up only after someone falls in the gap and dies or is left handicapped for life?”
    Another resident, Deepak Singh, said, “The distance between the footboard and platform varies across platform No 1 and 2. This shows that the work of raising the height of platforms was not carried out in a proper manner and is now causing problems for commuters. What’s more, these gaps are at their worst at the spots where the ladies compartment and senior citizen’s special coaches halt.” 
    When Mumbai Mirror contacted CR officials for their comment, they said that they will send a team to Ambernath on Wednesday and get the platforms fixed immediately. 
SLIPPERY GRAB POLE Rail commuters across the city have also been complaining about the stainless steel grab poles that were introduced in the current Siemens rakes. They say the poles are slippery and cannot be gripped easily. 
    Commuter Zeeshan Ansari said that the old rakes, which had painted iron poles, afforded a firm grip. 
    “But the stainless steel grab poles are extremely slippery and can cause someone to slip and fall if he tries catchingthetrainwhilerunning,”he said. 
    While Railway officials agree that the poles could be slippery, they say that these poles are strong and durable and require low maintenance. 
    “Using a rubber covering to improve the grip would make it a hygienic issue as sweaty palms will only cause it to emit a foul smell,” an official said. “However, some modification could be brought about,” he agreed.

A commuter boards a train at Ambernath station on Tuesday. This is the spot where several commuters have slipped because of the gap between the train’s footboard and the platform and the crater; According to daily commuter S Murughan, everyday somebody or the other falls due to uneven platforms

CASE STUDY Death took him to his beloved hometown Abraham planned retirement to his native town, but had his funeral there

Aditya.Anand @timesgroup.com TWEETS @_anandaditya  http://epaper.timesofindia.com/Default/Scripting/ArticleWin.asp?From=Archive&Source=Page&Skin=MIRRORNEW&BaseHref=MMIR/2014/01/14&PageLabel=5&EntityId=Ar00500&ViewMode=HTML     Just a week ago, fifty-four-year old Ulhas Abraham, a journalist with a Saki Naka-based English publication, had been planning his retirement to Kottayam in Kerala. He hoped to stitch up some writing assignments to keep him busy there. But all his dreams of an idyllic life back in his home state were waylaid by a tragic suburban railway accident on Friday which killed him. This Monday, his funeral was held at the Pambady Orthodox Church in his beloved Kottayam.      Kalina-resident Abraham became another victim of Mumbai’s over-crowded suburban railway system when he fell out of his train near Kurla. “Despite the train being packed, they boarded it as they were very eager to meet their friends in Kalyan,”Abraham’s son Philip told Mirror.      Philip, 24, who works in the operations department of a Pune-based company, said that it was about 3:30 pm when the incident occurred. “It was not peak time.My parents had always been mindful about not getting into crowded trains,” he said. On Friday, the Kalyan-bound fast train that Abraham boarded was crowded as a preceding fast train had been cancelled.      Philip recalled that his father, who had been a journalist for 20 years, relocated from Ulhasnagar to Kalina only to avoid doing the commute in overcrowded suburban trains. “It was a terrible situation on Friday. The train was full. While Beena (Ulhas Abraham’s wife) got into the ladies’ compartment, Ulhas and I were at the door. As the train left Kurla, passengers started getting restless and trying to re-adjust themselves and suddenly there was a scream. Someone had fallen off,” Ulhas’s brother-in-law N G Alwyn said.      Alwyn who could not look behind him because of the crowds, called out for Ulhas. But there was no response. “I then got off at Ghatkopar. Ulhas was not there. I immediately rushed back to the spot, and we rushed him to hospital,” Alwyn said. Abraham was taken to Sion hospital, but was declared dead before admission. An autopsy was conducted and the family left for his hometown of Kottayam in Kerala for the funeral. Philip said the Railways have not got in touch with him so far. “Mumbai is growing very fast and its infrastructure growth is not in proportion. But while the railways cannot be blamed entirely, some actions pointing to change should be evident,” said a gracious Philip. “My father will never come back, but I hope his death will highlight the need for better service and station standards,” “Increasing capacity is the key to reducing deaths on the Mumbai suburban section. If this means an increase in fares, that will not be an issue to most people. Better connectivity while keeping safety in mind will bring in a change,” Alwyn said. Ulhas Abraham

MIND THE GAP, MUMBAI All Mumbai platforms are designed for passenger trains, that’s why the dangerous gap between local trains’ footboards and platforms. With new taller rakes coming in, this gap will only grow and gobble up more lives

Virat A Singh and Yogesh Sadhwani mirrorfeedback@timesgroup.com 

TWEETS @singhvirat246 

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    Asolution to prevent a mishap like last Saturday’s, when 16-year-old Monica More lost her arms after falling off a local train at Ghatkopar station, is sitting in a file with the Railway Board for four years now. 
    Monica slipped onto the tracks after falling off a crowded train because of the gaping hole between the train’s footboard and the platform. The Central Railway had four years ago written to the Railway Board, seeking permission to raise the height of platforms in Mumbai to 92 cm (36.22 inches) as against the nationally prescribed 76-84 cm (30-33 inches). 
    The logic was simple – prescribed height of platforms across the country was decided with passenger trains in mind. But Mumbai locals are very different on two counts – one, like passenger trains, locals don’t have steps to board and alight; two, locals stop at a station only for 15 seconds, leading to a mad frenzy to board and alight, and that is when a lot of accidents occur. 
    In the four years that the Railway Board has been sitting on the proposal, nearly 10,000 lives have been lost to accidents on the tracks in Mumbai and probably an equal number have suffered grievous injuries. According to a senior railway official, who did not wish to be identified, at least 10 per cent of these accidents involved the killer gap between local trains’ footboards and platforms.During peak rush hour, a Mumbai local carries 5,500 passengers, that’s nearly3,500passengersexcess.People falling off the trains because of overcrowdingisnotuncommon.Butamajority of accidents take place while boarding and alighting. 
    The average gap between a local’s footboard and the platform is 14 to 18 inches.Withanaveragestepinhouses and offices measuring 5 to 8 inches, the killer gap on Mumbai locals is as large as three to four steps. 
    The old trains with spring-coil suspension took care of the gap to a certain extent as Mumbai’s crazy passenger overload would push the trains down,closertoplatforms.Butthenew 
    Siemens rakes are not only taller, but their air-suspensions can take a lot more load and do not squat. Aquick survey carried out by Mumbai Mirror on Monday revealed that the gap between thefootboardandtheplatform in old rakes was an acceptable eight inches. But for Siemens 
    rakes, that are taller than the old trains, this distance is over 14 inches. 
    TheBombardierrakes,thatarecurrently undergoing trials, will only aggravate the problem because they are taller than even their Siemens counterparts. The Western Railway, which will soon have both Seimens and Bombardier rakes, recognised the gravity of the problem last year and sought a condonation for Mumbai from the Railway Board – in common English that’s a request that an exception be made ignoring all norms and procedures. That request now has been pending for five months. 
    “WR is concerned about the commuter inconvenience and safety. As we have Siemens rakes and will soon introduce Bombardier rakes too, we have requested Railway Board for condonation. We have carried out trials with help of Research, Designs and Standards Organisation with 92 cm platforms last year,” said WR chief PRO Sharat Chandrayan. 
    But the Railway Board can’t also be blamed alone. Almost all stations in Mumbai service both local and longdistance trains. Raising heights of platforms could create risks for passenger trains. 
    The Central Railway, in fact, raised the height of platforms at CST station to 92 cm and the results have been excellent. “We were able to do it at CST because here there are dedicated suburban platforms,” said an official, explaining that a durable solution to the problem will be a complete segregation of platforms for long-distance trains and local trains. 
    But that may take years. Till then Mumbai seems to be condemned to live with the killer gap.

A woman tries to board a train at Churchgate station on Monday. (Inset) Monica More, 16, who lost her arms when she slipped onto the tracks through the gap between the train and the plotform at Ghatkopar last Saturday

MP Kirit Somaiya measures the gap between a train’s footboard and the platform at Ghatkopar station

Railways faces FIR over college girl’s accident

TIMES NEWS NETWORK 

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Mumbai: The Government Railway Police (GRP) has been given a seven-day ultimatum to file an FIR against the railways for letting a signal pole and a gap remain on Ghatkopar station’s platform No 2. On Saturday, junior college studentMonika More (16) lost her arms under a train after falling into the gap. 
    On her part, Monika is showing remarkable spunk in coming to terms with her tragedy. On Monday, she was talking to her friends and relatives. “I am in pain and feeling weak. I ate normal food but don’t have an appetite. I hope this passes quickly,” Monika told TOI. “She is trying to forget about the accident,” a cousin said. 
    Monika’s college has decided to provide her with a writer for her exams. Also, she can be fitted with advanced prosthetic arms that are controlled by brain impulses. The only hitch is their cost: between Rs 10 lakh and Rs 1 crore, depending on sophistication. BJP leader Kirit Somaiya has promised a Rs 12 lakh aid. 
    Before she is fitted with prostheses, Monika’s injuries have to heal, which will take at least two months.

Girl to get writer for exams, funds needed for prosthetic arms Train Accident Victim At Great Risk Of Infection: Docs Sumitra Deb Roy & Shreya Bhandary TNN      Monika More, who lost her arms under a train at Ghatkopar station on Saturday, was much stable two days later and putting up a brave fight. Surrounded by friends and family members, she said she wanted to forget about the accident and move on. The immediate challenge for her is to beat infections that may slowdown her recovery andthreaten her rehabilitation.      On Monday, the 16-year-old was shifted to a separate room in KEM Hospital’s orthopaedic ward. Doctors are planning to give her a blood transfusion to acceleratehealing and remove weakness. Monika’s wounds may take at least two months to heal,  following whichthe processof fitting her with prosthetic armswillbegin.      “This is a trying period for Monika andher family and morethan anything else, she needs emotional support right now. Her classmates and some of her teachers visited her on Monday to cheer her up,” said Lina Raje, principal, TD Mehta Junior College,whereMonika is a studentof Class XI. The college has decided to provide her with a writer so that she may appear for her finalexams.Also, the papers will be scheduled as per her convenience,saidRaje.      Monika’s family wants the railwaysto rehabilitateher. “Sheis pursing commerce. Her parents have pinned all their hopes on her. Her father has a monthly income of less than Rs 10,000 and may not be able to affordthebestof medicalcare and rehabilitation for her,” said her uncle Vishwas Jadhav. The family will be in need of funds for prosthetic arms, a pair of which costs Rs 10-100 lakh. Thesophistication andfunctionality of prostheticdevices aredirectly proportionaltothecost.      Doctors at KEM said they are being extra careful to keep infection at bay. “The wound was contaminated with oil and dirt, worsening already complicated injuries. We are cleaning the wounds daily,” said Dr Pradeep Bhonsale,headof thehospital’s orthopaedic department. For a good prosthetic fitting, long stumps are ideal. “But the sizes of her stumps are not much. We are trying hard to preserve whatever remains,” the doctor said.      The hospital’s plastic surgery departmenthadtriedto reattachMonika’s arms, but failed in their efforts, mainly because much time had lapsed and also the injuries were extensive.  GRP to study CCTV footage      The Kurla GRP will go through CCTV footage from Ghatkopar station to study Monika More's accident."Shesaysshe gotintotheladies’ compartment, but overcrowding caused her to lose balance and fall off,” saidconstable S Morewhospoke toMonika.  DID RLYS, GRP, HOSPITAL FOLLOW RULES? HOPE AHEAD Monika can be fitted with artifi cial arms  TYPES | Available according to functionality and sophistication BEST |Myoelectric arms, which work by reading brain impulses COST | Thousands to lakhs of rupees COST | 10-50 lakh TRAINING | 1-2 years of rigorous training to perform basic functions like holding things REATTACHMENT SURGERY  Reattachment of limbs needs to be carried out within six hours of an accident for best results  The time window for amputated fingers is 12 hours  First bones are reattached, followed by blood vessels, nerves, muscles and skin  Nerves take the longest to regain functionality WHY MONIKA’S ARMS COULD NOT BE SAVED  Rajawadi doctors did not preserve the severed arms in an ice box Crucial four hours were lost before surgeons could start working on the severed limbs The injuries were so severe that there was a high possibility of dead tissues leading to infection and endangering Monika’s life  Contamination of the wound site was severe  Monika’s arms were badly crushed, forcing doctors to amputate higher upACCIDENT      On Saturday, around 1.45 pm, Monika More (16) lost both arms under a train after falling into a gap on platform No 2 at Ghatkopar station      Two brothers pulled Monika out of the gap and walked her 500 metres out of the station. They hailed an autorickshaw and took her to the civic-run Rajawadi Hospital, the nearest from the station      All this while, Monika was bleeding profusely and was in a subconscious state. One of her arms had been cut off on the spot and the other was hanging by the skin     After being stabilized at Rajawadi, she was referred to KEM Hospital, Parel, where doctors tried a reattachment surgery around 6pm, but failed PROTOCOL BREACH      A stretcher and an ambulance were not available at the station      Railway police personnel were not around to take Monika to hospital      At Rajawadi, doctors showed no urgency in shifting her to a tertiary care hospital RULE BOOK      If someone meets with a serious accident at a railway station, the station master has to call an ambulance or a taxi      Station staff are supposed to provide fi rst aid before rushing the victim to the nearest hospital      The Bombay high court ruled in 2006 that the railways must foot a victim’s private hospital bills      The court directed railway authorities in 2004 and 2006 to provide immediate medical attention to victims  HELPING VICTIMS Put the severed limb in a clean plastic bag and tie its mouth tightly or seal it Don’t wash or clean the limb and ensure it does not come in contact with water Fill another plastic bag with ice and put the bag with the severed limb in it If ice is not to be found, don’t waste time looking for it and rush to a hospital with the severed limb With inputs from Nitasha Natu A basic, cosmetic arm (above) and a myoelectric arm (right). The accident spot (below) on Monday Monika More in hospital

25000 Volts, Danger of rooftop travel,