“We are lucky if we get information about an attack within the golden hour”

Tuesday's Maoist attack that killed 76 personnel of the Central Reserve Police Force and Chhattisgarh Police and injured seven, shows that despite the sharp increase in troop deployment in Chhattisgarh, paramilitary forces are yet to formulate a medical evacuation plan.

Experts told The Hindu that while the Army, the Navy and the Air Force, had specific evacuation plans for encounter situations, the central paramilitary forces such as the CRPF, the Border Security Force (BSF) and the Indo-Tibetan Border Police (ITBP) did not have any.

Around the world, medical experts are agreed on the concept of the “golden hour” of evacuation in which the maximum lives can be saved. “All trauma patients, particularly in warzone situations, must be evacuated to a tertiary medical centre within 60 minutes if they are to survive,” said retired Admiral S.K. Mohanty, who served as a surgeon in Kashmir during the Kargil War. “During the Kargil operation, we lost only five of the 1,400 soldiers who made it to our hospital alive. Medical evacuation plans are of primary importance in any counter-insurgency operation.”

Admiral Mohanty's observations are backed by statistics from an article titled “Battlefield Trauma Care: Focus on Advanced Technology” by Russ Zajtchuk and Gordon R. Sullivan published 15 years ago in Military Medicine, the official journal of the Association of the Military Surgeons of the United States.

According to the authors, historic wound and casualty data suggests that more than 90 per cent of those severely wounded die within the first hour of injury unless treated with life support.

According to figures made available by the Chhattisgarh police, in 2008, 75 per cent of the troops injured by gunfire died as a result of their wounds. In 2009, 55 per cent of those injured by gunshots died, suggesting that current medical infrastructure is unable to deal with the stringent demands of mobile warfare. In Tuesday's incident only seven out of the total 83 soldiers wounded made it out alive — a post-injury survival rate of 8.5 percent.

“In Chhattisgarh, we are lucky if we get information about an attack within the golden hour, let alone evacuating people in 60 minutes,” said a senior police officer. “The lines of communication are poor and the telephones don't work.”

Despite having about 20 battalions of central paramilitary forces and an additional 6,000 state policemen (exact troop figures are confidential), in the Bastar Zone alone, Chhattisgarh has only five helicopters, none of which is specially equipped to provide mobile trauma care.

Officials also told TheHindu that these helicopters are routinely shared with neighbouring States in case of emergencies.

There are also no dedicated military hospitals. Injured troops are either flown to the Maharani Hospital in Jagdalpur or the National Mineral Development Corporation hospital in Dantewada.

After the latest attack, one helicopter flew multiple sorties to evacuate the injured to Jagdalpur. “We called for the second,” said the official, “But I don't think it made it on time.”