The Urgent Need for Setting up Trauma Hospitals, and Trauma Units in Jammu and Kashmir
Accidents in the form of trauma are a major cause of loss of precious life worldwide. They are a result of carelessness, overconfidence and nowadays preoccupation with simultaneous use of mobile gadgets. The accidents are turning into modern epidemics in view of the alarming rate of increase. Road Trauma can effect an individual or a group or a family. The worst cases are those in which many people are injured simultaneously and the urgent need for managing these cases together in the absence of proper assessment and management makes life saving a difficult proposition. With the added fact that the quality of roads especially the highways of the State is not good and the driving licenses are allotted without vigorous testing, the compelling desire to complete the small journeys of life quickly and not thinking about the safety of the larger journey, the haste with which we want to move quickly has been a source of increasing incidence of Road Traffic Accidents.
The mechanisms of injury and the types of trauma in the form of isolated or Polytrauma differ a lot as do the prognosis of different cases but the bottom line is that an urgent and well established trauma care facilities are lacking in the state. Any form of trauma be it thoracic, abdominal, neurological needs urgent response. The only thing which is precious in management of any trauma is the time. Time makes the difference between life and death.
In ideal setting an incident of accident reported is dealt effectively within minutes , Highly equipped ambulances placed at vital points resuscitate the patients immediately and in case of severe cases, chopper services with highly trained staff transfer the patient (poor or rich) to the nearest possible trauma facility.
In our setting there is a lag time of hours of reporting a trauma, I have yet to come across neither a fully equipped ambulance nor any vital points where ambulances along major routes are present. Then how can we dream of a chopper. The biggest drawback is lack of a proper trauma centres, and burden on the General Hospitals like GMC Srinagar, GMC Jammu and SKIMS Soura, where all of the trauma cases of the state are managed.
Without making any criticism of any department, any healthcare facility I think that the main focus is to make a suggestion to the authorities for making urgent proposals for trauma units along the major highways of the state.
The effective modalities of preventing the loss of life are multiple and involves a multi modality approach. From an engineering perspective this includes maintaining existing roads, improving the road surface, removing obstacles, constructing guards, rails, proper signs and widening of the narrow sections of roads. The vehicles need restraining devices as seat belts compulsorily present and proper maintenance of vehicle and regular inspection of vehicles, use of specialised seats for children with locking facilities . Road Users: should be properly trained by authorised centers, medically fit and mentally alert, issuing licenses after strict testing of driving skills, medical fitness “and periodic review of driving skills specially annual medical examination of drivers above 50 years of age. All these measures can be achieved through proper public awareness, educating the people about precautions while driving. Legislative Measures: Enforcing traffic rules strictly, proper legislation to avoid drunken driving and in repetitive offenders’ license should be cancelled.
As far as management of trauma is concerned adequate and vigilant staff working 24 x 7 with specialised training is a prerequisite. Specialised training courses for Doctors
(Accident and Emergency ) , nurses and technicians are needed with proper planning and organization of setting trauma units is needed.
With the Lack of Proper Machinery needed in the form of Advanced trauma Life support (ATLS), Airway Equipment Blood storage facilities, Emergency Lab testing facilities, Well equipped Operation theatres, a group of Specialised Neuro-Surgeons, Cardiac Surgeons, Trauma Surgeons, Ventilators, infusion pumps, crash carts, disposable ICU Equipments, there is an urgent need to upgrade the existing small health units in addition to the need for setting up new trauma units in the form of Level1 and level 2 trauma units.
I personally feel that trauma care does not exist at all in the state and A perceptible change is needed in improving the health system of the state in general and the trauma care in particular.
I request the administration to take up the issue of additional training of medical professionals in trauma management, making public awareness about safe driving possible, improve the quality of roads and increase the level of testing of seekers of driving license in addition to the need for basic facilities of trauma management in the form of trauma hospitals so that we can save precious lives in times to come.
Author is Consultant SKIMS Medical College Bemina