Ambulances Trapped in Traffic: Kashmir’s Golden Hour at Risk

✒️ :. Dr. Fiaz Maqbool Fazili

An ambulance trapped in gridlock represents one of healthcare’s most tragic paradoxes: life-saving technology rendered helpless by infrastructure designed for a world that no longer exists. When an emergency vehicle cannot reach its destination, every minute of delay translates into dying brain cells, irreversibly damaged heart muscle, and preventable deaths. Recent incidents near Alijan Road and along National Highway 44 underscore a grim reality—our roads, laid sixty to seventy years ago, were never designed to accommodate today’s traffic volumes, let alone facilitate emergency response during the critical golden hour.
Advanced ambulances without suitable roads, road space and traffic control are like procuring advanced aircraft without a runway. We highlighted this point years ago at SKICC when an advanced ACLS ambulance was displayed. I recalled Kashmir’s first such ambulance, generously donated by the late Nisar Bakshi, facilitated by Dr. Mir Rouf and Dr. Nahid. As an ACLS consultant involved in emergency-transfer protocols, I humbly shared a genuine concern: “We are bringing a jet aircraft to an airport where there is no runway. “The message remains relevant: a sophisticated ambulance cannot save lives if it is trapped in congestion. Without dedicated road space, disciplined traffic control, and public awareness to give way, precious minutes of the Golden Hour are lost.The ambulance may be advanced. The emergency system must be equally advanced.

The mathematics of our failure is brutally simple. When Kashmir’s first Advanced Cardiac Life Support ambulance was inaugurated years ago, the event symbolized progress. Yet beneath the celebration lurked an uncomfortable truth that I shared quietly with a colleague that day: “We are bringing a jet aircraft to an airport where there is no runway.” The ambulance was world-class, equipped with sophisticated monitoring and resuscitation technology. But the system surrounding it was not. A sophisticated vehicle cannot save lives if it spends the golden hour trapped in traffic, its advanced capabilities rendered useless by congestion.

The Anatomy of Emergency Failure; Consider what happens when an accident occurs in Srinagar today. Crowds gather immediately—curious onlookers recording videos on mobile phones, some offering water to semi-conscious victims (an act that can actually cause fatal aspiration), while relatives make frantic phone calls. Traffic comes to a standstill. When an ambulance finally arrives, or when families settle for an autorickshaw, the patient is transported over bumpy roads with potholes, causing secondary injuries. Even if traffic police desperately attempt to create a corridor for the ambulance, vehicles have nowhere to move. They cannot disappear, cannot reverse hundreds of metres, and cannot move laterally. Emergency lanes do not exist. Footpaths have been encroached upon. Road shoulders have vanished. Every available inch is already occupied. The problem transcends traffic management—it is fundamentally a problem of traffic mathematics and engineering. No amount of whistle-blowing by traffic personnel can manufacture road width where none exists. Even ten thousand traffic officers cannot alter road geometry. We often criticise the traffic police unfairly; they cannot regulate what was never designed to be regulated.

The Siren Syndrome; A more insidious challenge has emerged: the siren itself has lost its meaning. VIP cavalcades, escort vehicles, and official movements have historically commanded priority on our roads. More troubling is the private misuse of sirens—unauthorised vehicles displaying “Emergency” or “On Duty” boards. The result is what might be called the “Siren Syndrome”: 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 as rule of law gives way to a culture of privilege.This is profoundly 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, a friend, or even ourselves.

What Emergency Systems, prehospital phase should look like; In developed emergency medical systems, an ambulance represents 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 minutes, a coordinated command centre activates. GPS identifies the nearest trained paramedic team, outsourced to organisation’s like 911- or red crescent etc . Dispatchers communicate simultaneously with police, hospitals, fire services, and transport authorities. Highly trained first responders (BLS, ATLS, ACLS, PALS certified) often reach victims within minutes. Life-saving interventions begin at the roadside—not after arrival at the hospital.

Modern resuscitation follows a systematic ABCDEF approach: Airway management with cervical spine protection, breathing with oxygenation and ventilation, Circulation or catastrophic haemorrhage control, Disability assessment using neurological evaluation, Exposure for complete examination, and Further care including definitive treatment and reassessment. Meanwhile, traffic management systems automatically create green corridors. Motorists instinctively yield to ambulances, fire engines, and emergency responders. This culture is taught from childhood and reinforced through strict enforcement. The ambulance hardly stops. Hospitals receive advance notification and prepare before the patient arrives. Compare this with our reality. An accident occurs. People gather and record videos. Someone searches for private transport. Someone gives water to a semi-conscious victim. Relatives make frantic calls. Traffic remains stationary. When the ambulance arrives, it becomes another victim of congestion.

The Path Forward; The solution does not lie in acquiring more expensive advanced ambulances. 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 must 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 require fundamental 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 runways after purchasing advanced aircraft.

A Shared Responsibility; As acute care emergency surgeons often say, 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.

Encouragingly, some initiatives demonstrate what is possible. A WhatsApp network of doctors conceived by Dr. Imran Hafiz, HOD Cardiology SKIMS, has reportedly saved over 6,000 lives through early intervention since 2017. This is how Kashmir is curbing heart attack deaths. But such grassroots efforts cannot substitute for systemic reform. 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.

A Measure of Civilisation; 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 acting as emergency response team—can reach a dying patient and return safely with a living one. That is the smartest measure of urban civilisation.This issue has been a long-standing public demand, especially from Kashmiris returning from overseas who have experienced disciplined emergency response systems where motorists instinctively yield to ambulances. Respecting the ambulance siren is not merely a traffic rule but a moral, civic, and humanitarian obligation. The greatest lesson remains as relevant today as it was when that first ACLS ambulance was unveiled: buying sophisticated ambulances is relatively easy. Building a system worthy of them is infinitely harder. Until we acknowledge this fundamental truth, every ambulance will remain a jet aircraft without a runway—sophisticated, expensive, and tragically useless when it matters most.

(Author is an Acute Care Surgeon and healthcare policy analyst. ATLS and ACLS certified, he has worked as advisor to the health Ministry on emergency and prehospital care reforms, protocols, quality improvement-drfiazfazili@gmail.com)