Much has been discussed about the need of a composite trauma center in Kashmir. This is because of an ever increasing number of bullet, pellet, and shell injuries in the valley. Kashmir is now a full-blown conflict zone. The turmoil being wide-spread where even peripheral villages are caught in a spate of violence. It is horrible to see that most of these injured cases are rushed to Srinagar based hospitals like SKIMS, SMHS, and Bone and Joint Hospital at Barzulla. Huge crowds converge at these centers making it humanly impossible to manage such big numbers due to lack of space and manpower.

    Our health planners have to upgrade the whole health department and start trauma centers at district and sub-district levels so that injury cases are evenly distributed throughout the valley and not bought at one single place. In other words trauma care facilities have to be decentralized. This way our doctors will be able to work without being overburdened.

    The government has to send young doctors and paramedical staff including nurses for advanced courses in trauma management and critical care medicine and post them proportionately in the valley hospitals and other peripheral trauma care centers. They should be provided all facilities including residential quarters.

    It is disappointing to see that in-spite of the efforts of the government to upgrade health delivery system the overall scenario of patient care is not bright. No doubt the surgeons of SKIMS, SMHS, and bone and joint hospitals deserve appreciation for their tireless work. They have been striving hard to save the lives of bullet and shell injury cases, but this is not enough.

    Handling trauma cases is a special subject. traumatology is the top-most priority even in countries which are peaceful and conflict-free. Trauma is a phenomenon of modern and competitive life. Air and road traffic accidents occur everywhere in the world. Trauma management is an advanced science. It needs a highly specialized approach. Everyone in the team has to be a trained personnel. And then you have to have advanced life support systems which among other things include ventilators, monitors, portable body scanners, life saving fluids, surgical items, special drugs and broad-spectrum antibiotics to combat infections, and so on. In addition an expert physician has to be around who is trained in critical care. A patient who has received injuries can develop kidney failure, electrolyte imbalance, metabolic disturbances, coagulation disorders, respiratory problems, resistant infections, cardiac events, etc. These are non-surgical problems which have to be treated by a physician trained in emergency medicine.

    All the facilities mentioned above have to be available under one roof. It is unscientific, shocking, and barbarous to shift a trauma case from one place to another. You cannot transfer a critically unstable, profusely bleeding patient from one place to another, especially when these hospitals are miles apart and the run is not easy because of traffic jams. It means to invite death during such transit. Yes, this may at times be done after a patient is risk-free and sufficiently stabilized by experts. The transportation of a patient from the site of accident to hospital needs a well equipped ambulance having the facilities of first-aid.

    Injury cases when received in a hospital have to be categorized according to the severity and nature of trauma so that severely unstable patients are treated first. When a huge number of patients are admitted, the trauma expert categorizes them mainly into three groups: -

      a.) Patients who are severely critical and cannot wait.
      b.) Those who can still wait an hour or so.
      c.)Those who can wait a day or so after receiving first-aid treatment.
    This categorization has to be done within minutes by the expert. For quick identification of these categorized patients special tips are employed. For example, a red-band is wrapped around the arm or leg of a patient who is critical and needs immediate care. Thus bands using different colors are used to denote degree of trauma. This helps in quick identification of patients and treatment is accordingly prioritized.

    The aim of my write-up is not to discuss the subject of trauma management. Those running the affairs of health department have to wake up and give suggestions to the government regarding up-gradation of health delivery system in the state. In a governmental setup the authorities get inputs from expert professionals like directors, deans, medical superintendents and so on. How much efforts these professionals have invested in this direction remains to be seen.

    When SKIMS started functioning in 1980s, Dr. Anand and Dr. Nagpal inspite of their expertise had kept the emergency department closed. It was only when Dr. Syed Zahoor took over as the Director that the department was thrown open for emergency patients. Since then the load on the department has tremendously increased. We have been giving so many suggestions to our directors from time to time to upgrade facilities in the causality area, but more often than not the authorities remained busy solving their own career problems and promoting their interactions with bureaucrats and ministers to enhance their social influence. We have in the past, when militancy was at its peak in the valley, held so many meetings regarding disaster management. Highly valuable suggestions were given by senior colleagues like Dr. Showkat A. Zargar, Dr. Afzal Wani, Dr. S. Jalal, Dr. Nazir A. Wani, Dr. Mehraj-u-din, and  many others. Dr. M. S. Khuroo wrote very nice articles suggesting various road maps to streamline health care system in the state. The government has even constituted a task force to suggest methods to improve hospital functioning with Dr. G. Q. Alaqaband and Dr. Nagpal as its members. Those who manage our institutions and hospitals have a tremendous duty towards people. Time has come to pay heed and now the time has come when they need to act.

Lastupdate on : Sat, 4 Sep 2010 21:30:00 Mecca time
Lastupdate on : Sat, 4 Sep 2010 18:30:00 GMT
Lastupdate on : Sun, 5 Sep 2010 00:00:00 IST