"Life most persistent and urgent question is what are you doing for others"

Humanity can be defined as quality of being human; the peculiar nature of man, by which he is
distinguished from other beings. Being human does not mean that an individual possesses humanity.
Humanity means caring for and helping others whenever and wherever possible. Humanity means
helping others at times when they need that help the most.

Humanitarian activities should never be performed in order to achieve fame or to gain a status symbol.
You can easily achieve fame by the work you do.

Happiness begins from the moment you do something for others. Those who consistently help others,
are happy, and do not come across any obstacles to their lives. Research indicates that they are less
stressed and experience improved mental health. Lifting the heavy bag of an old lady is humanity,
helping a disabled to cross the road is humanity and giving way to the ambulance is humanity.

"The sole meaning of life is to serve humanity"

--Leo Tolstoy

Do you know two out of ten people die in ambulance before reaching to hospital, this delay is the cause
of death and permanent disfigurement of the body.

Though trauma is the leading cause of death across the world, it is made worse in developing countries
because the victims are not being able to get treated on time. The delays in transfer of patients to
hospitals and the lack of adequate equipment, supplies and doctors in countries like Pakistan contribute
to the high death toll caused by trauma.

Dr Saeed Minhas, an associate professor of orthopedics at the Jinnah Postgraduate Medical Centre
(JPMC) while delivering a presentation on Accident-Trauma and Management during the first public
awareness program of Pak-China Med Cong held at the Pakistan Medical Association (PMA) House said
that Long distances over which casualties may have to be transported to reach a medical facility in
poorly maintained vehicles, the time taken for patients to reach hospitals and subsequent absence of
appropriate equipment and supplies, besides skilled doctors, are some of the reasons behind the high
mortality rate due to trauma.

"Life is not measured by the number of breaths we take but by the moments that take our breaths
away"

In emergency medicine, a term Golden Hour which is the time period lasting for one hour, following
traumatic injury being sustained by a causality or medical emergency, during which there is the highest
likelihood that prompt medical treatment will prevent death.1

R.Adams Cowley, the founder of Maryland's well-known shock trauma hospital in Downtown Baltimore,
famously said" there is a golden hour between life and death. If you are critically injured you have less

1 https://en.wikipedia.org/wiki/Golden_hour_(medicine)
than 60 minutes to survive. You might not die right then; it may be three days or two weeks later but
something has happened in your body that is irreparable." 2

Merrian-Webster online dictionary defines "Golden Hour" as the hour immediately following traumatic
injury in which medical treatment to prevent irreversible internal damage and optimize the chance of
survival is the most effective.

Motto of Vanderbilt life fight is:

"Give us an hour; We will give you a lifetime"

If this golden hour is spent while on the way to the hospital and patient wouldn't be able to get the
critical care, its outcome will be hazardous.

The 2nd edition of Prehospital Trauma Life Support said:

"The critical trauma patient has only 60 minutes to reach definitive surgical care or the odds of a
successful recovery diminish dramatically"

Thus first hour is the predictor of the outcome of the patients' life. Ambulances play a vital role in rapid
transfer of sick and injured to the health care and trauma centers where they receive definite care.
Various researches have been carried out by the various research centers and governmental and non
governmental organizations on national and international levels to estimate the role of ambulance in
saving patient's life.

The outcome after trauma is affected by the magnitude of injury, early care at the scene and transport
to the hospital3456. Western literature is replete with data on the principles of scoop and run (urgent
transfer for definitive care) versus stay and play (attempts on at the site stabilization) with proponents

2 "Tribute to R Adams Cowley, M.D.," Archived 2005-12-24 at the Wayback Machine. University of Maryland Medical Center, R Adams Cowley Shock

Trauma Center, Accessed June 22, 2007.

3 I.J. Mehdi Emergency medicine in Pakistan Ann Emerg Med, 27 (1996), pp. 8488

4A.B. Nathens, R.V. Maier, S.I. Brundage, G.J. Jurkovich, D.C. Grossman The effect of interfacility transfer
on outcome in an urban trauma system J Trauma, 55 (2003), pp. 444449

5R.W. Petri, A. Dyer, J. Lumpkin The effect of prehospital transport time on the mortality from traumatic
injury Prehosp Disaster Med, 10 (1995), pp. 2429

6 P. Zhu, J. Jiang Employment of trauma and injury severity score and a severity characterization of
trauma in the outcome evaluation of trauma care and their research advances Chin Med J (Engl), 111
(1998), pp. 169173
of both camps78910. In the stay and play policy, emergency response teams utilize the pre-hospital time
in managing and stabilizing patients.

The burden of trauma remains considerable in developing countries like Pakistan and the mortality rate
as a result of trauma is high11. In the year 2006 alone, 10,125 road traffic accidents were reported to the
police in Pakistan with 4193 fatalities (41.4%). These figures do not include cases that have not been
reported and therefore, underestimates the actual number of accidents. Homicidal attacks increased in
Pakistan by 55% over 10 years from 1985 to 199412 and road traffic accidents increased substantially
(17.5 times) in the 40 years from 1956 to 199613. Karachi, the largest city of Pakistan lacks an organized
public ambulance response system and because of the cruel reality that people don't give way to
ambulance during transfer to a hospital mortality is greatly increasing. Mock et al. found a six times
higher mortality of trauma patients in the setting of a developing country compared to an US trauma
hospital14. It is logical to assume that there would be a considerable number of preventable and
potentially preventable trauma deaths in-hospitals in Pakistan15.

In a study by Husain et al.16 conducted in Peshawar, there was a lower hospital mortality and higher
patient mortality associated with more than 12 h of pre-hospital time the lower hospital mortality with
increased pre-hospital time in his study, showed that patients with vascular trauma who are unable to
get early medical care never reach the hospital in time and are thus filtered out, reducing hospital
mortality. The association between pre-hospital time and outcome following trauma has been widely

7J.R. Border, F.R. Lewis, C. Aprahamian, J.A. Haller, L.M. Jacobs, A. Luterman Panel: prehospital trauma
carestabilize or scoop and run J Trauma, 23 (1983), pp. 708711

8C.D. Deakin, J. Allt-Graham Pre-hospital management of trauma patients: field stabilisation or scoop
and run? Clin Intensive Care, 4 (1993), pp. 2427

9C.R. Gold Prehospital advanced life support vs scoop and run in trauma management Ann Emerg
Med, 16 (1987), pp. 797801

10 S.G. King Stay & play vs. scoop & run JEMS, 28 (2003), p. 14

11
J.A. Razzak, S.P. Luby Estimating deaths and injuries due to road traffic accidents in Karachi,
Pakistan, through the capture-recapture method Int J Epidemiol, 27 (1998), pp. 866870

12
A. Ghaffar, A.A. Hyder, M.I. Mastoor, I. Shaikh Injuries in Pakistan: directions for future health policy
Health Policy Plan, 14 (1999), pp. 1117

13
A. Ahmed Road safety in Pakistan National Road Safety Secretariat, Ministry of Communications,
Government of Pakistan, Islamabad (2007)

14C.N. Mock, K.E. Adzotor, E. Conklin, D.M. Denno, G.J. Jurkovich Trauma outcomes in the rural
developing world: comparison with an urban level I trauma center J Trauma, 35 (1993), pp. 518523

15
A.A. Jat, M.R. Khan, H. Zafar, et al. Peer review audit of trauma deaths in a developing country Asian J
Surg, 27 (2004), pp. 5864

16S.T. Hussain, S. Aslam, R.A. Khan, P. Mannan, J. Khan, J. Collin An observational study of 256 cases of
vascular trauma in the north western province of Pakistan Ann R Coll Surg Engl, 83 (2001), pp. 388391
studied. It is believed that reduction in time between injury and definitive treatment improves the
outcome and is the concept behind the slogan of the "Window of opportunity" also known as Margin
of opportunity or Critical window. It is a period of time during which some actions can be taken that will
meet a desired outcome. Once this period is over the specified outcome is no longer possible 17.

In Pakistan the major reason behind the higher mortality is the poor transport system, lack of awareness
among people to give way to the ambulance. Everyone in this 21st century remains always in hurry,
everyone wants to reach to their destination before time, people prefer to use their own vehicle over
the public transport to reach their destinations as a result of which thousands of vehicles remain jam on
roads for hours including ambulances and even people have become so selfish that they don't give way
to the ambulance. Thus many of patients end up in ambulances before reaching to the hospitals. The
Golden Hour of patient care is thus spent on the road without giving any life saving measure to the
patient because it's also the fact that our country has poor ambulance services.

In addition the absence of pre-hospital care and poor inter hospital transfer facilities can be responsible
for secondary injuries, and lead to preventable deaths in the hospital. In Pakistan there is no air-
ambulance service available, overland transport is the only mean of transferring patients to the hospital.
Everyday many lives would be saved if ambulances carrying critical patients reach the hospital in golden
hour.

People should remember that their support will make a difference, if you are late to reach your
destination you may lose your one day salary but if an ambulance is late to reach the hospital a life is
lost forever. Give way to ambulance, somebody you love might be in there.

"Whoever saves one life, saves the world entire.

Thomas Keneally

With the increasing traffic on the roads, ambulances have a tough task in taking the patients to hospitals
on time. The motorists must move left making way for the ambulance on hearing the siren. More and
more motorists in the busy streets of Karachi, Lahore and other major cities of Pakistan are refusing to
yield to emergency vehicles like ambulances. Instead of clearing and pulling to the side of the road when
an emergency vehicle approaches, many motorists are racing ahead of ambulances or following closely
behind them to pass more quickly through traffic. Even worse, some people simply ignore the sirens
altogether, or leave their cars parked on narrow streets, creating a tight squeeze for ambulances.

Nearly 50% of the emergencies that hospitals receive each year are classified as high-priority where a
person is suffering from chest pains, breathing disorders, heart attacks, trauma or some other serious
condition. However unyielding motorists delay their arrival by precious minutes that often mean the
difference between life, death or severe brain damage. The bottom line is that people who dont give
way to the ambulances increase the chance that someone who is critical will die because ambulance
cant get them to a hospital fast enough to save their life.

Edhi Foundation is the single best foundation across Pakistan and one of the best social welfare service
providers across the world running on non-commercial, non-political, and non-communal basis, serving
round-the-clock without any discrimination of color, class, and creed is enjoying exclusive credentials in

17 https://en.wikipedia.org/wiki/Window_of_opportunity
the shape of awards and shields conferred upon Mr. Abdul Sattar Edhi(late) and Mrs. Bilquis Edhi by
governmental and non-governmental organizations on national and international levels for rendering
their exemplary services to humanity in multidimensional fields. One of the diversified fields in which
Abdul Sattar Edhi played his greatest role is Ambulance services including land, air, and marine
ambulance services during accidents to shift patients to hospitals, national and international relief and
aid assistance to the affecters of natural debacles, providing relief aid to refugees in various countries,
providing emergency services to the sufferers of drought, fire, and flood, saving the lives of drowned
people added with recovering dead bodies from the seas and floods. Earlier, there were just the St
Johns and Red Cross ambulances doing most of the work in the cities but the Edhi and Chippa services
have taken over in a big way. As of March 2016, the Edhi Foundation owns over 1,800 private
ambulance vans stationed in areas across Pakistan. The ambulance dispatchers in Karachi, one of the
busiest cities in Pakistan, have reported up to 6,000 calls a day, with the average response time for each
incident falling within 10 minutes, it is only possible if people give way to ambulance. It was also an Edhi
ambulance which responded to and picked up the body of the American journalist, Daniel Pearl, when
he was killed in 2002. Life of Edhi is proof of true love for humanity his Slogan is:

"Live and help live"

-Abdul Sattar Edhi

What do you do when you see an ambulance struggling for its way in the middle of the traffic fiasco?

It's the routine for many of us to push our way ahead, honking, saving our vehicle from all sides
screaming at others, getting screamed at, calling out names even on the ambulance drivers while on our
way in heavy traffic during peak work hours without thinking that someone we love might be in that
ambulance. Can our system and more importantly our people not adapt to a system where they
proactively start making way for an ambulance or we could have a pilot rider making way and clearing
the traffic ahead (A scene in the famous Amir Khan movie 3 Idiots?) It would not only save time and help
preserve the golden hour of emergency treatment but also increase the accountability of our citizens in
contributing to build a better emergency healthcare plan for public at large.

The VIP culture has spread across our country and is responsible for incidents like death in ambulances,
deaths at the doors of the health care centers only because traffic remain jam, routs remain closed for
general public for hours whenever any political leadership is going anywhere in the country even to
celebrate the birthday party of their loved ones. They even don't think that their this VIP protocol can
take away the life of a child fighting for his every breath with the death in a poorly organized ambulance
provided by the leaders for the patients, when this ambulance stuck in the middle of the traffic fiasco.
They are the leaders but still they don't want to give way to the ambulance at the cost of their VIP
protocol, then why other people will give way to the ambulance.

Lets be honest about one thing though. The political leaders are not the only one who enjoy their VIP
treatment. This is a culture spread evenly across Pakistan. It fuels its own expansion because in this
environment, those who do not have VIP protocol, who do not have taxpayer-funded protection
working privately for their own benefit, are perceived as weak and treated accordingly.

A public awareness campaign on respecting ambulance ' Right of way, entitled "Rasta Dein" was
launched in Karachi in 2016 as a part of health care in danger project. The results of danger project in
Karachi suggests that there is behavioral negligence among vehicle operators on road in regards to
giving way to ambulances18. A mass media campaign was conducted to give people awareness regarding
giving way to the ambulance. According to this study traffic congestion and resistance/negligence were
the two main factors that are responsible for not giving way to the ambulances. Several other factors
like VIP movements, sudden stoppage of minibuses on roads, obstruction by public transport, obstacle
by a single vehicle and constructive processes on roads leading to obstruction are also responsible for
the fact that people never want to give way to the ambulances. A conclusion was drawn that mass
media campaign play crucial role in creating awareness among people. The reason behind the success of
the media campaign could have been due to careful planning in which potential moderators of the
campaign's effectiveness were addressed. Thus to achieve a sustained behavioral change over a long
period, periodic mass media campaigns should be organized and on aired through different media
channels.

In normal days, during normal commute we often witnesses many such scenes where an ambulance had
a tough time negotiating around one dump fellow. It's a saddening thought that how anyone took
precious minutes of an unknown fellow inside that ambulance while he don't know that someone he
loves might be in that ambulance. If just by giving way to the ambulance we can save someone's life let's
do that, "Give way to the ambulance and save life."

"We are all cells in the same body of humanity"

Due to this brutal reality that people don't want to give way to the ambulances as a result of which
ambulances will have to stay stuck in traffic jam, even the ambulance drivers are not willing to take the
patients to the hospitals in case of local strike for any cause, if any ambulance driver agree to take the
patient in that case a lot of events occur on the roads, from the death of the daughter in her father's lap
to the birth of the child in ambulance. Hospitals are meant to save the life of the person, to deliver the
babies and to offer the basic health care to the citizens but if this melodrama will always occur on the
roads and people will not become willing to give way to ambulances then in that situation hospitals will
remain abandoned and the people's mortality and morbidity increase rapidly.

Ambulances rush to take patients to the hospital on time. But quite often, ambulances fall short because
of time, the congestion and negligence on the roads. And few minutes of the delay claim several lives
every year. Though we know the rules, we unconsciously put our own needs before others and dont
give way to ambulances. Unless we rectify our behavior and learn road etiquette, this sad scenario is
going to stay the same. Let us be more responsible, vigilant and get disciplined on the roads. Let us
refrain ourselves from such negligent attitude and pledge to always give way to an ambulance. You
might get little late for your work or home, but your one-act of responsibility would make sure that
someone, somewhere, makes it to the hospital bed on time. Give Life A Chance By Giving Way To An
Ambulance.

Ignorant, unsympathetic, cold-hearted. Have you ever thought what describes you the best? Incidents
or accidents can happen anytime with anyone anywhere. Is this happening only in Pakistan or in every
country of the world? Why is everybody turning cold-blooded?

18https://www.dawn.com/news/1245020/do-you-move-out-of-an-ambulances-way-a-childs-life-could-depend-
on-it
"Different places and one issue!

Why do people behave like illiterates? Is something more important than saving someones life?
Nothing is going to happen if you reach your destination a little late. But somebody will live. And that
will make you happier. Lets just swap someone that you love, with the one fighting for life in that
vehicle. Would u still not give way to the ambulance? No.

So, if you hear a siren or see the flashing lights, you must pull over to the left until the ambulance
passes.

"Go left, save a life. Someone you love might be in that ambulance."

Everyone knows the value of few seconds, minutes, hours at the time of medical emergency, we need
not be a doctor to know the emergency situation but if we are benevolent and having a humanitarian
care for others, we can save a life by just giving way to the ambulance. Seconds are precious to keep a
dying heart pumping. A few minutes is all it takes for the brain to lose oxygen completely from the time
the heart stops beating. Then life is taken. Millions of heart attacks happen every year, out of those
many patients die because they cannot make it to the hospital on time only because people don't give
way to the ambulances.

These are the problems encountered not only in Pakistan but also in other countries of world as well. A
number of campaigns have been run in various countries to create awareness among people on this
issue. A number of laws have been made by the governments regarding this issue in several countries of
world. In India a number of campaigns by the name of "Giving way to the ambulance" have been run in
various cities to create awareness among people. Not only in India but also in the countries like Dubai
and Australia various mass media campaigns are organized by the governmental and non governmental
organizations to reduce the pre-hospital mortality rate.

Several interviews of the ambulance drivers are conducted by the different organizations in different
cities of the Pakistan to know about the problems they encounter during their job. One of them was
they face difficulty while making their way in heavy traffic and that's because people don't give way to
the ambulances. Rather they move in front of the ambulance so that when other people make the way
for the ambulance they take advantage of it and move hurriedly from the heavy traffic and save their
time. Ambulance drivers also narrate different sad stories that happen due to this selfish act of people.
Many newspapers and magazines publish such interviews of and on as a mean to create awareness
among the people. Not only this that people don't give way to the ambulance but also that they don't
slow down the speed of their vehicles and sometimes it results in collision with ambulance. I just
remember such incidence that I read in newspaper that A woman and her 22-year-old son were among
five persons died when the ambulance they were riding in was hit by a truck in Dadu. The other persons
killed in the accident were a relative of the deceased victims, the ambulance driver and his cousin. It's
not a single incidence, daily newspapers are filled with such stories.

In an emergency, it is not a matter of minutes rather seconds that can save a patients life. Cardiac
Pulmonary Resuscitation (CPR) in many cases can save a patients life if he or she is brought to the
hospital in time. So it is a matter of seconds which can save a patients life. Besides, life saving the next
most important concern is to minimize the damage. If a patient leaves the hospital alive but with a
deformity that is also condemnable and many deformities occur due to delay in reaching the hospital.
Yes, that's the reason every second matters.

What we all need to do to facilitate ambulance in traffic?

Being a responsible citizen its our first and foremost duty to facilitate emergency vehicles in traffic. Its
the duty of every citizen to play its role in doing so. Its not an individual work its a team effort but its
said that:

"Charity begins at home"

So to create change we will have to be changed. We will have to start playing our role in facilitating the
others. We will have to be the role model for others. Many people look to someone to serve as a model
or motivator for their life. They want someone to look up to, who has good values and a sense of
humanity and integrity. Most people choose one person to act as their guiding light for their life. What
we all need to do? We should try to be the guiding light for the all those who drive, by giving way to the
ambulance. No one is perfect but everyone has few traits that can be admired. We will have to develop
those traits. One of them is humanity. We will have to show our humanitarian nature by helping others
like when we are on the roads we can play our part to facilitate the ambulance in the traffic.

The question arises what we should do around the ambulance?

Slow down

Move left to give the vehicle a clear run down the middle of the road. If you can't move left safely, stay
where you are and let the emergency vehicle overtake you

Not move your vehicle suddenly

Not drive into the path of the emergency vehicle

We should develop a sense of situational awareness. People often dont notice that an ambulance is
approaching them until its getting close, even though it has been approaching them for a mile. There are
a lot of distractions in cars now. We need to stay aware of our surroundings. A lot of cars these days
have noise cancelling engineered into them, then what are sirens for? Only noise. Its becoming
increasingly common that people just dont hear the sirens until an ambulance is upon them, and then
they panic because, from their angle, it just appeared out of nowhere. Keeping a window cracked breaks
a little bit of the noise cancelling and will let them hear sirens much sooner.

The lights and siren are the request for the right of the way. Its your choice whether you fulfill that
request or not. If not; you will do that at the cost of someone's life. So acknowledge the request of the
ambulance by moving out of the way using your indicator and slowing down. People, even the literate
ones don't understand the urgency, criticality and trauma faced by the ambulance driver, the staff and
the family who want their loved one to reach the hospital on time and get immediate medical attention.
There must be awareness campaigns to give way to these ambulance.

A move over law is a law which requires motorists to move over and change lanes to give safe clearance
to law enforcement officers, firefighters, ambulances, and in some cases, tow-truck drivers. In the past,
Canada and United States have used this term to apply to two different concepts; however, this is
beginning to change as Canadian provinces have begun expanding the scope of their move over laws 19.
In Canada, the move over laws are intended to encourage the fast response of emergency vehicles.
These laws require motorists, upon noticing an incoming emergency vehicle (coming from any direction)
with sirens or flashing lights operating, to move to the farthest right lane/shoulder and stop, until the
vehicle has passed the vicinity. Move over laws were originated in the United States after a South
Carolina paramedic, James D. Garcia, was struck and injured at an accident scene Jan. 28, 1994, in
Lexington, SC. Garcia was listed at fault, leading to his work to create a law to emergency responders.
SC's version (SC 56-5-1538) passed in 1996, and was revised in 2002. After a series of similar events
across the US in 2000, the US Department of Transportation and Federal Highway Administration began
to address the issue of Emergency Scene Safety, and issued recommended changes for the new Manual
of Uniform Traffic Control Devices (MUCD) that finally addressed the need for improved standards and
protection for Emergency Workers. With the further assistance of public interest groups such as the
Emergency Responder Safety Institute, "Move Over Laws" became standard across the US and Canada 20.
The laws require drivers, upon noticing either emergency vehicle with sirens and/or flashing lights, to
move away from the vehicle by one lane, or if that is not possible, slow down to either a reasonable
speed or a fixed speed below the limit as defined by local law. This includes law enforcement vehicles,
fire trucks and ambulances.

Responding to an emergency is probably the most dangerous situation that an ambulance faces on a
daily basis. The danger is mostly due to the unpredictability of other motorists. Every ambulance driver
has a story:

The vehicle that pulls in front of them.

The driver that they follow for more than a mile.

The driver that stops in the middle of the freeway.

The driver that pulls to the left.

The driver that suddenly jams their brakes when they see the lights.

So what should we do?

Always be aware of what is going on around us.

Never assume that the lane that was clear a few seconds ago is still clear.

Dont panic!

Move to the Right, Never to the Left!

19 https://en.wikipedia.org/wiki/Move_over_law
20 Ministry of Transportation (Ontario) Public Notice
Never assume there is only one emergency vehicle. More then one can be there. So always keep space
for others as well.

There are many times when a few minutes or even seconds can make the difference. Thats why value
the request (siren and lights) of ambulance and save a life.