There is a growing crisis unfolding quietly in the corridors of government hospitals—one not caused by scarcity of infrastructure or shortage of medicine, but by a deeply entrenched misunderstanding of what the word “casualty” truly means. Casualty departments exist for emergencies—those critical windows of time where delay in medical attention could lead to serious harm or irreversible outcomes. Yet in many hospitals today, casualty is being used as a second outpatient department, open beyond the hours of the regular OP, and flooded with conditions that can easily wait.
Every evening, and especially on holidays, government casualty wings witness a tide of patients arriving with minor symptoms that have persisted for days. Headaches, back pain, mild fevers, allergic rashes, and joint aches—all ailments that could have been addressed in a routine OP setting—are presented in casualty as emergencies. The reasons may vary: convenience, work commitments, or a belief that after-hours treatment guarantees faster service. But the effects of this behaviour are far from harmless.
Casualty departments are designed to triage and manage acute conditions: accidents, cardiac arrests, strokes, seizures, trauma, and life-threatening complications. When these areas become crowded with non-urgent complaints, the system falters. Doctors are forced to juggle high-stakes cases alongside routine check-ups. Prioritisation becomes harder. Patients in real danger are made to wait. And most importantly, the quality of care is compromised for everyone.
Dr Anoop Prathapan
There is also an often overlooked consequence—the rapid depletion of essential drugs and medical supplies. Every patient consultation, whether urgent or not, draws from a shared stock of medicines, consumables, and diagnostic services. When casualty services are used for routine ailments, it leads to disproportionate usage of resources that were intended for true emergencies. Over time, this imbalance contributes to stock shortages and procurement strain—making it harder for the hospital to respond when a real crisis unfolds. Free services must be valued, not exploited.
The misuse of casualty also extracts a human cost from those who serve. Casualty doctors are expected to make rapid decisions in intense conditions. Their shifts are invariably unpredictable and demanding. When they are overwhelmed by avoidable cases, their focus blurs, their endurance stretches, and the risk of clinical error increases—not due to lack of skill, but due to structural overload. Over time, this burden leads to burnout, emotional detachment, and in some cases, withdrawal from public service itself.
The solution is not merely administrative. It begins with awareness and public participation. Citizens must learn to distinguish between emergencies and non-emergencies. They must respect the hierarchy of medical urgency. A low-grade fever or a body ache at 2 am is not an emergency. A cold lasting four days does not require a casualty consultation. Government services are free, but they are not infinite. When the system is misused, it is the poorest and the sickest who suffer the most.
Policymakers must also be willing to introduce basic deterrents—token fees for repeated misuse, stronger OPD systems, tighter security and effective crowd regulation strategies. Hospitals must ensure that casualty wards are treated with the seriousness they deserve, not as extended OPDs for the after-hours crowd.
Casualty is a safety net for the unexpected. Let it not become a dumping ground for delay, convenience, or habit. A healthcare system thrives when its people participate with understanding, restraint, and responsibility.
Let us preserve what little order we have—so that when true emergencies arise, there is a place, a doctor, and a moment of clarity left to respond.
Dr Anoop Prathapan is a general practitioner based in Thiruvananthapuram. He is also a published translator of two books and is currently awaiting the release of his English translation of Benyamin’s acclaimed novel Nishabdha Sancharangal, titled Silent Journeys, brought out by M/s Penguin Random House India.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
