| Abstract|| |
Background : Poly trauma is a major killer. Team work is essential for better management.
Method : Survey was undertaken to collect baseline data in polytrauma patient.
Result : Two thousand patients were studied. Cause was fall in 904, vehicular accident in 776 and assault in 320 patients.
Conclusion : There should be good prehospital emergency service and quick transport to equipped hospital.
Keywords: Poly Trauma, Rural India, Road Safety, Vehicle increase,Young Population, Equipments in Civil Hospital, Changing Trends.
|How to cite this article:|
Goyal S, Sancheti K H, Shete KM. Poly Trauma in Rural India-Changing Trends. Indian J Orthop 2006;40:259-61
| Introduction|| |
Polytrauma constitute as one of the most serious health problem to the extent. Polytrauma is the major killer of the present day not only in a specific area or state or country but all over the world. Most people think that injuries are mainly a problem of rich countries, this is not so. That data available from developing countries suggest that in every sphere of activity the proportion of persons, who are injured or killed, is similar or higher than that of industrialized or urbanized countries.
With increase in urbanization and industrialization more and injuries of varied type are increasing day by day. Industrialization and increase vehicles giving rise to more trauma rather poly-trauma patients, who require not only urgent treatment, but also different types of attitude, approach, dedication, planning, preparedness and the well coordinated as well as timely team - work to have an effective outcome of a "Golden hour".
| Material and Methods|| |
The present study was conducted in the form of survey in rural area of our state with following aims and objectives.:
- To collect baseline data of polytrauma patients in rural India.
- To categorize type of the traumas sustained.
- To evaluate in brief the existing health care system.
- To formulate and suggest and ideal infrastructure for trauma patients that too, to suit the Indian conditions.
To collect baseline data of poly-trauma patients in rural India all daily admissions, injuries sustained, cause of the injury, site of the accident, nearest medical care center, type of treatment given on the spot, mode of transportation from the spot of accident to the nearest medical center were categorized.
At the time of collecting the date all the possible details were collected from the patients' medical records, which helped to categorize various types of the traumas and injuries sustained by the patient and also helped to know various modes of treatment received by the patient.
| Observations|| |
A through retrospective as well as prospective study was carried out over a period of 4 years in the rural areas of Maharashtra taking Jalna as one of the district as a representative data. Maximum possible details were recorded of all the patients of trauma admitted in Civil Hospitals well as private clinics of Jalna.
We also studied various limitations of the present situation (present scenario), which has helped us to project and to suggest future action plan to minimize the limitations existing in turn to improve a lot over a period, in phase wise manner.
Most patients were in productive age group [Table - 1]. Seven hundred and two patients were from urban population and 1298 from rural areas. Cause of injury was fall in 904 patients, Vehicular accidents in 776 patients and assault in 320 patients. Most injuries were upper and lower limb injuries followed by head injuries [Table - 2].
| Discussion|| |
Road traffic accidents are ever on the increase and so polytrauma. Besides the routine road traffic and domestic accidents, natural calamities like earthquakes, cyclones, land slides communal riot, terrorism, rail and air accidents, all are contributing to the changing scenario of trauma and its management.
Not only Urbanization is compelling to increase in number of vehicles and so many types of accidents even in the rural part of the India, as industrialization is spreading not only in outskirts of major cities but also is penetrating in various rural areas. Also various villagers are moving not only towards the cities but also towards various spurting industries of varied scales.
A representative survey of data and its analysis of rural India have revealed that the number of deaths per year ranges from an absolute minimum of 130000 to possibly of 650000 per year.
A rough estimate indicates that 15% of all hospitals and clinical beds are occupied by victims, thus making polytrauma as one of the single leading cause of hospital admission .
Males dominate in our study. During this study so many vital observations were noted like, age-majority patients were in younger age group (528 patients were in the group of 2140 years to the extent if you take up to the age of 40, 704 were the patients of polytrauma whereas relatively few patients were seen in middle age and more or less in old age group, nearly same was the picture even for the patients admitted in private clinics of Jalna). Younger people (i.e. dynamic and moving) were very much vulnerable for the accidents. Because younger are the major supporting pillars not only of the family but also of society and the future generation. Means these need more protection, more intensified and more specified treatment that too as early as possible, so that so many vital lives can be saved to make their family more stable as well as healthier society. Also if timely and correct treatment delivered to these victims with multi-specialty involvement as well as pre-hospital care, there are fair chances of survival Children and younger are most of the times disease free except that of trauma. So our aim should be to give best possible treatment and care at the earliest not only to these children and young age group but also to the middle aged as well as elderly victims, which in turn can make not only the family but also the society (as all the components are equally important being interdependent and preparative nature).
When we analyzed the number of the patients received by various hospitals of Jalna and reviewed their sources, majority were from remote rural areas once again confirming that they neither could reach in a required time nor received any pre-hospital care and in spite of reaching to their highest possible destination i.e. civil hospital at a district headquarter. Also could not deliver the best possible treatment to them ultimately creating a situation to have more mortality and even the morbidity making great loss of family as well as of society and the nation.
Study analysis of causes of injury of the patients admitted in Civil hospital shows major chunk constituted by the vehicular accidents i.e. 49% confirming that increase in number of vehicles, urbanization, industrialization, affected a lot to the routine life, giving rise to more trauma.
When analyzed has shown that extremity injuries are very common constituting nearly 74.6% in which there was a slight difference in the incidence of upper extremities and lower extremities trauma. What is more important that significant percentage of patients had associated head injuries (i.e. 13.4%) which were the main cause for increase in the mortality, morbidity as well as referral to the higher centers.
Patients of Polytrauma having a component of associated head injury (208 out of 268) were admitted to civil hospital, indicating private clinic didn't admit them for increase in risk involved and medico legal causes. So civil hospital were compelled to face, increase in the mortality, morbidity as well as referral to the higher centers. Next to that were the chest injuries i.e. nearly 8% even though % seems to be small but all the time it has added more and more to the mortality, morbidity as well as referral to the higher center.
Nearly 16.4% patients were discharged against medical advise, cause may be indirect reflection of services rendered by various specialists, more particularly in a non-coordinated manner; also it's an indirect reflection of that particular hospital.
3.05% patients absconded from the hospital; this may be due to illiteracy, ignorance, and poverty and less dedicated work by the hospital personnel.
Just over a period of 48 year in India number of the vehicles has increased from 306 thousand to 40939 thousand, which is nearly 134 times. In which two wheelers have increased so significantly i.e. from as low as 27 to as high 28342 (1049 times), depicting and confirming two-wheeler is a common vehicle as the mode of transport nearly for 69% of the total. Rest are some kind of four wheelers, which constitute 31%, four wheelers have some protection for driver as well as travelers in comparison with two-wheelers. That's why in general, less morbidity and mortality and on most of the occasion, but if major accidents occur, there is a swing of mortality and morbidity immediately to other extreme.
It is clear that the data available, collected, analyzed are so sketchy that polytrauma victim management, can't be chalked out very specifically. It appears that there is an urgent need for much more wide spread knowledge about easy and effective methods of handling emergency cases particularly polytrauma patients. This is especially true for rural areas. As per our analysis population and vehicular number has increased very fast over last four decades. But infrastructure like roads, vehicular conditions, transportation at times of casualty, skilled personals for managing a polytrauma victims, necessary equipments for the same, physical, mental and social rehabilitation of the victim.
If people or at least paramedics available in rural and remote places can give the correct first aid, the job of physicians, surgeons would become much easier and golden hour principle can be honored very well. In turn it will give maximum possible survival because mortality is directly proportional to the time taken and types of first - aid given to the patient till he or she reaches to definite surgical treatment place or center. Also it is very important to know and keep in mind the basic aim of total trauma care concept is to "to get the patient to the right hospital in right time".
To give best possible outcome for critically ill patient, particularly for any polytrauma patient, there should be a good pre-hospital emergency service including pre-hospital transportation by well equipped ambulance also there should be smooth and safe intra-hospital transportation as well as inter- hospital transportation.
'Injury, Trauma and Polytrauma are the disease like any other'. Polytrauma is a major killer of the present day for modern society. For a trauma victim it is not the life but the quality of life it is not the function, but the quality of function that matters.
| References|| |
|1.||Bhattacharya A. Trauma anaesthesia and critical care in developing country- a multidisciplinary approach. Paper presented at annual meeting of SIOR, Pune1995. |
|2.||Jadhav DG. Transport commission motor transport statistics book. Govt of Maharashtra. 2000:45-50 |
|3.||Verghes M. Pre hospital care- introduction to injury control and safety promotion. Paper presented at Delhi, Activity Week of BJD-India 2000. |
|4.||Dave PK. Organisation of an accident Service. Delhi; Jaypee Brothers,1995: 62-65. |
|5.||Mohan D. Injuries in India, a Survey. ICSSR research abstracts. IIT Bulletin, IIT Delhi. 1992 Vol XXI No.3 pages 8-10. |
Dhanvantari Charitable Trust, Goyal Hospital, Devalgaon Road, Jalana 431203. Maharashtra
Source of Support: None, Conflict of Interest: None
[Table - 1], [Table - 2], [Table - 3]