Providing Medical Stores in Indian Trains & Railway Platforms at the earliest

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Respected Sir,                                                                                                                       I would like to bring to your kind notice that as a passenger while traveling on Indian Railway we don't get easy access to medicines making us land in a helpless situation & loss of valuable time especially in case of emergency. Whenever medical help is needed the procedure followed is  

a. Passenger gives message to TTE/ 138/ twitter to Ministry of Railway.

b. message than received & acted upon by the Divisional commercial control room through which the train is passing.

c. message than forwarded to Dy. Station Superintendent of next stopping station or next station with Railways hospital or health unit. 

d. message than given to casualty or doctor of railway hospital.     

This usually takes 1-2 hours. During this period patient don’t get any medical help as railway has no manpower or infrastructure to attend any emergency on Indian Railways immediately. The TTE or Guard just forward the message without giving any medicines to the patients. This is evident from the first aid box on Indian Railways & Platforms which only has Paracetamol & Diazepam tablets. It's not being updated since ages. We can't even get an allergy/ antacid/ anti-vomiting tablet or syrup immediately. Link

http://www.indianrailways.gov.in/railwayboard/uploads/directorate/health/downloads/IRMM/Chapter7.pdf                                                                                                       Indian Railway Medical Manual (IRMM) Chapter 7 Page 212 - 217. Majority of Trains have First Aid box as per Annexure IV (Page 212). It doesn't even have the basic medications which might be needed during travel. Tablets Diazepam being a scheduled drug can only be given after Doctor's prescription but don't know why it is still included. If one Google's we won't find Diazepam (sedative) in first aid box. On Rajdhani/ Shatabdi Express the First Aid box is as per Annexure V (page 213-14) which has more medicines kept under Train superintendent or Pantry Manager.    

                 When we compare it with the first aid box of other transportation industries like Director General of Civil Aviation(DGCA) link  

 http://dgca.nic.in/ftppub/D2X-X3%20(1%20DEC%202010).pdf                          (CIVIL AVIATION REQUIREMENTS SECTION 2 – AIRWORTHINESS & PROVISION OF MEDICAL SUPPLIES IN AIRCRAFT) It has First Aid Kit & Physician/Medical Kit with extensive detail list of all the Essential, Emergency Medicines & Equipments

Director General of Shipping(DGS)         

http://dgshipping.gov.in/Content/PageUrl.aspx?page_name=MedicinesMedicalStoresandAppliancesRules1994 Merchant Shipping (Medicines, Medical Stores and Appliances) Rules, 1994

            Its seems like 70 year’s Post Independence Railway Ministry is yet to figure out the content of its First Aid Box & Medical kit with the minimum Essential, Emergency Medicines & Equipment needed to be present always on board Indian trains. Being the largest transportation industry of the country it should at least learn from its counterparts. If the DGCA & DGS have issued such clear guidelines for airworthiness & seaworthiness than why Railway being transporter of lacs of passenger daily still carrying First Aid kits with Paracetamol & Diazepam.

            Traveling for long distance in Trains with poor food quality, unhygienic coaches, toilets dusty AC compartments, cold atmosphere, long journey hours, overcrowding predispose passengers to many illnesses like Diarrhea, Gastroenteritis, pain in abdomen, Fever, Cough/cold, Backache, Joint pain, children & elderly suffer from Airway reactivity, Allergy (Breathlessness) due to Dusty AC compartments which are never Vacuum treated, Injuries while boarding, Fall, stone pelting at train.       

             Besides these many ill passengers with morbid conditions like Asthma, Heart diseases, Diabetes, Hypertension, Renal stones, Epilepsy, Cancer etc. board Indian Railways need medicines & treatment immediately in Emergency. Ideally such seriously ill cases (i.e. cancer) should not be allowed to board train.      

              Supreme Court of India recently advised to keep Oxygen cylinder on Indian Railway which is needed in rare cases but minimum lifesaving medicines which need to be present always & at right time especially in emergency situation are more important than just an oxygen cylinder which itself can't save life.      

               If railway can’t maintain a First Aid box & Medical Kit with the minimum essential emergency medicines & instrument than why not start Medical Store on trains & Railway stations run by private contractors where people at least have an option to purchase medicines & a traveling doctor might be of immediate help.

A rough list of oral, inhaled medicines which should be made available on Indian Railway Medical Store. The DGCA & DGS list can also be used as a guide.

1. Analgesics (Pain killer & anti-inflammatory)  

a. Paracetamol (tablets for adults & syrup, drops for children's), b. Dicyclomine for pain in Abdomen (tablets, drops), c. Ibuprofen tablet & syrup, d. Diclofenac as oral tablets or local gel e. Tramadol for severe pain in cancer patients  

2.Antacids

a. Ranitidine, b. Omeprazole, c. Pantoprozole, d. Syrup Gelucil( liquid Antacid) 

3. Anti-Vomiting

a. Domperidone (tablet, syrup, drops), b. Ondansetron tablets, syrup, drops, patches) c. Chlorpromazine (tablets for adults & syrup, drops for children's)        Anti-Vomiting patches are very important in patients with Vomiting as drug is absorbed through skin.  

4. Antibiotics

a. Azithromycin (tablet, syrup, drops), b. Cefixime (tablets for adults & syrup, drops for children's), c. Norfloxacin Tinidazole / Ofloxaxin Ornidazole combination for Loose motion or Gastroenteritis. (tablets for adults & syrup for children's), 4. Oral Rehydration solution (ORS) powder sachets (200ml or 1 liter)            

5. Anti-Allergy

a. Cetrizine as tablets & syrup, b. Phenaramine( Avil) tablet & syrup, c. Hydroxyzine as syrup, d. Fexofenadine tablet

6. Motion sickness/ giddines

a. Cinnarizine tablet for motion sickness, b. Betahistine (Vertin) tablet for giddiness

7. Anti-Asthma

a. Salbutamol as tablets & inhalers, b. Deriphylline 150 or 300mg tablet, c. Formoterol Inhalers, d. Aerocort inhalers (Bronchodilator+ steroid combinations), e. Bricanyl solution (Salbutamol + Budesonide) for nebulization.

8. Antibiotic Betadine / soframycin / ointment / solution for local application to injuries

8. Antiseptic ointment / solution like Dettol/ savlon for local application to injuries

9. Roller Gauze / bandages / cotton wool/ Band-Aids for local dressing of Injuries.

10. GLUCOSE powder

11. Cough medications: mucolytic syrup, anti tussive syrup, Bronchodilator syrups for kids, antiseptic lozenges.

11. Sanitary pads

12. Chloramphenicol eye applicaps

13. Triangular Bandages

14. Anti-Diabetic, anti-Hypertension, anti-Epilepsy, anti-Heart attack, anti-Paralysis medications can also be kept in small quantity as standby only to be given after Doctor's prescription in case of emergency. Besides these the following instruments should be kept in case of emergency.

1. AMBU Bag with Mask & attached Oxygen reserve

2. Face mask adult & child

3. Nebulization machine with adult & child masks (every coach or at least the AC coaches be fitted with sockets to plug nebulization machine)

4. 5-10 liter Oxygen cylinders or a Machine which can deliver natural air at optimal pressure, temperature & humidity.

5. Automatic Blood pressure recording machine

6. Glucometer machine with glucose Strips

7. Stethoscope

                All these medicines can be kept in a shelf with proper labels easily understood my layman with Pantry Manager or Head TTE. The strips of these medicines can have names, guidelines written on it in English & Hindi. Blister kits of 2-3 doses for Diarrhea, common cold/ cough can also be procured. The TTE, Guards & the person in charge of the medications can be given basic training about the name, indications, dosage of these medications. Passenger can be charged as per MRP of the medicines. Charges for the use of these instruments be fixed & displayed. These medicines must be procured from reputed brands, preferably Generic, of good potency & efficacy.  

             Majority of these medications are sold as over the counter medicine in medical stores so it won't be a problem as far as law concerned with prescribing of medicines is concerned or if necessary help of onboard doctor passenger can be taken before prescribing these medications or Radio Medical Advice can be taken through phone/ SMS as it is taken in other transportation industries like Flights, Merchant Navy.

             The contract for maintaining the General medicines & medical instrument can be given to the same contractor who's running the pantry or through a central contract at zonal level ensuring uniformity of items available with periodic inspection by Railway Authorities. Outsourcing this Medical Store will also avoid Railways from any financial or manpower loss.

              Its my humble request to all the citizens of Indian to sign this petition & share it on all social networking sites like Facebook, WhatsApp, Twitter, Gmail etc. so that it reaches the PMO & Railway Ministry  and a definitive action is taken at the earliest in the interest of the Railway passengers & citizens of India. Also do share the medical issues faced by you during travel on Indian Railways in short so that the government understand the sufferings of passenger's.

              I humbly request our Honorable Prime Minister Shri. Narendra Modi & Railway Minister Piyush Goyal to look into this matter & allow Medical Stores onboard Indian Trains as well as on Platforms so that passengers easily get Paid & easy access to medicines & valuable time is not lost in case of emergency.

              Thanks for signing the petition...

                                                             Dr. Vijeta Kshatriya



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