The importance of creating awareness about trauma In India

Dr Sandeep B. Gore, Director-Emergency Medicine, Fortis Hospital & Vice President-Society for Emergency Medicine India highlights that considering the high rates of trimodal deaths, generating awareness about Golden Hour becomes essential. This can happen with aggressive resuscitation and lifesaving interventions in the initial hours of injury

According to a report by the National Crime Records Bureau, traffic-related accidents in 2021 have risen by 14.6 per cent to 4,22,659. Road accidents were significant contributors to this prominent figure, amounting to 4,03,116. These road accidents also claimed 1,55,622 lives, while 3,71,884 people suffered significant/minor injuries. Even worse, this fatality rate was the highest in the last five years.

In India, lives of many road accidents can be saved, especially when rules and regulations regarding to traffic rules are followed regularly and at the same time, victims are provided immediate care in the aftermath of an accident. Since people are unaware of how to tackle trauma, there is a tremendous need to create awareness about how trauma care can be uplifted in the country.

Around the world, World Trauma Day is celebrated on 17 October so that proper focus can be paid to the increasing rate of accidents and injuries that has the potential to cause death and disability and the increasing need to prevent them, not just in India but also around the world. In India, there is a definite need to develop pre-hospital medical services and emergency care systems so that trauma patients can be effectively treated with minimum complications. If you are still confused about the impact of trauma, here are more facts that might change your mind.

• Trauma is the leading cause of death in the age group of 20-40

• Every 1.9 minutes, someone dies of an injury

• Eighty per cent of accident victims do not access medical care within the Golden Hour

• Thirty per cent of emergency patients die before they reach a hospital

• Sixty-nine per cent of road accident victims suffer Acquired Brain Injury or ABI, which can cause massive complications

• Seventy per cent of death and injuries among men 15-44 years of age

• Trauma deaths are sudden and unexpected, leading to a substantial socioeconomic impact

In 2017, there were 2,18,876 road injuries in India, with a death rate for road injuries of 17.2 deaths per 1,00,000 population. The death rate was much higher in males (25.7 deaths per 1,00,000) than in females (8.5 deaths per 1,00,000). The number of deaths due to road traffic accidents has increased by a staggering 58.7 per cent from 1990 to 2017, and current trends are such that it will increase further in the next decade.

Are trauma deaths preventable? And why is the ‘Golden Hour’ so important?

In road accidents and trauma casualties, there is a high possibility of trimodal death. The first instance occurs when there is a death at the site of the accident due to severe brain injury or rupture of the heart’s arteries, leaving minimal chances of survival. The second instance occurs minutes after the accident due to haemorrhage, although if the patient is rushed to the hospital, their life can be saved. The third instance or peak occurs from organ failure, which generally happens several days and months after the accident due to trauma-related complications in ICU or outside.

Considering the high rates of trimodal deaths, generating awareness about Golden Hour becomes essential. This can happen with aggressive resuscitation and lifesaving interventions in the initial hours of injury. Most of the fatalities that occur in the second peak of the trimodal cycle are preventable if the right interventions are done during Golden Hour. These interventions can be as simple as the compression of external bleeding, protecting the airway, providing oxygen and timely resuscitation of the fluids and blood, and draining trapped air in the chest due to traumatic lung injury, usually performed by some lifesaving surgeries. Proper care during Golden Hour can be a game changer for trauma victims as it can help save their life through systematic and methodological resuscitation. 

Besides ensuring that trauma/accident victims are given valuable care during the Golden Hour, there is an equal need to improve trauma management systems within India. Our country lacks pre-hospital medical services, trauma centres, level-one trauma care facilities and a trained workforce (especially Emergency medicine-trained doctors) who can take care of accident victims in emergencies. There is a growing need to develop trauma centres on significant highways at specific distances. Level 1 trauma care centres should be available throughout the country with appropriate infrastructure and workforce to save patients’ lives wherever possible. These trauma centres must include the below facilities. 

• Emergency physicians should always be on duty.

• There should be 24-hour availability of surgeons in all operating personnel, including anaesthetists, surgical assistants, and nursing teams.

• Radiography capability, including CT scans and angiography, should be always available. 

• The centre must be able to deliver definitive care to all types of trauma patients.

• A continued focus on organised trauma research programs, injury prevention and public education

• Trained medical and paramedical staff must be given prime importance within the country and the healthcare system.

• Trauma resuscitation training should be conducted for all doctors and nurses.

• Increasing the number of Emergency Medicine trained doctors in trauma resuscitation is a core competency and sub-specialty of Emergency Medicine.

• Awareness about trauma should be given to the public, especially in schools and workplaces. 

• Implementation of traffic rules like wearing a helmet on two-wheelers, use of seatbelts for all passengers sitting in a car, driving within the speed limit and others

• Ensuring strict prevention of allowing people to drink and drive. Also, laws in this regard should be made more stringent. 

• Vehicles should be allowed on the road after protection checks that include an optimal number of airbags and other protective features per global standards. 

Team of emergency medicine trained doctors is minimum requirement of any level one trauma centre.

A team of emergency medicine-trained doctors is a minimum requirement of any trauma centre or level one trauma care facility. Compared to developed countries like the USA, Singapore, Canada, Australia, and the UK, we don’t fulfil even five per cent of emergency medicine-trained doctors’ requirements. We should implement measures and tactics to reduce this gap to help us get there. The government must make extra efforts to increase the number of Emergency Medicine trained doctors in the country because mortality among trauma and accident victims is rising. Besides building emergency care system infrastructure, we also need to focus on ensuring a trained workforce that makes it easier to run these systems more efficiently.