ABSTRACT
Introduction:
Road traffic injuries are the eighth leading cause of death in India. The Law Commission of India report says that 50% of the victims who died of preventable injuries could have been saved had they received the medical care on time. To protect the people who help road accident victims, Good Samaritan Law was enacted.
Objectives:
To assess awareness and knowledge about Good Samaritan Law among the general literate population and to assess the impact of awareness session on awareness score.
Methods:
In this cross-sectional study, adult participants of either gender, literate enough to read and comprehend the material provided, were included in the study through either an electronic or written informed consent process. The participants were asked to complete a questionnaire, watch/read the awareness video/material provided, and then complete the post-awareness session questionnaire. The participants were divided into the aware and unaware groups for further assessment of pre-awareness scores. The pre- and post-awareness session scores were compared in the participants using paired-t-test.
Results:
In this study, 379 participants gave consent for participation; however, only 288 participants attempted the post-awareness questionnaire. The mean pre-awareness session score was significantly higher in the aware group (8.5) as compared to the unaware group (5.6). The pre-awareness scores were significantly high in doctors as compared to medical students in the aware group and as compared to medical students, graduates, teachers, and general public in the unaware group. Post-awareness session scores (9.2 ± 2.8) were observed to be significantly higher (p < 0.001) than pre-awareness session scores (6.4 ± 3.4).
Conclusion:
In this study, it was observed that the percentage of participants who were aware of the law was less. It demonstrated the impact of awareness session on increasing GSL awareness score in participants. These findings indicate the need of awareness programs to transform bystanders into good samaritans.
Keywords: Accident victims, good samaritans, road traffic accidents
Introduction
Road traffic injuries are the eighth leading cause of death in India.[1] Over the past two and a half decades, the burden of road traffic injuries in India has increased, while that due to many infectious diseases has declined. Among young adults aged 15–49 years, road traffic injuries are the fourth leading cause of death and health loss.[2]
The effectiveness of many proven health interventions declines with delays to care, and timeliness is a critical dimension of quality. Every 10-minute delay in total pre-hospital time was associated with a 6% increase in the odds of a poor functional outcome. Poor functional outcome indicates severe disability in daily life or death.[3]
Bystanders’ quick response to the road accident victims is required for saving the lives, but the majority of them do not respond due to hassles from police, courts, hospitals for payment of bills, and so on.[4]
The Law Commission of India report says that 50% of the victims who died of preventable injuries could have been saved had they received the medical care on time.[5]
To protect the people who give information or help road accident victims, Good Samaritan Law (GSL) was brought in, but the majority are unaware of the law and do not extend help to accident victims.[6]
Therefore, there is a need to create awareness of GSL in medical professionals working in the public sector, which includes primary, secondary, and tertiary care set-ups and private sectors, which includes clinics and hospitals, as outcomes in victims can be improved if emergency care is provided immediately and to make them aware that they are liable if GSL is not complied with in word and spirit. It is equally important that the general public, both educated and uneducated backgrounds, are aware of this law so that they extend help to the accident victims.
A Good Samaritan is a person who, in good faith, without expectation of payment or reward and without any duty of care or special relationship, voluntarily comes forward to administer immediate assistance or emergency care to a person injured in an accident, or crash, or emergency medical condition, or emergency situation.[7]
This study was therefore taken up to assess awareness and knowledge about Good Samaritan Law among the general literate population and to create awareness regarding GSL and assess impact of awareness sessions.
Methodology
This study was done after obtaining IEC approval from AIIMS BBN-IEC on 07/07/2021. The study was designed in accordance with Good Clinical Practice guidelines. This was a quasi-experimental, cross-sectional, questionnaire-based study. This study was conducted to assess the awareness regarding Good Samaritan Law in the general literate population of Telangana.
The primary objective of the study was to assess the knowledge and awareness regarding Good Samaritan Law, and the secondary objective was to assess the effect of awareness session on knowledge of Good Samaritan Law.
This study was done after obtaining IEC approval in literate adult participants after obtaining either written informed consent or electronic informed consent. Adult participants of either gender aged between 18 and 60 years and literate enough to read and comprehend the questionnaire and material provided were included in the study.
The participants, who were recruited through electronic consent form, after consenting, could access the electronic questionnaire (google form) that included questions pertaining to demographics, education, and 13 questions to assess the knowledge and awareness of the GSL. Then after submitting the pre-awareness questionnaire response, the participants could get access to an awareness video of 2 min. After watching the video, the participants could access the post-awareness questionnaire that was the same as the pre-awareness questionnaire.
The participants recruited through printed written informed consent forms, after consenting, were given the printed questionnaire with questions pertaining to demographic and education details and 13 questions to assess the knowledge and awareness of the GSL. Then after completing the pre-awareness questionnaire, the participants were handed over printed material to create awareness related to GSL. After reading the material, the participants were asked to complete the post-awareness questionnaire that was the same as the pre-awareness questionnaire.
The contents of the questionnaires by both electronic and printed modes were the same. The knowledge and awareness of GSL were assessed from pre-awareness responses. The awareness score was computed for each participant. The maximum awareness score was 13 marks for 13 knowledge-based questions. The participants were then divided into two groups, aware and unaware, based on the response to the question no. 16 “Are you aware of Good Samaritan Law?” for further analysis of pre-awareness session scores.
Pre-awareness session scores were then compared between aware and unaware groups. In addition, subgroup analysis was done to compare the pre-awareness session scores by occupation for which participants in aware and unaware groups were categorized into five groups by occupation as doctors, medical students, graduates, teachers, and general public. Similarly, subgroup analysis was done between aware and unaware groups for different age groups and between those who assisted accident victims and those who did not.
The pre-awareness session scores were compared with post-awareness session scores to assess the effect of awareness session on knowledge regarding GSL. In addition, the impact of video-based awareness session and print-based awareness session was also assessed.
The data thus obtained were described as mean (SD) for quantitative variables and percentages for categorical variables. The pre-awareness session scores were compared between aware and unaware groups using unpaired-t-test after testing for normal distribution. Sub-group analysis for age group and occupation was done using one-way ANOVA for both aware and unaware groups, while unpaired-t-test was used for gender and assistance. The pre-awareness session scores and post-awareness session scores were compared using paired-t-test. A p value of less than 0.05 was considered significant.
The sample size was estimated as 379 participants in the study considering sample proportion of participants with awareness as 56% for general public estimate taken from a previous study done at Delhi by Verma S et al.,[5] with a margin of error of 5% and a confidence level of 95%.
Results
In the study, a total of 412 participants were invited to participate, of which 379 (91.9%) gave consent, while 33 (8.1%) participants did not respond (non-responders). Of the 379 participants who responded to pre-awareness questionnaire, only 288 participants attempted the post-awareness questionnaire [Figure 1].
Figure 1.
Participant flow diagram
The responses of 379 participants were evaluated. It was observed that 58 responses were incomplete; therefore, they were not included in the study. The 321 participants were then divided into two groups, aware and unaware, for further analysis of pre-awareness session scores. The percentage of participants was observed to be less in the aware group as compared to the unaware group [Table 1]. The mean pre-awareness session score in the aware group (8.5) was significantly higher than in the unaware group (5.6) (p < 0.001) when tested by unpaired-t-test as the data were observed to be normally distributed [Table 1]. The pre-awareness session scores were compared between groups across different age groups, genders, occupations, and prior experience in assisting accident victims within groups, and the results are presented in Table 2.
Table 1.
Comparison of mean pre-awareness session scores between aware and unaware groups
| Characteristic | n (%) | Unaware | n (%) | Aware | P |
|---|---|---|---|---|---|
| Mean pre-awareness session score | 202 (62.9) | 5.6 (3.3) | 119 (37.1) | 8.5 (2.5) | <0.001 |
Table 2.
Comparison of mean pre-awareness session scores across sub-groups in aware and unaware groups
| Groups n=321 Characteristic |
Aware n=119 GSL Awareness Score Mean (SD) |
Unaware n=202 GSL Awareness Score Mean (SD) |
|---|---|---|
| Age group (y) | ||
| 18-24 | 8.2 (2.7) | 5.9 (2.9) |
| 25-29 | 8.5 (2.1) | 6.2 (3.2) |
| 30-34 | 9 (2.8) | 5.9 (3.5) |
| 35-39 | 9.7 (1.9) | 5.5 (3.3) |
| 40-44 | 10 (2.2) | 9.3 (1.9) |
| 45-49 | 10.3 (2.9) | 6.7 (2.8) |
| 50-54 | - | 5.3 (1.2) |
| 55-59 | - | 9.0 (2.8) |
| Gender | ||
| Male | 9.0 (2.6) | 6.1 (3.3) |
| Female | 9.1 (2.3) | 6.4 (3.1) |
| Occupation | ||
| Doctors | 10.3 (2.1)* | 8.9 (2.1)*,#,%,! |
| Medical students | 6.6 (2.9) | 5.9 (2.3) |
| Graduates | 8.9 (2.7)* | 6.5 (3.3)! |
| Teachers | 8.5 (3.4) | 5.8 (3.2) |
| General Public | 9.4 (2)* | 4.9 (3.2) |
| Assisted victims | ||
| Yes | 9.3 (2.3) | 7.1 (2.7)** |
| No | 9.0 (2.9) | 5.4 (3.3) |
*P<0.05 when compared to medical students; #P<0.05 when compared to graduates; %P<0.05 when compared to teachers; !P<0.05 when compared to general public; **P<0.05 when compared to unaware group
Percentage of participants in aware and unaware groups of each subgroup is depicted in Figure 2. In almost across all the subgroups depicted, the percentage of participants of the aware group is less than that of the unaware group of participants, except in 45–49 y age group, doctors, and hesitated to assist victims, where the percentage of participants in the aware group is high. However, it was observed that among the participants of aware, 62% assisted accident victims, whereas among the unaware group, 46% assisted.
Figure 2.
Percentage of participants in aware and unaware groups of each subgroup
It was observed that the mean awareness score was the highest (10.3) in the 45–49 y age group in the aware group, while the mean awareness score was the highest in the 40–44 y (9.3) age group in the unaware group. The mean awareness score of male and female participants was found to be comparable within both aware and unaware groups. Among the participants in the aware group, the mean awareness score was comparable between those who had or had not prior assisted accident victims; however, it was significantly higher (p < 0.05) in participants with prior experience of assisting accident victims in the unaware group than those who did not [Table 2].
In the aware group, the awareness scores were significantly high in doctors (10.3) compared to medical students (p < 0.05), while awareness scores in graduates (8.9) and general public (9.4) were observed to be significantly high compared to medical students (6.6) (p < 0.05) [Table 2].
In the unaware group, the awareness scores in doctors (8.9) were significantly higher (p < 0.05) than medical students (5.9), graduates (6.5), teachers (5.8), and general public (4.9). The mean awareness score of graduates (6.5) was observed to be significantly higher (p < 0.05) than general public (4.9) [Table 2].
When pre- and post-awareness session scores in 288 participants were analyzed using paired-t-test, post-awareness session scores (9.2 ± 2.8) were observed to be significantly higher (p < 0.001) than pre-awareness session scores (6.4 ± 3.4). To further understand the impact of video-based awareness and printed material-based awareness, the post-awareness session scores were compared with pre-awareness session scores in both groups. The post-awareness session scores were significantly higher (p < 0.001) in both the groups than pre-awareness session scores [Table 3].
Table 3.
Comparison of pre-awareness session scores and post-awareness session scores
| Characteristic | n | Pre-Awareness Session Score (Mean(SD)) | Post-Awareness Session Score (Mean(SD)) | P |
|---|---|---|---|---|
| Awareness score | 288 | 6.4 (3.4) | 9.2 (2.8) | <0.001 |
| Video | 177 | 7.4 (3.6)** | 10.5 (3.3)* | <0.001 |
| Printed | 111 | 5.8 (3.2) | 8.4 (2.1) | <0.001 |
**P<0.01 when compared with pre-printed awareness score; *P<0.05 when compared with post-printed awareness score
The pre-video and post-video awareness session scores were significantly higher than pre-printed and post-printed awareness session scores, respectively [Table 3]. To understand the cause, the heterogeneity in the participants enrolled by electronic or google forms and written consent forms was assessed. It was observed that the enrolled population was heterogeneous by occupations; 80% of participants who gave electronic consent and watched video awareness session included doctors, medical students, and graduates, while 90% of participants who gave consent on written informed consent form and read printed material for awareness included graduates and general public.
Discussion
This study demonstrated that the percentage of participants who were unaware of GSL was more than participants who were aware of the law and the awareness among the participants increased significantly after watching awareness video/reading printed material.
Of the 412 participants reached out for enrolment, 45 have not responded for electronic consent, while most of the participants gave consent for printed form when approached in person. However, only 9 participants did not answer the post-video awareness session questionnaire and 24 participants did not complete the post-printed awareness session questionnaire.
The percentage of participants who were unaware of good samaritan law (62.9%) was more than that of participants who were aware (37.1%) of the law before awareness session. The pre-awareness session scores were significantly higher in the aware group when compared to the unaware group. Although 81% of participants from Hyderabad expressed the desire for a law to create a supportive environment for them to assist accident victims in the study done to determine the impediments for bystander response to assist victims of road traffic accidents done in 2017,[8] the percentage of participants with this awareness was found to be less in this study. In doctors, though the percentage of participants is higher in the aware group (51.4%) than in the unaware group (48.6%), there is still scope to create awareness of GSL in doctors as they need to implement it at all levels, primary, secondary, and tertiary care, and treat the victims in compliance with the law. Primary care physicians at times have to handle emergency care; awareness of GSL helps to structure their practice to give immediate and effective management whenever the need arises.[9] This emphasizes the need to increase awareness of Good Samaritan Law by incorporating it into medical curriculum, high school curriculum, graduate curriculum, and social media.
Among the participants of unaware group, 93/212 (46%) assisted accident victims, whereas in the aware group, 74/119 (62.2%) assisted accident victims. This finding is encouraging as among those who were aware of GSL, a higher percentage of participants reported to have assisted accident victims.
Among the participants who hesitated to assist victims, 56.1% belonged to aware group, while 43.9% were unaware group participants, which emphasizes the need of making the public thoroughly understand the law. Of the reasons quoted to hesitate, fear of legal hazzles was the highest, followed by police interrogation. Before introduction of GSL in India according to a study done nationwide, 88% bystanders who were unlikely to help accident victims believed that good samaritans are subjected to legal hazzles and police interrogation.[8]
The highest pre-awareness session scores were observed in doctors, followed by general public from aware group; however, among doctors, 51.4% were aware of GSL, while among general public, 40.9% of general public were aware [Figure 2]. A higher percentage of doctors were reported to be aware of GSL in a study at Delhi NCR, in which the percentage of participants who responded that were aware of GSL was the highest in police (100%), followed by teachers (82.5%) and doctors (80%), while in general public, 56% were reported to be aware.[5]
The mean pre-awareness session score was observed to be significantly high in participants who assisted accident victims in aware group when compared to unaware group. In the study done at Delhi NCR, among participants who helped accident victims, a higher percentage were reported to be aware of GSL.[5] This indicates that with an increase in awareness of GSL, more bystanders can be expected to be good samaritans.
In this study, in the aware group, doctors were observed to have significantly higher pre-awareness session scores when compared to medical students (p < 0.05), while in the unaware group, they had significantly higher scores than medical students, graduates, teachers, and general public. This finding emphasizes the importance of introduction of GSL law in early medical graduate curriculum on par with BSL and ASL courses.
Among the medical students who participated in this study, 75.9% responded they were unaware of GSL before awareness session. In a study done at Maharashtra, 48.03% of medical students were reported to be unaware of GSL.[10]
In this study, post-awareness session scores were significantly higher than pre-awareness session scores. In a study done at Maharashtra, the response to whether they are willing to intervene and help the accident victims, it was reported that the positive response increased from 54.57% to 67.64% in the post awareness workshop.[10]
The post-awareness scores of both video-based awareness and printed material-based awareness sessions were significantly higher than corresponding pre-awareness session scores, indicating that both methods were useful in increasing awareness of GSL.
However, subset analysis done to understand the impact of video awareness session and printed awareness session revealed that both pre-awareness session scores and post-awareness session scores of video-based awareness sessions were significantly higher than pre-printed awareness session scores and post-printed awareness session scores, respectively. This could be due to heterogeneity in occupation of participants recruited by electronic forms and printed forms.
Conclusion
This study observed that the percentage of participants who were aware of the Good Samaritan Law was less, though the Good Samaritan guidelines were framed in 2016[11] in India. It also revealed the impact of awareness session on increasing GSL awareness score in participants. These findings indicate the need of awareness programs to transform bystanders into good samaritans so as to realize the goal of the law and primary prevention of the morbidity and mortality of victims due to delay in reaching hospitals.
Financial support and sponsorship
Self funded.
Conflicts of interest
There are no conflicts of interest.
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