ACCIDENT RELIEF & INSTRUMENTSDr. S.K.Mitra Prof. H.M./R.S.C./ Baroda

GENERAL POLICY CASUALITIES IN RLY. ACCIDENTS TO BE RAPIDLY EVACUATED,AFTER NECESASARY FIRST AID.TIME FACTOR IS OF PARAMOUNT IMPORTANCE FOR NECESSORY MEDICAL TREATMENTDOCTORS TO KNOW ABOUT THEIR DUTIES TO RENDER MEDICAL AID TO INJURD BUT ALSO,PREPAREDNESS TO DEAL WITH ACCIDENTS &MAINTENANCE & USE OF A.R.M.E.WHERABOUTS OF DOCTOR TO BE KNOWN.

VARIOUS TYPES:

*SCALE- I-for MAJOR accidents*SCALE II-MAJOR ACCIDT.*POMKA-MINOR accidt.*FA BOXES-MINOR*SPL. FA BOXES-MINOR*FA BOXES FOR GANGMEN-MINOR

TYPES OF A.R.MEDICAL EQUIPMENTSSCALE 1 IN MEDICAL VAN AS PART OF ACC. RELIEF TRAIN & STATIONED AT DIVISIONAL H.Q. & OTHER IMP.STATIONS PREFERABLY WHERE THEIR IS HOSPITAL OR HEALTH UNITIN CHARGE OF M.O.IT CARRIES MEDICAL EQUIPMENTS TO THE SITE & INJURED PERSONS ARE TRANSPORTED TO NEAREST HOSPITALS.

-CONTD2.AUXILLARY VAN IS PROVIDED WITH MED. VAN &STABLED IN SAME SIDING WITH BOTH ENDS OPEN. IT SHOULD HAVE PROVISION OF EMERGENCY TOOLS TO EXTRICATE PASSENGER FROM DEBRIS& ALSO REFRESHMENT

ARM.VAN3. THE MEDICAL EQUIPMENTS LIKELY TO BE REQU. IMME. FOR OPENING A TEMPORARY FIELD DRESSING STATION SHOULD BE IN PORTABLE CONTAINERS & NUMBERED, EACH WITH A PRINTED CARD ATTACHED TO ITS FRONT WITH DETAILS OF CONTENTS.

-CONTD4. THE MEDICAL VAN SHOULD BE STABLED IN A SIDING HAVING OPENING AT BOTH ENDS IS THE DUTY OF OPERATING & MECHANICAL BUT A DISCRIPENCY CAN BE BROUGHT TO THE NOTICE OF OFFICIAL INCHARGE.

PORTABLE MEDICAL KIT FOR ACCIDENT (POMKA) CONTENTS ARE STORED IN SUITCASES OF SIZE 21INCHES FOR EASY TRANSPORT BY ROAD / RAIL.

HEALTH UNIT/POLY CL.ONESUB DIVISIONAL HOSP.TWODIVISIONAL HOSP./ZONAL HOSPTHREEARME SCALE IITHREE SET & ADDI.

CONTENTS:53+09 Dressing materials,Surgical instruments,Emergency Injections,Dispos.infusion bottles&sets,wooden splints,rubber tourniquets,adhesive plasters,sterile adhesv.strip dressings,crepe bandages,arm bands with red cross.torch of 3 cells.rain coats,etc.Additional 09 items kept separately along with 03 sets of POMKA at Divs./Zonal hosp.: POP bandages.Mackintosh sheet,Aero.spray dressing,Folding stretcher,Portable Boyles appart,Dictaphone,Generator set,Laryngoscope set &Endotracheal tube.

-CONTDPOMKA - ONE KEY SHOULD BE ATTACH WITH HANDLE OF THE POMKA BOX AND OTHER KEY IN A SEALED BOX IN THE ROOM WHERE IT IS KEPT.

SCALE II EQUIPMENT1 LOCATED AT SELECTED STATION WHERE THERE IS NO ACC. RELIEF TRAIN SHOULD BE 80 - 100KMS. APART &PREFERABLY AT H.UNIT OR HOSPITAL GENERALY ONE SCALE II EQUIPMENT ON EITHER SIDE OF SCALE- I. SO, IN CASE OF MAJOR ACC. ONE OR THE OTHER CAN REACH AT SITE OF ACC. IN QUICK TIME.

A.R.M.EQUIPMENT SCALE IIROOM SHOULD BE SPECIALY CONSTRUCTED FOR THE PURPOSE.SHOULD HAVE SEPERATE EXIT & ENTRY ON EITHER SIDE&SO SITUATED AS TOFACILITATE EASY LOADING OF BOXES IN TRAIN. A WHEELBARROW WITH HANDLE SHOULD BE THERE.

-CONTD2. THE EQUIPMENT WHICH NOW CONSISTS OF 3 SETS OF POMKA & ADDITIONAL ITEMS AS PER LIST SHOULD BE IN CHARGE OF SS/DY. SS & SHOULD BE STORED IN PORTABLE BOXES & STANDARD PATTERN AS APPR. BY C.M.D. ON RAISED PLATEFORM SO BOTTOM NOT ON FLOOR.

-CONTDTHIS EQUIPMENT SHOULD BE USED IN MAJOR ACCIDENTS ONLY & TO BE HANDLED BY DOCTOR OR TRAINED F.AIDER ONLY. UNDER SUPERVISION OF A DOCTOR NOT NORMALY IN MINOR ACC.S

SPECIAL FIRST AID BOXESSPE. F.A. BOXES WITH CONTENTS AS PER LIST SHOULD BE PROVIDED IN ALL LONG DISTANCE TRAIN SUPERFAST,&RAJADHANI & NOMINATED STATIONS.

ALL TABLETS & INJ. PROVIDED WILLBE USED BY QUALIF. DOCTOR ONLY WHO IS AVAILABLE AT SITE. OTHER F.A.MATERIAL BY TRAINED PERSON.

-CONTDTRAIN SUPDT. WILL BE IN CHARGE & GET THESE REPLENISHED FROM HOSPITAL.PANTRY CAR MANAGER WILL TAKE CHARGE IF NO TRAIN SUPDT. IN ADDITION TO FA BOXES SIZE OF BOXES 30CM WIDTH ,13 CM Ht. METALIC

FIRST AID BOXESSTATIC FIRST AID BOXES IN BREAK DOWN VAN,OFARME,STATION,WORKSHOP,YARD,LOCOSHED,C&W DEPOT. TO BE HUNG AT PROMINANT PLACE ON WALL.METALLIC PREFE. ALUMINIUM WITH HANDLE. SIZE STANDERDISED BY C.M.D.

-CONTDF.A. OF GUARD -STANDARD AS ST.J.A.A(WGHT. 1.5 KG&NOT EXCEEDING 02KGS), WITH ALL 11 CONTENTS. PERSONAL EQUIP. OF GUAEDOF PASSENGER TRAIN & CARRIED IN GUARD BOXES.

F.A.BOXES OF GUARD OF SUBURBAN TRAIN SMALL& COMPACT.WITH CANVAS STRAP

FIRST AID BOXESF.A. BOXES FOR GANGMEN: SHOULD BE OF AN ALUMINIUM OR METALLIC, WHICH IS NOT LIKELY TO BE RUSTED. WITH ALL CONTENTS(08 NOS.)-DIAZEPAM TAB.,COTTON WOOL &SPLINTS NOT INCLUDED.

EQUIPMENT CONTAINED IN THE F.A.BOXES ARE ONLY FOR FOR FIRST AID &TO BE USED BY THOSE QUALIFIED IN FIRST AID.

-CONTDFA BOXES IN WORKSHOP AS PER STATE GOVT. FACTORY ACT . IN CASE THEY ARE DIFFERENT FROM LAID DOWN RAILWAY NORMS.

MAINTENANCE OF KEYSSCALE I EQUIPMENT KEYS OF EXTERNAL DOORS WILL BE IN DUPLICATE ONE WITH J.E.(LOCO) OR S.M. & OTHER WITH MEDICAL OFFICER INCHARGE. KEYS TO BE SUITABLY MARKED,KEPT IN A SEALED GLASS FRONTED CASE WITH MEDICAL.OFF. OR S.MASTER.& FIXED IN A PROMINANT PLACE IN RESPECTIVE OFFICES.

-CONTDKEYS OF ANY LOCK INSIDE THE VEHICLE ALSO IN DUPLICATE, ONE SET IN A GLASS FRONTED CASE FIXED INSIDE THE VAN DULY SEALED & OTHER SET IN HIS PERSONAL CUSTODY & FIXED PROMINENTLY.

SCALE II EQUIPMENTSTHE BOXES OF SCALE II EQUIPMENTS WILL NOT BE PROVIDED WITH LOCK AND KEY BUT ONLY SEALED BY MO INCHARGE . SCALE II ROOM WILL BE LOCKED AND PROVIDED DUPLICATE KEYS , ONE WITH THE SM AND OTHER WITH MO . KEYS WILL BE KEPT IN GLASS FRONTED CASES WITH THE SEAL AND FIXED AT PROMIENT PLACE .

FIRST AID BOXES KEYS OF STATIC F.A. BOXES AT STATION YARD ETC.WILL BE WITH LOCAL SUPERVISOR

FIRST AID BOXES WITH GUARDS OF PASSENGER TRAIN WILL HAVE NO KEYS .

-CONTDSPEACIAL F.A. BOXES SHOULD BE SEALED , IF LOCKED KEYS WITH PROSPECTIVE INCHARGE FIRST AID BOXES WITH GANG MAN SHOULD NOT BE LOCKED

DETAILS OF ARM EQUIPMENTS A PRINTED LIST OF FULL DETAILS OF SCALE 1&SCALE II EQUIPMENT SHOULD BE A FIXED IN A PERMANT PLACE .

A PRINTED LIST OF EACH BOXES , CUPBOARD , CABINET , SHELVES , WILL BE DISPLAYED OUT SIDE THESE IN ARME SCALE I .

-CONTDOUTSIDE OF THE EACH BOXES OF THE SCALE II SHOULD BE PAINTED WITH A NUMBER AND CONTENTS TO BE EXHIBITED , PRINTED LIST OF CONTENT OF EACH BOX FIXED INSIDE THE LID OF BOX .

-CONT.OUTSIDE OF F.A.BOXES SHOULD BE PAINTED WITH A NUMBER ,SIGN OF WHITE CROSS ON RED BACKGROUND , THE WORD FIRST AID BOX NAME OF STATION , WORKSHOP ETC.

A PRINTED LIST OF CONTENTS INSIDE THE LID OF FIRST AID BOX TO BE PASTED .

-CONTDMO INCHARGE RESPONSIBLE FOR ENSURING CONTENTS OF ARME SCALE I SCALE II IN ORDER . AFTER USE OR BEFORE EXPIRY THEY SHOULD BE REPLACED IMMIDIATELY

-CONTD.(7) SCALE II EQUIPMENT STORED AT ST. BLDG. THE SM IS RESPONSIBLE FOR SAFE CUSTODY & WHEN SENT AT THE ACCIDENT SITE , THE UNUSED MATERIAL SHOULD BE RETURNED BACK TO THE SM WHO HAS SENT THE MATERIAL . THE MO WILL CHECK THE SAME & ARRANGE FOR IMMIDIATE REPLACEMENT OF THE ARTICLES USED .

THE FA BOXES WITH A SMALL ST. SHOULD BE SENT TO HU FOR REPLACEMENT . ARMEQUIPMENTS SHOULD BE REGULARLY INSPECTED BY THE MO INCHARGE REPORT SENT. -CONTD

-CONTDPOH SHOULD BE DONE EVERY YEAR AND CERTIFICATE SHOULD BE SUBMITTED TO DIVISIONAL INCHARGE BY THE END OF NOVEMBER & CMD BY THE END OF DEC. THE DATE OF REPLACEMENTS SHOULD BE CLEARLY SHOWN . SCALE I &AUXILLARY VAN MUST BE MONTHLY INSPECTED BY MO ,SM/SS, JE,(S&T), JE (TR EXM) &ELEC. OFFICIALS

-CONTDTR.EXM. SHOULD ENSURED THAT COACHES ARE IN GOOD CONDITION, WATER TANKS ARE DRAINEDAND REFILLED WITH FRESH WATER ONCE IN A MONTH . THE TELECOMMUICATION OFFICIAL SHOULD ENSURE ALL PHONES IN ORDER.

-CONTD SCALE II EQUIPM. INSP. BY M.O ONCE A MONTH WITH S.M.C.M.S. SHOULD INSPECT SCALE I & SCALE II ONCE IN 6 MONTHS. SCALE I TO BE JOINTLY INSPECTED BY SR. DME, SR.DEE,DSTE . CMD SHOULD INSPECT BOTH I&II ONCE IN A YEAR.

-CONTDTHERE SHOULD BE A TRIAL RUN TO NEAREST STATION ONCE IN A QUARTER . THE DATE OF SUCH RUN SHOULD BE ENTERED IN A INSPECTION NOTE.

TO ENSURED THAT ALL STAFF ATTENDING ACCIDENT ARE ALERT AND CONVERSANT WITH WHAT TO BE DONE AT THE TIME OF ACCIDENT , AN ACCIDENT TRIAL SHOULD BE DONE ONCE IN THREE MONTH .

OTHER MO CAN MAKE SURPRISE CHECK OF ARME AND FA BOX , ENTRIES TO BE MADE ON INSPECTION BOOK.

COMPART: ARTICLES OF MEDICAL COMFORT SUCHAS TEA,COFFEE,MILK POWDER AND SUGAR ETC. SHOULD REPLACED ONCE IN A YEAR OR EARLIER IF THEY SHOW SIGN OF DETERIORATION INSTOCK .ALL ITEMS OF EQUIPMENTS PERIODICALLY REPLACED MAY BE COMSUMED IN RLY. HOSP.-CONTD

-CONTD

STRCHERS /SHELTERS , BLAKETS,UMBRELLS SHOULD BE CHECKED REGULARLY . NAPHTHALENE BALLS SHOULD BE PUT INTO THE BLANKETS,OTHER LINENS.

PETROMAX LANTERNS AND LPG GAS STOVES SHOULD BE LIT AND TESTED ONCE A QUARTER .

RUBBER GOODS SHOULD BE POWDERED .

TRANSFUSION FLUIDS A.R.M.E. SHOULD BE KEPT IN DISPOSABLE POLY. CONTAINERS

COMPART.:A MINI OT with O2 cylinders,all modern surgical & electronic gadgets,anaesth. tools,autoclave machine- in SPART.A ward with arranged beds &stretchers(12)- for caring the injured and transportation and keeping and caring the post-operative patients.

-CONTDTORCHES CELLS SHOULD BE NORMALLY BE KEPT OUTSIDE THE TORCH . THE PLASTIC COVER OF THE TORCH CELL SHOULD BE REMOVED . THIS SHOULD BE REPLACED ONCE IN A SIX MONTH OR EARLIER TORCHES SHOULD BE TESTED AT EACH INSPECTION. ALLMO HAVE FULL POWERS FOR REPLACEMENT OF ANY ITEMS THAT BECOMES DUE OR ANY DEFICIENCIES THAT OCCUR ON ATTENDING AN ACCIDENT.

-CONTDSTAFF SHOULD BE TRAINED WITH PUTTING OF SHELTERS .

SURGICAL INSTRUMENT NOT MADE OF STAINSTILL SHOULD BE APPLIED WITH VASELINE .

STERILE DRESSING DRUM 23CM X 23 CM SHOULD BE KEPT AND STERILISE EVERY MONTH AND DATE OF STERILISATION SHOULD BE INDICATED .

ALL PERISHABLE ITEM SHOULD BE REPLACED ONCE A YEAR OR ANY SIGN OF DETERIOATION. BOTTLES OF TINTURE IODINE SHOULD SEALED WITH CANDLE WAX TO MAKE AIR TIGHT.

-CONTD ARME SHOULD BE REGULARLY CLEANED AND ALL ELEC. CONNECTIONS SHOULD BE ON AND ONLY THE MAINS SHOULD BE OFF.

THE WARD OF THE ARME SHOULD HAVE A DOOR OPENING TOWARDS THE TRACK .

-CONTDALL OTHER ITEMS THAT ARE FOUND TO HAVE DETERIORATED OR BECOME UNSERVICABLE ON EACH INSPECTION SHOULD BE REPLACED .

AVAILABILITY OF VIALS FOR COLLECTION OF BLOOD SAMPLES FOR ALCOHOL CONTENT SHOULD BE ENSURED .

OXYGEN CYLINDER SHOULD BE TESTED REGULARLY FOR AVAILABILITY OF OXUGEN .

-CONTDclassified as under -(i) Serious '(include 'grievous' injuries as defined below)(ii) 'Minor' or 'Simple', but excluding 'trivial' injuries such as abrasions or bruises.

(2) The following are considered to be grievous injuries (as per section 320 of theIndian Penal Code) -(a) Emasculation.(b) Permanent privation of the sight of either eye.(c) Permanent privation of the hearing of either ear.(d) Privation of any member or joint.(e) Destruction or permanent impairment of powers of any member or joint.-CONTD

-CONTD(f) Permanent disfigurement of head or face.(g) Fracture or dislocation of a bone or tooth.(h) Any hurt which endangers life, or which causes the sufferer to be during the space of twenty days, in severe bodily pain or unable to follow his ordinary pursuits.(3) Injuries other than those defined above are considered to be minor or simple injuries.

-CONTD(4) Apart from the injured cases as above, there may be cases where a passenger or trespasser receives only petty abrasions or bruises. These are of trivial nature and technically speaking should not be taken as 'injured ' persons.

-CONTDNote: Change of classification of injuries may he necessary in the light of' X-rays and other detailed findings after admission. Advice with regard to change of classification of injuries should be furnished to the Chief Medical Director as early as possible.

-CONTD708. Display of detailed road maps:-In case where the site of accident is approachable by road, medical aid may be rushed more quickly and more conveniently by road than by train. A detailed road map for each division should therefore be obtained and kept framed in all Railway control offices.

Duties of the staff at the time of an accidcnt:-(1) The most suitable responsible Railway official on whom is to devolve theresponsibility of summoning the nearest available medical aid according to the urgency of the case is the Station Master. When the Station Master on duty receives information that there has been a serious accident in his jurisdiction and the services of the medical department are necessary, he should immediately take action to send the accident relief medical equipment to the site of accident by thefirst available means of transport.

If the equipment is being sent by the relief train, and the medical officer docs not arrive before the train is ready to start, the equipment should be sent with the train in charge of a responsible person, preferably one holding a first aid certificate. This medical equipment will be placed at the disposal of any available medical man on the spot.

(2) The medical officers will keep themselves in readiness for such an emergency.Immediately on receiving notice that a serious accident has occurred for which theservices of the medical department are required, the medical officer in charge ofthe section himself, if time permits, or a responsible official deputed by him, willtake the following steps:-

(i) Notify his superiors.(ii) Notify the Matron/Sister on duty (where there is a hospital and nursing staff).(iii) Ask all concerned authorities to co-operate with the medical department and toallow first aid men belonging to their departments to render first aid and assist inthe transport of the injured from the point of accident to the non-railway /Railway Hosp.

(iv) Call for assistance from the neighbouring divisions and neighbouring Railway also, if the nature and the magnitude of the accident warrant it.(v) Inform the local non-railway hospitals about the occurrence of the accident so that they should remain in readiness to receive and treat the injured.(vi) Instruct the nearest St. John Ambulance Brigade to send with equipment as manyBrigade personnel as possible.

(vii) Detail one medical officer if he can be spared or a senior dispenser to remain on duty for seeing that all arrangements are made at the hospital at the receiving end for the reception of the injured, that transport is in readiness, that all first aid men available are informed of the accident, etc. ,(viii) Proceed to the site of the accident by the first available means of transport, alongwith the necessary staff and medical equipment.

(ix) Advice any medical personnel enroute to accompany him.Note: (a) If the medical officer in charge of the section is not available at the time of receipt of the information of the accident, the official next in charge should take the nitiative and proceed to the site of the accident with aHthe available equipment and ihc staff at his disposal and by the first available means of transport.(b) In an accident case. the question of jurisdiction does not arise. It is the duty of every Railwaydoctor to respond.to the all, whenever required, irrespective of the jurisdiction.(c) In large stations, where there are number of doctors, details of duties to be carried out by each in case of an accident may be laid down.(para 1416 and 1417 of Indian Railway Establishment Manual)

711. Medical aid at the site ofaccident:-(1) In major Railway accidents where the number of casualties is expected to be large,it may be worthwhile to establish one or more temporary field dressing stations atthe site of accident, in bivouac shelters as per the sketch given below for guidance:BACK CONTENT HOME PAGE FORWARDINDIAN RAILWAYS MEDICAL MANUAL(2) When the accident has occurred near a station, the medical officer in charge mayalso make use of any building belonging to Railway which might be suitable forsetting up of temporary field dressing station, for example, refreshment room orwaiting room.

(3) The temporary field dressing station should consist of the following posts: -(a) Reception post,(b) First aid post,(c) Fuel, lighting, water, and refreshment post, -(d) Resuscitation post,(e) Surgical post,(f) Comfort and dispatch post,(g) Mortuary,(h) Latrines.(4) The Railway doctor in charge should detail the staff available to take over thenecessary equipment from the accident relief medical vehicle and the boxes etc.,give instructions to open them and keep everything in readiness to receive anddeal with the casualties