100, 101, 102

When a deadly debris flow on the night of 12 July swept two intercity buses into the Trisuli River along the Mugling highway, it took more than an hour for rescue to arrive as shocked survivors groped in the darkness.

One bus had left Kathmandu for Gaur with 36 passengers the previous evening. The other was heading to the capital from Birganj, carrying 26 passengers. 

Three passengers managed to escape from broken windows and climb back up to the road in pouring rain. They then sought help from vehicles stuck on either side of the landslide to get themselves to the hospital. 

Security forces and the Chitwan District Administration Office reached the site soon after they were notified. A team from the Armed Police Force’s Disaster Management Training School (DMTS) in Kurintar arrived soon after. The Nepal Army division in Bharatpur was notified at 4:30AM, and a Quick Response Team (QRT) was immediately dispatched. Nepal Army divers arrived in the morning.

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In the fortnight since the tragedy, up to 500 trained rescuers have been working to find the buses (pictured). So far, the bodies of 25 passengers have been recovered, two from downstream in India. A 12-member team from the Indian National Disaster Response Force also arrived to help in the search.

“Search and rescue operations in an accident like this typically last for 10 days,” says Khimananda Bhushal of the District Administration Office in Chitwan. “But we have to keep going until we locate the buses.” 

Rescuers have used rafts, anchors, air and water drones, as well as magnets to search for the missing buses and the remaining passengers. The Indian team is said to have sonar for the underwater search. 

“We have dedicated units for disaster response in our security forces, we have enough trained manpower to respond to most disasters,” says Bharat Mani Pandey, former joint secretary of the NDRRMA (National Disaster Risk Reduction and Management Authority). 

The Nepal Police has 1,250 personnel while the Nepal Army has more than 1,200 members assigned for disaster risk reduction and management. There are 2,500 others in the APF with disaster management training. All districts have District Disaster Management Committees. 

Water

So far this monsoon, 133 people have died in floods, landslides and drownings and 147 others people have sustained injuries. Seven people across the country are missing. 

Many of the highway fatalities are a combination of bad roads that are not built to be safe during monsoon rains. The road network has expanded, there are more hospitals with trauma care and ambulances, but Emergency Medical Technicians (EMT) are still not available in much of Nepal. Most ambulances are actually just ordinary vans to trasnport the injured to hospitals, with no specialised emergency care equipment.

Much of Nepal’s pre-hospital emergency care is dependent on bystanders and passersby who self-mobilise to get injured people to hospital after accidents, especially on Nepal’s rural highways where ambulances and EMTs cannot reach on time. But even though well-intentioned, such first responders are rarely trained in emergency care and protocols. In many cases, improper handling of the injured does more harm than good. 

Roads

Road Traffic Accidents (RTAs) take more lives annually in Nepal than floods, landslides, plane crashes, and other accidents and ‘natural’ disasters put together. There have been 21,287 road mishaps in Nepal so far in 2024, resulting in 2,198 fatalities and 5,713 serious injuries. 

The Nepal Ambulance Guidelines 2021 defines an ambulance as ‘a vehicle to transport patients that include ambulance equipment, sirens, GPS, a trained driver and an EMT’. 

But there are only 705 ambulances equipped with GPS across the country, and only 81 offically approved. Ambulances have to be certified as Type A Advanced Life Support (ALS) ambulances, or Type B Basic Life Support (BLS) ambulances.

There are 119 trained EMTs and 929 trained ambulance drivers certified by Nepal’s National Health Training Center. Meanwhile, there are 30 trained dispatchers who work out of 11 ambulance dispatch centres across the country. These dispatchers respond to 102, the emergency number for ambulance services in Nepal. 

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The Nepal Red Cross Society (NRCS) operates 242 Type A, 60 Type, and 182 Type C ambulances across Nepal. Type C is essentially a normal transport vehicle.

And while accessibility, technology, and skilled human resources were always a challenge for Nepal and its relatively basic pre-hospital services, this was made glaringly obvious during the 2015 earthquake, says Bal Krishna Sedai, deputy director of the NRCS.

“We realised that Nepal’s pre-hospital care system was in no way prepared to handle mass casualty events,” Sedai explains. 

Ambulances are a 24-hour service, but Nepal’s laws state that no individual can work for more than eight hours. This means each ambulance would need three EMTs and three drivers and that is near impossible because of budget constraints.

“The government has been unable to allocate enough human resources to sustain pre-hospital care,” adds Sedai.

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Nepal’s topography hinders first responders from getting to accident or disaster sites on time, even though they are ideally supposed to be there within 15 minutes in the Tarai, and within 30 minutes in the mountains. 

Says Sedai: “We urgently need to map where ambulances need to be stationed across the country in order to provide effective service, and this must take into account Nepal’s geography and population density.”

Quakes

Disaster response and management is perhaps most critical in times of mega-disasters like earthquakes that Nepal is prone to. Himalayan seismologists have warned that 2015 was not the Big One, and neither was the Jajarkot earthquake last November.

Yet, the country remains unprepared. Among others, it lacks modern equipment for search and rescue from reinforced concrete buildings.

In the aftermath of the Jajarkot earthquake, 915 Nepal Army, 853 Nepal Police, and 35 APF personnel had been deployed for search, rescue, and relief by the 10th day after the disaster.

“A mega quake in western Nepal will impact the whole country, including northern India. This is a level of disaster the whole country needs to be prepared for, not just western Nepal,” Surya Narayan Shrestha of the National Society for Earthquake Technology (NSET) wrote in Nepali Times last year. “Given how disaster-prone we know Nepal is, we must seriously put our efforts and money into reducing the risks.” 

While ambulance services have been integrated to operate under the 102-dispatch system across Nepal following the National Ambulance Guidelines 2021, experts say that Nepal needs an integrated emergency response system. At present, emergency numbers 100, 101, 102, and 103 puts people in touch with the police, fire services, ambulance services, and traffic police respectively.

Former NDRRMA Joint Secretary Bharat Mani Pandey coordinated an 11-member task force earlier this year that included members from key ministries as well as security forces to develop an integrated emergency information system so they do not have to dial different numbers for police, ambulance, or fire.  

“We found that police is the most contacted agency even when people are in need of ambulance or fire rescue services,” says Pandey. “We must have a command centre that incorporates different emergency service providers into an integrated response system.” 

Fire

Fire support services are in an even woeful state, especially given the record-breaking wildfires threatening settlements this year. There are only 211 fire brigades in Nepal, which means one fire engine per 110,254 people across the country. More than 1,100 people have died in forest fires and household fires in the last decade. 

“Our fire response system is very weak to put it bluntly,” admits Sundar Sharma at the NDRRMA. “211 fire brigades is not nearly enough, and we do not have enough trained firefighters and first responders.” 

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As it is, trauma care and infrastructure are inaccessible to a large number of Nepalis. Tertiary hospitals that specialise in trauma and critical care are largely centralised in urban areas, and the rescue, ambulance, and medevac fees are unaffordable for most.

There is also limited clarity and knowledge of which hospitals and health institutions are primary, secondary, or tertiary, which is crucial for emergency responders and medical professionals to direct trauma patients to relevant hospitals on a case-by-case basis. That way, first responders can triage survivors of accidents and disasters.

“There is a weak link in our life-saving mechanisms between accident sites and hospitals, and we do not have enough trained emergency responders,” Raju Dhakal of the Spinal Injury Rehabilitation Centre in Sanga told Nepali Times, citing a spate of highway mishaps killed more than two dozen people and injured many more within a week last year.

He added: “Even not-critical injuries become life-threatening because police and rescuers do not reach accident sites on time, or are not trained in handling spine or head injuries.”