Enhancing understanding of Good Samaritan law in trauma care: A pre-post study among medical officers in a hilly region of North India

INTRODUCTION

The World Health Organisation’s Global status report on road safety 2023 highlights that road collisions remain the leading cause of death among children and young adults worldwide. In India, this burden is particularly pronounced, with individuals aged 18 to 45 years accounting for 66.5% of all road traffic fatalities in 2022. This loss of life during the most productive years has profound social and economic impacts, underscoring the urgent need for effective road safety interventions and trauma care improvements.¹ Trauma remains a leading cause of morbidity and mortality worldwide, presenting significant challenges to healthcare systems and providers. Whether resulting from road crashes, falls, or intentional acts of violence, traumatic injuries often necessitate rapid and effective medical intervention to optimise patient outcomes. In many cases, bystanders are the first to assist at the scene of trauma incidents, highlighting the crucial role of laypersons in initiating life-saving measures.²

Over the last decade, road crashes in India have claimed over 1.3 million lives. According to the Law Commission of India, half of these fatalities could have been prevented with timely care. However, bystanders often hesitate to help due to fear of legal repercussions. In 2012, a public interest litigation (PIL) was filed in the Supreme Court of India to protect good Samaritans who come forward to assist the injured.³ The guidelines for the protection of good Samaritans were issued by the Ministry of Road Transport and highways and were given “force of law” by the Supreme Court on March 30, 2016, in SaveLIFE Foundation v. Union of India.⁴ Good Samaritan law plays a crucial role in encouraging bystander intervention and providing legal protection to individuals who offer assistance to those in need during emergencies. Good Samaritan law offers immunity from civil liability to individuals who render aid in good faith and without expectation of compensation.

“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 a crash, or emergency medical condition, or emergency”. The good Samaritan law enables individuals to provide immediate assistance or emergency care to individuals injured in crashes or medical emergencies, without expecting payment or reward, and without any obligation of care or special relationship.³

METHODOLOGY

This study employed a pre–post test design to assess changes in knowledge and understanding of the good Samaritan Law among medical officers attending a capacity-building program at the department of Trauma Surgery and critical care, AIIMS Rishikesh. Of the 150 officers nominated by the director general of health services, 125 participated. Training was conducted in six weekly batches of 25 participants each. To ensure consistency and minimise bias, all sessions were delivered by a single facilitator using standardised slides, instructional materials, and a uniform didactic approach. Each session began with a validated 10-item pre-test questionnaire (eight quantitative and two qualitative questions), followed by a structured lecture, and concluded with the same questionnaire as a post-test to measure knowledge gain.

Participants were government medical officers from Uttarakhand with an MBBS qualification, attending the capacity-building program at AIIMS Rishikesh. Officers who provided consent were included, while those who declined participation were excluded.

A structured 30-minute didactic lecture on the Good Samaritan law was delivered as part of the capacity-building program. The session focused on key concepts, legal provisions, and practical implications in trauma care. Topics included the definition of a good Samaritan, the need for the law, an overview of the 2016 legislation, legal protections offered, and the importance of encouraging bystander intervention. A validated questionnaire was used to assess knowledge of the good Samaritan law at three time-points: before training (pre-test), immediately following educational intervention (post-test), and at 16 months post-intervention via telephonic follow-up. The use of identical instruments across all assessment phases enabled direct comparison of baseline knowledge, immediate learning outcomes, and long-term knowledge retention among participating medical officers.

Data were analysed using SPSS version 25 (trial version) for Windows. Descriptive statistics, including proportions, percentages, means, and standard deviations, were reported. When required for comparison of the means between pre-and post-test groups, the paired t-test was used.

RESULTS

The study included 125 medical officers from 11 districts of Uttarakhand. The largest representation came from Pauri (25 officers, 20%) and Tehri (20 officers, 16%), together contributing over one-third of the participants. Almora and Nainital each contributed 17 officers (13.6%), while Pithoragarh accounted for 13 officers (10.4%). Moderate representation was seen from Rudraprayag (9 officers, 7.2%) and Chamoli (9 officers, 7.2%). In contrast, Uttarkashi contributed eight officers (6.4%), Haridwar 4 officers (3.2%), Dehradun 2 officers (1.6%), and Bageshwar only one officer (0.8%).

Table 1: Effectiveness of Intervention: Pre-test vs. post-test responses on knowledge of Good Samaritan La w. This presents the effectiveness of an intervention in improving participants' knowledge of the good Samaritan law in India, comparing pre-test and post-test responses. Correct responses improved across all seven questions, with scores rising from 33.6%–85.6% in the pre-test to 76.8%–100% in the post-test. The largest gains were seen in areas of low baseline knowledge, indicating the intervention’s effectiveness in enhancing understanding of the good Samaritan law.

Figure 1 shows data for the preferred medium for disseminating information about the good Samaritan law among common people. Among the 125 respondents, the majority expressed a preference for public service announcements (TV, radio, newspaper), accounting for 45(36%) of responses. Social media was also favoured by 44(35.2%) of respondents, while workshops and seminars were chosen by 36(28.8%). These findings suggest that while traditional media remains influential, digital platforms like social media are increasingly recognised as effective channels for spreading awareness about the good Samaritan law among the general population.

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Figure 1

Best medium to disseminate good Samaritan law information

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Figure 2 illustrates the preferences for three outreach methods (public service announcements, social media, and workshops and seminars) among different age categories. For ages 26-30, social media was the most preferred, with 23 responses. Ages 31-35 showed a balanced preference, with public service announcements receiving 23 responses and social media receiving 16 responses. Ages 36-40 favoured both public service announcements and workshops and seminars equally, with nine responses each. For ages 41-45 and 46-50, workshops and seminars were the most preferred, with 9 and 3 responses, respectively. In the 51-55 age group, both public service announcements and workshops and seminars received one response each. This data indicated that younger age groups preferred social media, while older groups favoured workshops and seminars.

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Figure 2:

Distribution of outreach method preferences across different age categories

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The data in Figure 3 shows strong support (86.40%) for the current good Samaritan law, with no changes deemed necessary by most respondents. A small minority suggested modifications, including rewards for good Samaritans in the form of recognition (4.00%), certificates (3.20%), cash incentives (4.00%), and tax exemptions (0.80%). This indicates general satisfaction with the existing law, though some interest in incentive-based enhancements exists. The results provide insight into public perception of good Samaritan legislation in trauma care contexts.

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Figure 3:

Showing the % of participants who think about any addition or change in the law

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Table 2: Descriptive statistics of participants Showspre-test scores ranged from 1–7 with a mean of 3.57 (SD 1.64), indicating wide variability in baseline knowledge. Post-test scores ranged from 4–7 with a higher mean of 6.11 (SD 0.81), reflecting both significant improvement and reduced variability. The increase in mean scores and tighter clustering of results highlight the intervention’s effectiveness.

Table 3: Paired samples t-test results comparing pre-test and post-test scoresA paired samples t-test was conducted to compare pre-test and post-test scores, which revealed a significant improvement in participants' performance after the intervention. The mean difference between the pre-test (Mean = 3.57) and post-test (Mean = 6.11) scores was 2.544, with a 95% confidence interval ranging from -2.784 to -2.304, indicating a substantial increase in scores. The t-value of 21.021 and a p-value less than 0.001 confirm that this difference is statistically significant, underscoring the effectiveness of the intervention.

Table 4: Summary of pre-post differences for six batches presents the statistical summary of pre-test and post-test score differences across six batches, showing significant improvements in all cases. The mean differences range from 2.09 (Batch 1) to 2.96 (Batch 2), with corresponding standard deviations indicating variability from 0.97 to 1.76. The standard error of the mean, reflecting precision, ranges from 0.21 to 0.39. All p-values are less than 0.001, indicating that these mean differences are statistically significant. Thus, the intervention consistently led to significant score improvements across all batches.

Table 5: Comparison of knowledge scores: pre-test, post-test, and 16-month follow-up assessmen t presents the findings from a 16-month telephonic follow-up assessment. Compared to baseline pre-test scores (Mean = 3.57, SD = 1.64), follow-up scores (Mean = 5.41, SD = 0.06) showed a significant improvement of 51.54% (t = −15.15; p < 0.001), indicating substantial and sustained knowledge retention. However, when compared to immediate post-test scores (Mean = 6.11, SD = 0.81), follow-up scores demonstrated a statistically significant decline of 11.46% (t = 11.7; p < 0.001), with a mean difference of 0.70 points. Despite this decline, follow-up knowledge scores remained substantially higher than baseline levels, with participants retaining 72.44% of the learning gains achieved through the intervention, demonstrating meaningful long-term knowledge retention 16 months after the educational intervention.

DISCUSSION

This study demonstrates that a structured educational intervention significantly improved the knowledge of medical officers in Uttarakhand regarding the good Samaritan Law(GSL). The findings highlight the effectiveness of even a single, standardised lecture in enhancing legal literacy among healthcare providers. Injuries are a leading global health problem, accounting for about 4.4 million deaths annually (≈8% of all deaths)⁸ , with road traffic injuries a major contributor in young age groups. Timely bystander intervention in the “golden hour” after injury is critical to survival. The WHO explicitly notes that bystanders must be empowered to act without fear of legal liability, underscoring the rationale for good Samaritan law.⁹ India’s 2016 good Samaritan judgment and later statutory rules aim to remove barriers to helping crash victims. However, evidence suggests that awareness of these protections remains low. For example, Kewalramani et al. found only 9–31% of surveyed citizens in major Indian cities knew of the law, and only post-GSL implementation did reported willingness to assist rise sharply by 65%, with legal fears plummeting 81%.¹⁰

Our finding – a significant rise in mean legal-knowledge scores after a brief lecture – is consistent with this literature. Similar education-based interventions have shown measurable gains in GSL understanding. In a recent Telangana population study, participants’ mean awareness score rose from 6.4 to 9.2 (out of 13) after an awareness session.¹¹ These parallels suggest that focused training can bridge the knowledge gap observed in baseline surveys. For instance, residents’ willingness to help in India can be enhanced by clear education on medico-legal protection.¹⁰ The magnitude of our effect is comparable to other contexts: in Nigeria and Ghana, brief first-aid training improved bystander confidence, and in the U.S., almost all resident physicians expressed that understanding Good Samaritan laws is essential and wanted more education on the topic.¹² Taken together, these results imply that systematic incorporation of GSL content into medical and emergency care curricula could have a substantial impact.

The importance of this knowledge for public health is highlighted by the barriers to helping that persist without it. Surveys in India consistently identify fear of police and hospital harassment as major deterrents. SaveLIFE Foundation reported that 74–88% of unwilling bystanders cited legal hassles or mistreatment as reasons not to assist, and 77% feared hospitals would detain them for fees.⁹ Mada et al. similarly found that before GSL enactment, 88% of people believed Good Samaritans would face police interrogation and legal obstacles.¹¹ Our own participants, though healthcare professionals, also expressed legal fears before education (consistent with these findings). By contrast, after our session, most understood that the law protects them, enhancing legal literacy among medical officers, thus has a dual benefit: it directly removes uncertainty among providers themselves, and it equips them to reassure lay bystanders who come to emergency care. In this way, legal education can strengthen the entire “trauma chain of survival” by improving early response and hospital handover, as emphasised by recent trauma care reviews.^9,10

Training 500 government doctors and paramedics on the good Samaritan law has been piloted in Odisha (per NGO reports) with the aim of institutionalising the policy.¹³ Our findings resonate with a U.S. survey in which 89% of physician trainees requested more Good Samaritan law instruction, believing it would make them more likely to respond to emergencies.¹² This suggests that formally embedding GSL training in medical education – alongside basic life support and trauma courses – could foster more proactive emergency care by providers. It also implies that public health campaigns alone are insufficient without aligning hospital policies and police practices to the legal framework.^10,14

In India and elsewhere, successful public-safety campaigns routinely blend traditional and new media. For example, Indian authorities have leveraged both “on-the-ground” outreach (e.g., traffic-signal placards, community events) and online campaigns to promote good Samaritan laws. NGO reports explicitly recommend “extensive and sustainable social awareness programs” that combine grassroots meetings with multimedia toolkits.¹⁵ Likewise, general public-health messaging in India historically relies on TV/radio spots and print ads to “shape public understanding of health risks”.¹⁶ Our participants’ high interest in Public Service Announcements (36%) and workshops (29%) mirrors this pattern: broadcast PSAs can rapidly reach broad audiences (including older or rural physicians), while in-person seminars allow dialogue and skill practice.

At the same time, digital media are indispensable, especially for younger demographics. In our cohort, 35% favoured social-media campaigns – and this preference was concentrated among younger officers. This accords with global and Indian evidence that youth engage more with online content. For instance, an analysis of the Uttarakhand police’s Facebook road-safety “meme” campaign found internet-meme posts achieved significantly higher reach and engagement among 18–29 year-olds than traditional posts.¹⁷ Similarly, Ravindra et al. showed that a nomination-based social-media “#CPR challenge” (coupled with onsite CPR training booths) doubled hands-only CPR knowledge in college students (p<0.001).¹⁸ These results mirror our group’s trend: younger medical officers (more digitally native) gravitated toward social platforms, while older officers preferred conventional channels.

Compared to best-practice models, our data confirms the value of integrated campaigns. International guidelines (e.g., WHO, ILCOR) and the trauma-education literature emphasise combining mass media, social media, and community training. For example, the global “World Restart a Heart” initiative has reached hundreds of millions by using coordinated TV, social hashtags, and public trainings.¹⁹ Likewise, injury-prevention NGOs advise mixing “traditional and modern approaches” for Good Samaritan outreach.¹⁵ Our respondents’ nearly even split between PSAs and social media reflects this hybrid approach. Crucially, we also observed that guided education works: just as Ravindra et al. doubled CPR knowledge with blended social-media and live training¹⁸ , our own lecture markedly boosted Good Samaritan Law knowledge (p<0.001). Other Indian studies similarly report that structured workshops (video or print-based) significantly raise GSL awareness..¹¹

The 16-month follow-up assessment in our study revealed knowledge retention of 72.44% of learning gains, with a 51.54% improvement compared to baseline, despite an 11.46% decline from immediate post-test scores. This retention pattern aligns closely with established forgetting curve principles and longitudinal educational research in medical settings. Custers and ten Cate's research on medical student knowledge retention found 75.5% retention over 16 weeks, comparable to our findings.²⁰ These findings suggest that periodic refresher training at 12–18 month intervals would effectively maintain optimal awareness of good Samaritan law protections among medical officers.

LIMITATIONS

The single-group, pre–post design without a control arm means we cannot exclude testing effects or selection bias. While the study measured short-term knowledge gain and 16-month follow-up retention, we could not assess actual bystander behaviour or patient outcomes from this knowledge. The sample was limited to one state and to self-selected officers who consented to training, which may overestimate effectiveness compared to general clinicians.

CONCLUSION

This study provides robust evidence that a structured educational intervention significantly improved Uttarakhand medical officers’ knowledge of the good Samaritan law. The marked rise in post-test scores and maintenance of 72.44% of learning gains at 16-month follow-up highlight the intervention's effectiveness. The modest 11.46% decline from immediate post-test to follow-up aligns with expected educational retention patterns and underscores the need for periodic refresher training to maintain optimal awareness. Future follow-up studies should assess behavioural outcomes and patient-level impact, guiding targeted educational programs and policies. These findings support the integration of legal literacy into medical training, with periodic refresher sessions, to optimize awareness and strengthen trauma care in India.