Trauma is not a region specific problem. Such cases are global. It is considered one of the commonest causes of mortality and morbidity worldwide. In India also the incidence of deaths related to trauma is also quite high. Death Rate per Ten Thousand Vehicles is  2 persons in USA, 32.5 persons in Pakistan, 140 persons in India.

                             In addition to motor vehicle accidents, our state has additional burden of mortality due to fire arm and ballistic injuries. This share of mortality has increased due to the hostile environment existing now. Apart from the trauma related deaths, we are losing a large number of patients suffering from various medical emergencies due to delay in reaching to the referral hospitals in our state. The concept of “Platinum 10 minutes and Golden hour” given by Dr.James Styner (Founder of Advanced Trauma Life Support – ATLS) does exist in our literature but unfortunately doesn’t exist in practice.

                           When we are talking of a system called EMS (Emergency Medical services), we mean an organized system of transporting the critically ill patients. This system is a chain of linking these patients from their home or other small hospitals to big referral ones.

                          This system is well known to the people at the helm and must be existing on paper also but on the ground the reality is different. All these patients are left to their fate without any assistance to be adequately transported. People suffering trauma on road side are being carried by anyone like a gunny bag in vehicles which are not even fit for normal people to travel. The first responders here are purely lay persons who don’t have any concept of transporting the injured patient. Though they are very eager in lending a helping hand to the injured ones, but it most of the time turns out to be counterproductive for the injured victim. These first responders are not to be blamed at all as they are not aware of any prehospital care.

EMS MODELS IN INDIA:
                       Although there is no organized EMS nationally, there are islands of excellence. Efforts to initiate EMS have been started since 1999 in various cities.  State Level Model is now available in Andhra Pradesh, Karnataka, Tamil Nadu, Assam, Gujarat, Himachal Pradesh and Kerala.

                      All other cities have tried to find their own solutions to start EMS. Different models have been developed. Some of them are hospital based EMS services while others are centrally coordinated. Both these models have their advantages and disadvantages. Ultimately we might have a mix of both.

                      States like Tamil Nadu, Andhra Pradesh, Karnataka and Kerala have a well organized system of prehospital care. They have a well trained fleet of paramedics who are on toes running in the sophisticated ACLS/ BLS ambulances in every knook and corner of these states. These ambulances are equipped with all emergency drugs in addition to spine boards and cervical collars which are mandatory for the transport of a trauma victim. The emergency paramedics are well versed with use of all this equipment and transporting the critically ill patients in short span of time. They are even trained in proper extrication of the victims from damaged vehicles.

                         In addition EMRI (Emergency Medical Research Institute – Hyderabad) has started its emergency medical services with well equipped ambulances in almost most of the states in southern, eastern and even western states of India. They have been providing very quick and free services since years.

                        Another EMS group by the name of Life Line foundation ( a NGO) operational in Maharashtra and its neighboring states since few years is also doing a worth mentioning job of providing prehospital services at very nominal charges. Live wise there are some other EMS models existing in various parts of India

                      If such a system is possible in other states why can’t it be started in our state, where it is needed the most?

                     In comparison to this our state is having only two ACLS ambulances for VIP use and unfortunately not a single paramedic trained in prehospital care. The doctors and paramedics receiving these victims in our referral hospitals are really doing a wonderful job in saving these patients despite of the fact that  prehospital link in this chain does not exist at all.

The Need:
             The need is to procure a fleet of good ACLS ambulances and start measures of training our paramedics at the earliest in prehospital care. Some of the most beneficial short term courses for paramedics can be started in various referral hospital of our state. In addition a system of first responder system has to be brought in vogue, be it fire personnel or our traffic personnel.

                       A lot has to be done in educating the common masses either through the screen media or the print media in dealing with such emergencies till they get the expert help.

It needs a dedicated and sincere effort from all those people who are directly or indirectly related to this issue. If we want our state to really have quality prehospital services, we all should stand together and get it done so that no more precious lives are lost for the want of early and organized treatment.

Dr. Shamim Ahmad Bhat is an Emergency Physician,  SKIMS, Soura. shamim_ahmeed@rediffmail.com)

Lastupdate on : Tue, 7 Sep 2010 21:30:00 Mecca time
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