Thiruvananthapuram: On an average 11 persons die and 120 sustain grievous to minor injuries in road accidents in the state daily. This trend has been continuing since past couple of years with the accident and injury rates even showing a slight increase during this period.
The state government’s decision to redesign and modernise Trauma Care Centres across medical colleges and district hospitals is aimed at bringing down the high rate of mortality and morbidity in accident cases. Experts say the most crucial part of trauma care treatment providing timely support to accident victims.
Mortality rate can be reduced by 85 percent if a patient is brought to hospital within the golden hour (it is now modified as golden seconds).
Along with state of the art trauma care facilities, trained staff and mobile ambulance fitted with oxygen sets and resuscitation gear are needed to start life saving activities right at the accident site.
Such facilities are needed for safe transportation of badly injured patients to check the high mortality. Only a trained person can ensure that even minor issues like food particles are not left in the mouth and are cleared in time to ensure availability of oxygen.
Experts say one of the major causes of death due to accident is hypoxic brain damage due to the non availability of oxygen. The second big factor is bleeding due to injury. A thigh injury can cause the loss of up to 45 ml of blood.
With road accidents being more frequent in two groups of people; mostly the pedestrians and motorcyclists, experts believe strict enforcement of helmet regulation can reduce chances of head injuries and fatal accidents by 70 per cent. Majority of the accident victims succumb to head injuries.
In two wheeler accidents the pillion riders are more vulnerable to fatal injuries as they rarely wear helmets. Referring to head injuries, Noted neurosurgeon Dr A Marthanda Pillai said; ''Sometimes the injury will be serious like 'diffused axonal injury' where the injury is inside the brain which could be fatal. In other cases the skull gets fractured, but it can be cured through surgery. At times the impact of collision is concentrated in one particular area which could be severe.”
Four years ago the UDF government had decided to put in place treatment protocol and better facilities at the Trauma Care Centres. The Government decision came in the wake of the death of Seethu, a migrant worker from Orrissa who died at the Kottayam medical college hospital.
The boy who was seriously injured in an accident was brought to medical college but the officials there failed to provide him timely treatment. Instead of admitting the boy in the ICU, the authorities had put him in a general ward. They even entrusted the task of administering artificial oxygen with one of his friends. The care taker reportedly fell asleep and Seethu succumbed to his injuries.
The incident led to major controversy and demands for better trauma care facilities. After a couple of inquiries and reports of expert committees, the proposal remained in cold storage. The state government has now come up with a fresh proposal to modernize and redesign trauma centres on the lines of All India Institute of Medical Sciences (AAIMS). This proposal came up after health minister K K Shailaja herself visited AIIMS trauma care centre recently.
Later a team of AIIMS experts also visited Thiruvanathapuram medical college.
Among the facilities that are being planned for new trauma care centres include centrally air conditioned space with centralized distribution of gasses and vacuum.
Emergency room equipped with shock bays, AlTS, ACLS trained personnel and advanced resuscitation equipment. Availability of 1.5 telsa MRI and round the clock digitl radiography and CT scanners.
Besides, there are plan to have state of the art operating rooms with laminar flow and advanced equipment. Well equipped ICUs including a dedicated neurosurgical ICU with higher number of beds and high end ventilators .
According to estimates the number of head injuries due to accidents comes to around 5000 annually. Despite such high incidence of head injuries, the health care facilities at some places have been able to bring down the death and morbidity rates to some extent.''About 70 to 76 per cent victims who survive serious head injuries, will have to confront minor and major problems including head ache, dizziness, physical disability, visual impairment and paralysis,’’ said a trauma care specialist.
Cost of trauma care has gone up because no doctor now leaves things to imagination. A series of X-rays, CT, MRI scans and repeat scans are carried out to ascertain primary and secondary injuries to the vital parts of the body. Many of the injuries are spotted during tertiary survey which is generally done after 24 hours. All diagnostic procedures and rehabilitation methods involve a huge cost.
Though the third party insurance covers most accidents, considering the growing cost of treatment there is a need to put in place some kind of scheme to provide financial assistance during the course of treatment.
Experts say health policy makers and insurance companies could explore the possibilities of such schemes in future. According to doctors, most attacks on their colleagues happen in casualty when accident victims are brought in. Because of the limited facilities especially inadequate numbers of operation theatres and equipment there is a delay in taking up all cases immediately. This leads to argument with medical staff and ends up in assault in most cases.
“Many of these ugly incidents can be avoided if trauma care centres are provided adequate facilities. Emergency operation theatres, diagnostic equipment and state of the art facilities are needed urgently,” sid Rahul U R, Kerala Medical Post Graduate Association.
With the government now roping in AIIMS experts, the latest step to redesign and modernize trauma centres will go a long way in checking mortality and morbidity due to road accident. Since most victims are in the productive age group, it is not only a personal loss for individual families but to the entire society.
