India is growing rapidly in patient awareness, transport modalities and digital revolution. But knowledge about basics of how and where to treat trauma victims still remains unclear. Trauma not only encompasses roadside accident victims but also household falls, fall from heights, sports injuries and miscellaneous injuries. The spectrum of injuries from road crashes varies from instant death to those requiring only first aid. Accordingly management will vary depending on age, nature and duration of injury, associated complications, previous co-morbidities and severity of injuries.
Every year the 17th of October marks World Trauma Day in the World Health Organisation calendar. Road traffic injuries are one of the leading causes of deaths, disabilities and hospitalizations with severe socioeconomic costs in the country. Accident survivors often live poor quality of life and have to live with pain and suffering. In a recent survey, Nagpur features high on the list of 23 cities that were surveyed as most prone to accidents. The high incidents of road accidents are largely attributed to drunk driving, over speeding and minimal use of safety measures such as helmets and seat belts
The whole spectrum of trauma care involves, from pre-hospital standard-setting and leadership, to emergency department resuscitation, appropriate transfer to definitive care with coordination of rehabilitation and reintegration of the patient and his/her family back into society. With different “levels” of trauma care facility, the right patient should be taken to the most appropriate facility in the most expedient timeframe.
Trauma care in India is poorly coordinated. Inadequate emergency and trauma care, lack of trauma audits and deficiencies in acute trauma care account for a higher number of deaths and greater number of disabilities. Lack of first aid, delays in transfer of patients, longer time interval between injury and reaching a definitive hospital, absence of triage, lack of facilities in hospitals (especially public sector hospitals) are some major problems in trauma care in India.
A trauma center is a type of hospital that has resources and equipment needed to help care for severely injured patients. A Level I trauma center provides the highest level of trauma care with all facilities and equipments, while Level IV trauma centers provide initial trauma care and transfer to a higher level of trauma care if necessary. Trauma systems help to ensure that the millions of people injured each year get the right care, at the right place, at the right time. The right care can help people continue to live to their full potential, despite having experienced a severe injury.
Management of trauma victims is done at trauma centers with trauma team. The trauma team is multi-disciplinary, ideally made up of a group of doctors, nurses, operating department assistants, radiographers, physiotherapist rehabilitaion and other support personnel. The ATLS (Advanced Trauma Life Support) protocol followed which is designed such that the lone doctor can safely look after a multiply injured patient. The aim of the trauma team is to provide a safe and efficient evaluation of the patient. Identify all injuries and instigate definitive management of such injuries. The golden hour starts at the time of injury. So most trauma teams will have about 30 minutes to accomplish this and should work towards achieving this goal.
Road traffic deaths and injuries need not be the dark side of our growth and development amidst transportation growth. Proper stratification of level of trauma centres with grades and facilities available should be known. A significant number of road accidents can be predicted and prevented and lives can be saved, if road safety is given a greater priority.
Dr Manoj Pahukar
MS DNB ORTH, MNAMS, FKS BELGIUM, AO TRAUMA HONGKONG
Sr Consultant orthopaedics & complex trauma surgeon
Wockhardt super-speciality hospitals, Nagpur
manojpahukar@rediffmail.com
9923239565
