Lack of trauma care in district hospitals proving costly in emergency situations

3 civilians injured in Kulgam blast lost lives in transit to Srinagar hospitals

On Sunday, when seven people died and scores of people were injured in an explosion in Kulgam, a 20-year-old youth was received by doctors at the SMHS Hospital with a firearm injury in the abdomen. He had lost blood and was in a state of shock when he reached the hospital, more than three hours after receiving injury. Doctors tried to resuscitate him, but to no avail. He was declared brought dead. 

In the next two hours, four more people were received in Srinagar hospitals in a similar state, profusely bleeding, with “blocked or compromised” breathing due to injuries and accumulation of fluids in chest cavity.  Two of these were declared brought dead, while two others are battling for life.

An old man, who was in the same ambulance in which one of the injured was brought to the hospital, said it took them four hours to reach Srinagar. 

“First they took us to PHC Qaimoh, then to district hospital Anantnag,” he said. At Anantnag, being Sunday, not much of the staff was available and the critically injured were referred to Srinagar. Three lost their lives en route to the city.

A senior doctor who works in Trauma Theatre of SMHS Hospital said that “some lives are lost due to loss of golden hour”. 

“If we could intervene in these injured in the first hour following injury perhaps we could have saved some of them,” he said.

He added that because of the lack of facilities, critically injured persons were referred to Srinagar, a move that often proves detrimental to their survival chances.

Another senior doctor rued failure of government to improve trauma care and make emergency services available round the clock. Citing an example, a senior administrator of a district hospital said, “In district hospital Kulgam, the nearest district hospital to Laroo, where the explosion took place, there are only two anesthesiologists and only two surgeons who work six days a week providing 24 hour service.

 “Is it possible that they also work on Sundays?” the administrator asked.

He added that at district hospital Anantnag too, there was a gross shortage of staff given the load on the hospital. On Sundays, he said, a surgeon is available on call only.

None of the three trauma centres in the vicinity—at Lower Munda, Qazigund and Bijbehara—that were announced six years ago have been completed, nor has any staff been hired to run them.

An official in health department said that even though Kashmir had witnessed “so many” deaths due to explosions and due to bullets and other firearms in the past three decades, no steps were ever taken to make trauma and emergency care efficient to save lives.

A source at district hospital Anantnag said that on Sunday, when a number of casualties started reaching hospital, many doctors living in the vicinity were brought to the hospital immediately. “However it takes time to mobilize resources and in such a scenario, we are left with no option but to refer the patient (to Srinagar),” the source said.

A doctor working in another district hospital said due to large crowds assembling at the hospitals and accompanying the injured it sometimes becomes difficult to perform duties efficiently.

Medical superintendent Pulwama district hospital Dr Abdul Rasheed Parra, who has taken many steps to minimize lives lost due to injuries in his hospital, said it was important to pool human resources in order to provide efficient emergency services.

“All of us need to work in the direction of creating a nodal point, a hub, which would always be ready and equipped to handle emergencies and in my opinion district hospitals are best suited for that,” he said.

Dr Fazil Kocchar, chief medical officer Ananatnag, said manpower was an impediment in delivery of emergency services. He added that the administration in the district was trying to put in efforts to optimize the limited human resources it had.

“Only yesterday, we created a social media platform to alert our staff and ensure they reach the hospital immediately after an incident is reported,” he said.