IntroductionAmbulance-based emergency medical systems (EMS) are expensive and remain rare in low- and middle-income countries, where trauma victims are usually transported to hospital by passing vehicles. Recent developments in transportation network technologies could potentially disrupt this status quo by allowing coordinated emergency response from layperson networks. We sought to understand the barriers to bystander assistance for trauma victims in Delhi, India, and implications for a layperson-EMS.MethodsWe used qualitative methods to analyse data from 50 interviews with frontline stakeholders (including taxi drivers, medical professionals, legal experts and police), one stakeholder consultation and a review of documents.ResultsRespondents noted that most trauma victims in Delhi are rapidly brought to hospital by bystanders, taxis and police. While ambulances are common, they are primarily used for interfacility transfers. Entrenched medico-legal practices result in substantial police presence at the hospital, which is a major source of harassment of good Samaritans and interferes with patient care. Trauma victims are often turned away by for-profit hospitals due to their inability to pay, leading to delays in treatment. Recent policy efforts to circumscribe the role of police and force for-profit hospitals to stabilise patients appear to have been unsuccessful.ConclusionsExisting healthcare and medico-legal practices in India create large systemic impediments to improving trauma outcomes. Until India’s ongoing health and transport sector reforms succeed in ensuring that for-profit hospitals reliably provide care, good Samaritans and layperson-EMS providers should take victims with uncertain financial means to public facilities. To avoid difficulties with police, providers of a layperson-EMS would likely need official police sanction and carry visible symbols of their authority to provide emergency transport. Delhi already has several key components of an EMS (including dispatcher coordinated police response, large ambulance fleet) that could be integrated and expanded into a complete system of emergency care.

Urbanization can change the local climate of an area, one manifestation of which is a rise in the local temperature of built-up areas, a phenomenon known as an urban heat island. The thermal response of built-up areas in comparison to natural areas is quantified in terms of surface urban heat island (SUHI) intensity. The work presented here evaluates the seasonal SUHI intensities in Delhi using local climate zones (LCZs) and conventional SUHI indicators in parallel. Statistical analyses are carried out to determine the relationship between them and to delineate heat stressed zones in the Delhi city region. The present study is the first one that utilizes LCZs for seasonal SUHI analysis in Delhi. The land surface temperature (LST) is assessed using a hundred and five night-time images from MODIS. Unambiguous night-time SUHI effect is seen for all seasons. The maximum night-time SUHI intensity is 3.5°C, between "compact low-rise" (LCZ 3) and "low plants" (LCZ D) in summer and winter. The conventional indicator "Inside urban-Inside rural" gives the highest night-time SUHI intensity of 3.3°C, in autumn. Statistical analyses show that "compact low-rise" (LCZ3) and "large low-rise" (LCZ8) are the most heat-stressed LCZs. The largest number of distinct thermal zones is created in the monsoon, followed by summer and winter. The results suggest that in order to minimize the UHI effect, further urban expansion in the Delhi region should be restricted to LCZ 5 (open mid-rise) and LCZ 6 (open low-rise).

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