Dr. Fiaz Maqbool Fazili
When an Ambulance Meets a Traffic Jam: The Golden Hour Lost on Roads Built for Another Era.
“What should we really be talking about?” a few friends asked me recently. “Everyone discusses traffic congestion, but very few speak about what it means when a patient is fighting for life.” Their question took me back many years. I remember vividly the day Kashmir’s first Advanced Cardiac Life Support (ACLS) ambulance was formally introduced at the Centaur Hotel. It was a landmark event. The ambulance had been generously donated by the late Nisar Bakshi (May Allah make his place in Jannah) facilitated by his friend Dr. Mir Rouf Sahib and DR. Nahid—a noble act that, unfortunately, never received the recognition it deserved. The hall was filled with policymakers, senior bureaucrats, hospital administrators and healthcare leaders. The then Chief Secretary was present, along with many CEOs of hospitals. As the ACLS consultant associated with framing emergency protocols, including inter- and intra-facility patient transfers during the Platinum Five Minutes and the Golden Hour, I sat listening carefully.Beside me sat my younger colleague and dear brother, Dr. Omar Javed Shah, who was then serving as Director at SKIMS., I quietly leaned towards him and said: “We are bringing a jet aircraft to an airport where there is no runway. “He smiled, but immediately understood what I meant. The ambulance was world-class, fast moving and equipped with an advanced system. Alas! The system surrounding it was not. A sophisticated ambulance alone cannot save lives if it spends half the Golden Hour trapped in traffic.
Medicine has taught us that trauma, stroke, heart attack and many other emergencies are races against time. Every minute lost translates into dying brain cells, damaged heart muscle and preventable deaths. An ambulance is only as effective as the system through which it moves. Unfortunately, our emergency transport system was never designed as a system or organisation like 911 or red crescent, who are responsible for prehosp services, early diagnosis, prompt treatment, at site, resuscitation and life saving interventions will be initiated and shall continue till patient arrives at appropriate hospital. Australians have gone step ahead. They have flying teams, what we saw when in a “Pub”, a person was stabbed in the chest, the rescue team had a surgeon who started what is called ER thoracotomy at site saved life. This is a dream or fantasy.
Our roads were laid sixty to seventy years ago for a fraction of today’s traffic. Since then, the number of vehicles has multiplied hundreds of times while road geometry has remained almost unchanged. Today we expect advanced ambulances to perform miracles on infrastructure that has already collapsed under its own success.
In developed emergency medical systems, an ambulance is merely one component of a much larger chain of survival. The emergency begins not when the patient reaches the hospital, but the moment someone dials a universal emergency number. Within a few minutes, a coordinated command centre activates. GPS identifies the nearest trained paramedic team. Dispatchers communicate simultaneously with police, hospitals, fire services and transport authorities.
Highly trained (BLS, ATLS, ACLS, PALS, First aid..) first responders often reach the victim within minutes. Life-saving interventions begin at the roadside—not after arrival at the hospital. Modern resuscitation follows the ABCDEF approach: A for Airway (with cervical spine protection in trauma), B for Breathing (oxygenation and ventilation), C for Circulation (or catastrophic haemorrhage control first in trauma and CPR in cardiac arrest), D for Disability (rapid neurological assessment using AVPU/GCS, pupils, and blood glucose), E for Exposure (complete examination while preventing hypothermia), and F for Further care, including FAST, fluids or blood products, definitive treatment, frequent reassessment, and appropriate family communication., is the recommended sequential approach for emergency and accidents trauma, especially in prehospital, both civilian and military settings.Meanwhile, traffic management systems automatically create a “green corridor.” Motorists know instinctively that ambulances, fire engines and emergency responders have absolute priority. This culture is taught from childhood and reinforced through strict enforcement. The ambulance hardly stops. The hospital receives advance notification and prepares before the patient arrives. That is what emergency medicine looks like.
Contrast this with our reality on ground and POC-point of contact. An accident occurs. Crowds gather, for”talla “let me see. Some insensitive people and on- lookers begin recording videos. Someone searches for a private vehicle. Someone does what should not be done, brings water to feed a semi- conscious or conscious person(victim) . Such an act instead of help can actually kill a person by choking aspiration etc.Relatives make frantic phone calls. Traffic remains stationary, and standstill. The ambulance finally arrives—,or people settle for an autorickshaw, but now becomes another victim of congestion., but in most of cases the victim is curled in auto with bumpy roads and potholes – whatever is left unharmed the second incident does that. Even if the traffic police desperately want to create a corridor, where exactly can vehicles in queue move? They cannot disappear, cannot reverse hundreds of metres.,and can’t move laterally. There are no emergency lanes. Footpaths have been occupied. Road shoulders have vanished. Every inch is already almost occupied.
The problem is no longer traffic management for the agile proactive team of SSP traffic Aijaz Bhat sahib. who are doing their best to improve traffic flow.t is traffic mathematics; engineering.Until administration with all stakeholders ,or whoever pulls shots are ready to take bold decisions, no amount of whistle blowing can create space where none exists. We often criticise the traffic police. That criticism is frequently unfair. Even ten thousand traffic personnel cannot manufacture road width. You cannot regulate geometry. Nor can you whistle away congestion. Another challenge has quietly emerged. The siren itself has lost its meaning. VIP cavalcade, Escort vehicles. Official movements. was understandable sadly private misuse of sirens. Everyone seems to demand urgency., except ambulances or fire tender. The result is what may be called the “Siren Syndrome. “Thanks to the Traffic team, they have started checking these unauthorised boards, of Emergency, On Duty etc.
When every vehicle behaves like an emergency, genuine emergencies lose priority. Citizens become confused. Some hesitate. Others ignore. The credibility of the siren itself diminishes. Rule of law gradually gives way to a culture of privilege. This is dangerous.An ambulance should command immediate respect—not because of authority, but because someone inside may be struggling between life and death. The person inside could be anyone. Your mother. My child. A neighbour. Friends Or even ourselves.
What is the way forward? The answer lies not in one expensive advanced ambulance, but in building an Emergency Medical Services ecosystem., with educating people how to make for emergency vehicles.Srinagar urgently needs an integrated Emergency Medical Response Centre connecting hospitals, traffic police, health services, fire services, disaster management and civil administration on a single digital platform.
GPS-enabled ambulances should be monitored in real time. Artificial intelligence can predict congestion and recommend faster alternate routes. Adaptive traffic signals can automatically remain green along ambulance routes. High-definition cameras can detect approaching emergency vehicles and synchronise intersections. Emergency bays should be created wherever feasible, especially on NH 44. Illegal parking and encroachments on critical corridors must become non-negotiable offences. Motorists should receive mandatory education on giving way to ambulances before obtaining driving licences. Schools should teach road ethics alongside road safety. Traffic discipline is not merely about avoiding fines. It is about saving strangers. Technology alone, however, will never solve the problem. Our cities themselves require re-engineering. Hospital access roads deserve special planning, often entrance gates are clogged by parking vehicles and vendors. Major tertiary hospitals should have protected emergency corridors.
Future urban planning cannot continue adding hospitals, malls and commercial complexes without simultaneously redesigning mobility. Otherwise, we will continue constructing and reconstructing runways after purchasing advanced aircrafts. As surgeons, we often say that the operation begins long before the first incision. Similarly, emergency care begins long before the ambulance reaches the hospital. The first operating theatre is the street. The first ICU is often the ambulance. The first lifesaver is the bystander. The first delay is traffic. The first responsibility belongs to all of us. A WhatsApp group, a network of doctors conceived by.Dr. Imran Hafiz, HOD Cardiology SKIMS, and his friends. According to its members, over 6,000 lives have been saved through early intervention via their WhatsApp group since the network started in 2017. This is how Kashmir is curbing heart attack deaths. Perhaps the greatest lesson from that day at Centaur Hotel remains as relevant today as it was then. Buying sophisticated ambulances is relatively easy. Building a system worthy of them is infinitely harder.
We are bringing a jet aircraft to an airport where there is no runway”—is the emotional hook of the article. I would move it to the very first paragraphs and make it the central metaphor running throughout the piece. Readers remember metaphors more than statistics.
The Platinum Five Minutes and the Golden Hour cannot be extended by administrative orders. They obey only biology. Every unnecessary delay costs lives. Every blocked intersection becomes a silent intensive care unit. Every ignored siren may become somebody’s last unanswered call. If Srinagar truly wishes to become a Smart City, it must first become a city where an ambulance, or an organisation like 911 or red crescent takes over as emergency response team can reach a dying patient—and return safely with a living one. That is the smartest measure of urban civilization.
Tail piece; This story has been a long-standing public demand, especially from many Kashmiris returning from overseas who have experienced disciplined emergency response systems where motorists instinctively yield to ambulances. I had deliberately refrained from writing on the subject for a long time, believing that public awareness should evolve organically. However, after reading Er. Danish Reshi’s thoughtful piece, I felt the time was right to revisit this important issue. His article reinforced what many citizens have been expressing for years—that respecting the ambulance siren is not merely a traffic rule but a moral, civic, and humanitarian obligation. Sometimes, a timely reminder can help transform public concern into collective action.
The author besides being a Medical doctor at Mubarak hospital , is very active in positive perception management of various moral, social and religious issues. He can be reached at drfiazfazili@gmail.com & twitter
