Mindset and not machinery is lacking in trauma care. What is required is an effective network which will safeguard the future. A High powered committee for trauma care was constituted for the purpose by the Kerala government in 2003. Had the envisaged network been in place, comprehensive care would have been available by now. The only shining example is a three-year project done by a pioneering Dr S. S. Lal who coordinated a network of auto and taxi services and created an Act which was in force in Thiruvananthapuram in the nineties. Funded by the LIC, it died a natural death. Trauma care requires coordination of several partners and the benign hand of the Government. Teamwork and supportive background are required. 24 x7 road accident ambulance services with an index phone number will require an ambulance station every 30 kms with at least two ambulances and 2 x 2 paramedics.
While this will take care of retrieval within the golden hour, the most essential component will be a regional control room. The control room can have real time data on the nearest trauma care centres including availability of ICU beds and ventilators. Handholding by the control room like the air traffic control room will save precious time. It remains a fact that many facilities in Government hospitals are utilised to the maximum while services and infrastructure in private hospitals are underutilised. Mismatch of availability and demand could only be solved through an effective public private partnership. Resources in both sectors should be pooled and deemed as a national asset. This is easier said than done. Successful implementation of any PPP model requires a strong public sector and an intermediary agency. The barrier to a PPP model is the Government itself. Being the regulator, the Government is often handicapped by its attitude. Effective networking of private hospitals could be mediated by an intermediary agency like a professional body or an NGO.
A comprehensive network consists of the retrieval team, control room and networked hospitals. This is the hardware part and the easier one to accomplish. The hardest part is how to make the system work and to identify the forces operating. There are two concerns of the private hospitals which have to be tackled upfront. (1) Who will bear the risk? (2) Who will bear the cost? With violence breaking out in hospitals on and off, safety becomes the concern of both the doctor and the hospital; And head injury management could cost a few lakhs in a few days. These are substantial questions which cannot be pushed under the carpet. Solutions are hard to come by but not impossible if there is political will. Strong implementation of the Hospital Protection Act with enactment of a Good Samaritan legislation could help. Creating a corpus fund for underwriting the cost of management of unattended accident victims may find acceptance with private hospitals. All this requires the benign presence of the Government. Partnership rather than prosecution is the solution.
(The author is chairman of IMA Hospital Board of India).
