By: Dr. (Prof.)V.S.Mehta, Padamshree, Chief of Neurosciences, Paras Hospitals, Gurgaon
Accident and trauma injuries are a major cause of morbidity and disability in India. With an estimated 400000 road accidents, India suffers a loss of up to 1.42 lakh lives every year, with many other victims left with permanent and serious disabilities. Apart from the poor safety standards of our roads, lack of adequate trauma management facilities and skills are another reason for this massive loss. In fact, the chances of an Indian road accident victim surviving the mishap are one sixth of the chances of survival of a victim in developed countries where trauma management systems are highly updated and well-equipped.
In medical terminology, major trauma is a term referred to any injury that has the potential of causing death of disability. Automobile collisions and falls are among the leading causes of trauma injuries. It is the sixth leading cause of death worldwide, resulting in five million or 10% of all deaths on an annual basis. It has also emerged as the fifth leading cause of disability.
With increased urbanization, greater penetration of automobiles, and increased construction facilities, the incidents of trauma injuries are expected to further rise in the next few years. The World Health Organization (WHO) has projected that by 2020 road accidents may account for as many as 546,000 deaths in India. This puts an increased focus on the need for improving access to better trauma management across the country including in smaller towns and villages.
A comprehensive trauma management system involving timely rescue, medically informed handling of the victim during transport, and adequate emergency care can save many lives. Unfortunately, a comprehensive trauma management system in India is conspicuous by its absence. Countries that have well-established trauma management systems have successfully reduced the burden of trauma deaths and disabilities.
There are several components of a successful trauma management system:
The Crucial First Hour
It is well recognized now that the first hour after a serious injury can make a difference of life and death to a victim. What is done (or not done) during the first hour also determines the extent of injury the victim would carry in case of survival. Evidence suggests that airway obstruction and blood loss are the two main causes of death following trauma. Another chief cause is delay in surgical intervention. This is why it is extremely important that a victim is able to reach a hospital as early as possible after the injury. Equally important is to resuscitate the victim’s breathing and limiting blood loss in the immediate aftermath of the injury. This calls for well trained ambulance services which need to be equipped with adequately trained emergency staff which is equipped to provide the required pre hospital care on way to the emergency.
In most cases in India, the first people who attend to a victim are bystanders or police personnel who unfortunately know nothing about emergency response. Unlike in western countries most common people are trained in skills like Cardiopulmonary resuscitation (CPR), Indians are mostly clueless about reviving a victim or handling him/her before an ambulance arrives or the victim is taken to hospital. India needs to create a well-informed army of Samaritans who know what to do in such cases — to administer CPR if needed, to take immediate steps to prevent blood loss, to handle the victim carefully so as not to aggravate spine injury. This training needs to be imparted in schools, colleges, offices on a large scale. Paras Hospitals, Gurgaon recently conducted such an exercise for traffic police personnel of the city.
Trauma Management in Hospitals
Even hospitals which are well equipped in most domains often do not have organized trauma management systems. For example, unlike in developed countries where the hospital emergency staff is informed by ambulance of the impending arrival of a serious trauma patient, in India there is no such system of pre-information, causing lack of preparation and delay in attending the patient. Triage is important in handling such patients to segregate the more serious ones from the lesser ones. As mentioned above, timely surgical intervention is very important to ensure survival or prevent disability. The aim of surgical intervention in cases of traumatic head injury is to ensure the flow of blood and oxygen to the brain which may be obstructed because of internal bleeding, clotting or swelling. A timely resumption of normal blood flow in the brain prevents secondary internal injury that may be fatal or cause paralysis of a part of the body. In some cases blood might need to be drained from the brain to prevent it from creating pressure on the brain & damaging the brain. Bleeding vessels may need to be repaired and skull fractures repaired. It is pertinent to understand that all this needs be done without delay to ensure the patient lives. For this to happen there needs to be an organized trauma management system in hospital.
Medical intervention in case of trauma patients doesn’t end with surgical process and recovery. Rehabilitation is a key part of the process as injury to any part of the central nervous system like the brain or the spinal cord affects movement in the entire body. To recover lost functions, continuous therapy and rehabilitation measures are needed.
Awareness among general populace
WHO has classified disability, unproductive life years and premature deaths on account of road injuries as a major health impact of motorization. Metro cities in India record high rates of deaths due to accidents. However, smaller cities are not far behind.
Lot of accident/trauma victims die due to unavailability of any immediate help. The general public needs to follow some simple steps to help such people:
- It’s necessary to check the patient’s breathing pattern.
- If the person is bleeding, put a clean cloth on that area.
- If the cloth gets soaked, place a fresh cloth over the earlier one.
- In order to minimize the risk of spine injuries hold the head, neck and body at one level.
- Keep the head in alignment with spine
- Get immediate medical help by dialing ambulance numbers or take the victim to the nearest hospital as soon as possible.