Amidst all this development, how about a lane for ambulances?
In Dhaka, a city considered the slowest in the world, the absence of emergency lanes means the odds are often stacked against critical patients being transported in ambulances
The siren is deafening. So is the miking. With the loud traffic, only muffled instructions can be deciphered. "Move out of the way!"
Bumper-to-bumper traffic is common in Dhaka, considered one of the slowest cities in the world. And in the case of medical emergencies, the odds are stacked against critical patients being transported in ambulances.
Ambulance service companies, the majority of which are privately owned, face a myriad of problems including sitting idle in traffic jams.
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"If ambulances did not face as much traffic as they do every day, about 200 people could have been saved daily in Dhaka city," estimates Golam Mustafa, president of Bangladesh Ambulance Owners Association.
This begs the question: In the face of so many ongoing development projects in and surrounding Dhaka city, have emergency lanes been considered?
A broken system
A 2017 study in the International Journal of Critical Care and Emergency Medicine found that the majority of people in Dhaka city opt for alternatives to ambulances to reach a hospital in the event of a medical emergency. Out of the 734 patients surveyed across four Dhaka hospitals, the study found that only 11.3% arrived by ambulance.
The study also interviewed families of 56 emergency patients and 23 stakeholders. The results showed that 80.4% of the patients' relatives did not wait for an ambulance due to unavailability or because they did not know how to contact a service provider.
The median delay of ambulances was 85 minutes. But when calculating the time delay just during the daytime, the median was found to be 102 minutes.
According to Mustafa, there are more than 8,000 ambulances registered under the Dhaka Metropolitan Ambulance Owners Association, out of which, he estimates, around 1,000 are government-owned.
"There have been cases when a patient of drug overdose expired by the time the ambulance reached the hospital in Dhaka, let's say from Gazipur, not only for the traffic delay but also because the roads are so bumpy," Mustafa said.
He estimates that about 1,000 ambulances carry patients on a daily basis in Dhaka city, out of which 300 carry deceased bodies and 700 carry emergency patients. He further estimates that about 200 of those patients are in critical condition. And because of traffic delays, they are unlikely to make it to the hospital alive.
"Uttara to Dhaka Medical without traffic can take 40-45 minutes, but with traffic, that is a couple of hours-long ordeal. You have to understand that journeys via ambulances are not comfortable," explained Mustafa, adding, "Many families may not realise this, but every ambulance comes with an allotted oxygen tank. It's limited. It's a common occurrence that the patient expires because oxygen runs out."
Not just deadly traffic delays, but ambulance drivers face other barricades too.
"Especially on Fridays and Saturdays, ambulances get stopped more often by traffic police. Regardless of whether we are carrying patients or not, regardless if our papers are in order or not, they [traffic police] look for a cause for commotion. In many cases, we have to pay them Tk1,000-Tk1,500 to let us through," said Babu Howlader, owner of Howlader Ambulance Service since 2009.
"It is our first priority to let the traffic signal go if we hear about an incoming ambulance carrying a patient, or if we hear or see an ambulance siren," said a traffic sergeant (requesting anonymity) in the Mohakhali zone.
But there have been so many instances when we see ambulances sit gridlocked in at a signal. How do you explain that? "I cannot deny such cases. However, that happens, or generally, that is supposed to happen, when I have no wiggle space in front of me. Meaning there is no space for cars to move ahead of the signal," replied the traffic sergeant.
Then there is the general public, who do not "want to budge an inch," according to Babu.
"We are also told to turn off the siren as it's a nuisance!" he added.
"This is a system of culture. [This] should be part of driver licence training," said Shamsul Hoque, professor of Civil Engineering at Bangladesh University of Engineering and Technology (Buet), adding, "Priorities are given elsewhere. Ambulance or emergency vehicles have to be given its due priority."
Mustafa and Babu are not aware of any talks or initiatives regarding emergency lanes in Dhaka city plan projects. "Emergency lanes are absolutely imperative," said Mustafa, "It doesn't have to be dedicated only to ambulances, but to all medical emergencies."
In cases of cardiovascular arrest or stroke, according to doctors, it is extremely critical to get treatment at the earliest. Other cases such as car accidents or burn injuries also demand medical attention at the earliest. "In fact even in cases of dengue fever, we have seen cases when young children had to be rushed to the hospital. But ambulances were stuck in traffic, losing vital minutes," said Mustafa.
More than any other kind of injury, a cardiac arrest or brain stroke requires immediate medical attention. "This is because once either one of those events takes place, our heart cells or brain cells die. It is absolutely imperative to bring the patient under medical care to treat him/her and prevent further damage. Once the cells die, there is no way to revive the cell," said Dr Tushar Mahmud, Orthopedics (Sports Medicine), DMCH.
In the case of burn injuries, "the first hour is considered the golden hour for treatment. The earlier the patient is brought under medical care, the less damage he/she will incur," Dr Samanta Lal Sen, the Chief Coordinator of SHNIBPS told TBS in an earlier report.
Broken beyond repair?
But is it feasible for Dhaka city to have emergency lanes? Experts say that with the existing city plan, emergency lanes are not possible on every road.
"In the process of making short-term [city] plans, we have forgotten to prioritise important roads such as dedicated lanes," said Hoque.
"Public transport is the backbone of a city. And this has been overlooked. If we had proper dedicated lanes, let's say for buses, these could have been used as emergency lanes as well for ambulances, fire service, etc.," he added.
This negates the concept of a "smart" city, according to Hoque.
"There is nothing to hide here. One can call Dhaka, and its upcoming [city] plans 'smart' as much as possible, but without the most basic facilities, how can Dhaka be a smart city?" he asked.
"We have seen [the making of] Purbachal and Uttara. We have seen 14-lane roads in Dhaka, but with no emergency lanes. Why is that? It reflects the stark lack of urban planning or a vision to prioritise emergency vehicles," explained Hoque.
Not just in developed countries, but emergency lanes are also seen in African countries. "Three-lane roads have a designated middle lane which is used in case of all kinds of emergencies including medical," said Hoque.
There are three government agencies responsible for controlling traffic in Dhaka: Rajdhani Unnayan Kartripakkha (Rajuk), Dhaka City Corporation (DCC) and Bangladesh Road Transport Authority (BRTA).
"If these three agencies do not function properly, you cannot control the traffic congestion," Professor Hadiuzzaman from the Department of Civil Engineering at Buet told TBS in an earlier report.
When Maksud Hashem, Chief Town Planner, DNCC was contacted for his comment about any future plans to implement emergency lanes in Dhaka, TBS was redirected to a general councillor (DNCC), who was unreachable.
Sirajul Islam, Chief Town Planner, DSCC redirected TBS to Dhaka Transport Coordination Agency (DTCA).
"The thing about emergency lanes is that it is very much at the 'mico-level' of planning," said Muntasir Mamun, Technical Consultant, mid-term review and updating of the revised Strategic Transport Plan (STP). "The updated master plan will be ready by the end of next year or early 2025. Currently, we have study teams, surveys are being conducted… etc"
The STP (2005) was divided into four periods, of five years each, beginning in 2005 and ending in 2024. "It was revised in 2016 and now it [the revised copy] is being updated," added Mamun.
So will there be emergency lanes in the updated revised STP? "It is now too soon to tell at this stage. When it progresses further, these things will be finalised," he concluded.
