Experts recommend national standards to improve trauma care

Falaknaaz Syed - Mumbai

In an attempt to curb the high mortality rate due to injury and to ameliorate the status of Emergency Medical Services (EMS) in India, trauma experts from WHO, national medical associations, medical institutions and various state governments, have

submitted a roadmap to address the growing burden of injury in the country to Union Ministry of Health and Family Welfare, last month.
Christened as ‘Report of First National Consultation on Trauma System Development in India’, prime features of the consultation report are creation of an apex body at the national level to deal with all the relevant issues of trauma care and standardisation of hospital-based care for the injured wherein hospitals providing trauma care are accredited for different level of care. The report also suggests measures for strengthening pre-hospital care, creation of a unified nation wide telephone number for EMS including critical illnesses and making trauma life support training mandatory to all involved in the care of the injured.

"The suggested policy recommendations will ensure that all injured patients receive essential life and limb saving care in an appropriate and timely fashion following injury throughout the country," says Dr Manjul Joshipura, a leading trauma surgeon and director, Academy of Traumatology (India) who organised the National Trauma Consultation meeting.

The report was compiled after a two-day meeting hosted jointly by the government of Gujarat and Academy of Traumatology (India) in Ahmedabad, which saw participation of 40 national and international experts including WHO; representatives from the states of Andhra Pradesh, Delhi, Goa, Gujarat, Haryana, Karnataka, Maharshtra, Punjab and Tamilnadu, Association of Surgeons of India (ASI), Indian Orthopaedic Association (IOA), Society for Emergency Medicine in India (SEMI) and Indian Chapter of International Association of Trauma Anaesthesia and Critical Care (ITACCS). The report has been submitted to PK Hota, secretary, Union Ministry of Health and Family Welfare, last month.

Explaining about the recommendation of setting up an apex agency for trauma care, Dr Amarjit Singh, secretary, family welfare and commissioner health, government of Gujrat said, "The agency will be a national body something like a 'National Trauma Council' and will work in collaboration with other stakeholders in trauma care, including representatives of pertinent professional associations, and government departments such as surface transport, home and law and other components of the emergency response system (e.g. fire, police, etc). Personnel of this agency will be trained to monitor and ensure co-ordination in the entire chain of help for an injured person that is from transportation, pre-hospital care to hospital based care and rehabilitation. We have suggested that the agency be given the adequate resources and the legal mandate to undertake this kind of exhaustive work."

Deaths due to injury have reached an alarming level in the country. Statistics reveal that injury has become a major cause of death and disability in India with around 5,00,000 deaths resulting from injury, with 80,000 deaths a year from road traffic accidents alone. A trauma related death occurs in India every 1.9 minutes. In addition to road traffic injuries, burns, occupational injuries (including agriculture-related) and suicides are rated as major injury problems in India. By 2020, injury will become the third leading cause of death in the country, predicts the World Health Report 2004.

According to India Injury Report 2005, the burden of injury through road traffic injuries alone amounts to Rs 55000 crore or three per cent of GDP in direct and indirect socio economic losses. Trauma victims occupy 10 to 30 per cent of hospital beds in the country (WHO SEARO January 2001). But the trauma care systems is lacking at all fronts.

A nation wide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems. Industrialised cities, town, and rural areas completely lack organised trauma care. Although injury is a major public health problem, the government of India has not yet recognised it as a priority.

Rues Dr Mahesh Joshi, consultant head, department of emergency medicine and co-ordinator, National Network of Emergency Medicine, Apollo Hospitals, Hyderabad, "Emergency medicine is a loss making proposition for the government and hence a neglected area. The government's focus till now has been immunisation and primary healthcare. Its only in the last 5-7 years that some kind of work has started. Although efforts have been made to provide pre-hospital care in a few cities like Ahmedabad, Pune and Hyderabad, these efforts have been largely in the private sector. The public sector has not seen any major initiative in the field of emergency services. A major reason being lack of resources."

"The Medical Council of India has not recognised Emergency Medicine as a speciality. There is no post-graduate accredited training programme in Emergency Medicine in India and very few structured training programmes for paramedics. As a result we find that most of the critical emergency rooms are manned by untrained professionals," adds Dr Joshi.

Agrees Dr Manjul Joshipura, "States and other agencies share common problems in developing an efficient system for trauma care like ineffective strategies, weak safety measures at road and work place, absence of credible data, lack of a national lead agency for guidance, deficiencies in pre-hospital services across the country, absence of training and legislation, lack of financing schemes and resources for the care of the injured and weak political commitment to develop an organised system. We have tried to address all these aspects."

Experts feel that organized approaches for prevention of road accidents and treatment are needed and that many low cost improvements can be made. Explaining about this recommendation, Dr BK Rao, president, International Trauma Anaesth-esiology and Critical Care society said, "Preventive measures like wearing a helmet can reduce the chance of a head injury. Solution to the problem lies in implementing a spectrum of injury control activities, including surveillance, prevention, and treatment for the injured. Presence of Road side first aid facility can make a lot of difference."

Dr Singh informed that work on developing an apex body has already begun in Gujrat, "We are planning to have EMS authority i.e a lead agency in the State comprising of a partnership between private, government and municipal hospitals.

These initiatives can then be replicated in the entire country. Also hospitals in Ahmedabad have agreed to bear the treatment cost of the injured individual in the 'Golden Hour'. The treatment in the 'Golden Hour' will be subsidised by the government he informed.

falak@expresshealthcaremgmt.com