Saving Time, Saving Lives: The Golden Hour as a Constitutional Guarantee in India

Shambhavi Singh

In trauma medicine, the “golden hour” is the first 60 minutes after a serious injury—the period when rapid intervention can be the difference between life and death. Countries have built emergency systems around this principle: in the United States, Emergency Medical Treatment & Labor Act obliges hospitals to stabilize emergency patients regardless of insurance status; the UK runs integrated trauma networks; Thailand guarantees free emergency care for the first 72 hours; and South Africa embeds the right to emergency treatment in its Constitution.

In January 2025, India’s Supreme Court in S. Rajaseekaran vs. Union of India, ruled that access to trauma care during the golden hour is not simply a matter of policy but a constitutional right under article 21—the right to life. The Court directed the Union Government to roll out a nationwide cashless treatment scheme for accident victims by March 14, 2025, warning that non-compliance would attract contempt of court. Trauma care became an enforceable fundamental right.

India’s road safety crisis underlines the urgency. In 2024, nearly 180,000 people died in traffic accidents, a 9% increase from the previous year; every three minutes, India faces a road fatality. Many of these deaths are preventable.

Only about 20% of accident victims reach medical care within the golden hour, and ambulance coverage is as low as one vehicle per 80,000–100,000 people—below the World Health Organization (WHO) recommendation of one emergency vehicle per 50,000 people. The Motor Vehicles Act already contained legal tools—Section 162 mandating golden hour treatment and Section 164-B creating a Motor Vehicle Accident Fund—but they remained dormant. In practice, police, not paramedics, are often the first responders, making survival a matter of chance rather than law.

Constitutionalising the golden hour

Indian constitutional jurisprudence on emergency care began with Parmanand Katara vs. Union of India (1989), where the Court declared that “preservation of human life is paramount,” requiring every doctor, public or private, to treat emergencies without delay.

Subsequent rulings deepened this framework: Consumer Education & Research Centre (1995) recognized the right to health for workers as integral to article 21; Paschim Banga Khet Mazdoor Samity (1996) held that denial of emergency care violates article 21 and directed states to establish referral protocols, designated hospitals, and budgetary measures; and SaveLIFE Foundation vs. Union of India (2016) gave binding force to Good Samaritan protections, encouraging bystander assistance.

These precedents gradually shifted responsibility from individual doctors to the state. But the 2025 Rajaseekaran ruling transformed this duty into a comprehensive state-funded trauma care system. The Court explicitly tied the dormant statutory provisions of sections 162 and 164-B of the Motor Vehicles Act to constitutional obligation and laid out strict timelines: a nationwide cashless treatment scheme with direct hospital payments, integration with national insurance and accident reporting systems, real-time digital platforms for registration and claims, streamlined documentation and audits, extension of coverage beyond seven days, strengthened ambulance standards, and completion of a national trauma registry. Most importantly, any administrative, financial, or procedural delay was declared a constitutional violation, enforceable with contempt powers. The Court’s detailed directions moved India from fragmented statutory measures to a unified, rights-based, and accountable trauma care infrastructure.

The ruling also resonates with international law. Article 12 of International Covenant on Economic, Social and Cultural Rights requires states to realize the highest attainable standard of health. The WHO Global Emergency and Trauma Care Initiative urges universal trauma systems, while SDG 3.6 calls for halving road traffic deaths by 2030. India’s constitutionalisation of the golden hour aligns domestic law with these global mandates.

Toward a landmark transformation

The government has already moved from promise to practice. In May 2025, India launched a nationwide cashless emergency treatment scheme for accident victims, covering expenses up to ₹1.5 lakh  (around US $1,800) for the first seven days. Hospitals empanelled under the program—including those in the country’s largest public insurance network (Ayushman Bharat)—are paid directly, eliminating upfront costs for patients. Registration, verification, and claims are processed through digital platforms (eDAR, an accident reporting portal, and the National Health Authority’s Transaction Management System). A dedicated budget of ₹272 crore (about $33 million) has been earmarked for 2025–2026 to cover uninsured or hit-and-run victims.

This is not theoretical. India’s experience with trauma care shows that when article 21 guarantees are judicially enforced, outcomes follow. Between 2018 and 2024, the government-supported ambulance fleet expanded to nearly 11,000 vehicles, reaching rural districts and cutting highway response times to 25–35 minutes. Tamil Nadu halved accident deaths from 17,000 in 2016 to under 9,000 in 2023 through golden hour triage and state-funded emergency care. Karnataka and Kerala corridors saw fatality drops up to 54%, while on the Mumbai–Pune Expressway, the Zero Fatality Corridor halved crash deaths through improved emergency care and better ambulance positioning.

These measures show that the Court’s directions are being translated into operational guarantees: cashless treatment, digital transparency, and financial backing. The golden hour is now a constitutional mandate, backed by enforceable rights and state accountability.

 Shambhavi Singh, BA, LLB, is a lawyer practising at the Supreme Court of India