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Cover page of the Journal of Health Sciences


 
 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 1-2

Trauma center is the need of the hour


1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JN Medical College Campus; KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
2 Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India

Date of Web Publication18-Jan-2019

Correspondence Address:
Dr. R B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), JN Medical College Campus, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_313_18

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How to cite this article:
Nerli R B, Ghagane SC. Trauma center is the need of the hour. Indian J Health Sci Biomed Res 2019;12:1-2

How to cite this URL:
Nerli R B, Ghagane SC. Trauma center is the need of the hour. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Jul 22];12:1-2. Available from: http://www.ijournalhs.org/text.asp?2019/12/1/1/250397



“Trauma” refers to a serious or critical bodily injury. The most common causes of injury that bring patients to a trauma center include falls and motor vehicle accidents. These events cause life-threatening injuries to multiple parts of the body. Other common causes of injury include burns, gunshot wounds, and assaults. Epidemiological data indicate that the number of patients affected by traumatic injury worldwide is over 10 million each year, and most die in cases of severe trauma.[1] Trauma remains the leading cause of death in the population under the age of 45 years in the United States.

The practice and evidence-based medicine in most of the developed countries have confirmed that the establishment of an integrated trauma center can significantly improve the success rate and outcome of trauma treatment.[2],[3],[4] Trauma centers are programmed and equipped to provide specialized medical services and resources to patients suffering from traumatic injuries. Appropriate treatment has been shown to reduce the likelihood of death or permanent disability to injured patients. Accredited trauma centers must be continuously prepared to treat the most serious life-threatening and disabling injuries. Even though trauma centers are within hospitals, they are not intended to replace the traditional hospital and its emergency department for minor injuries.[5] Trauma centers can vary in their specific capabilities and are identified by “Level” designation.

Level I trauma centers provide multidisciplinary treatment and specialized resources for trauma patients and require trauma research, a surgical residency program, and an annual volume of 600 major trauma patients per year.

Level II trauma centers provide similar experienced medical services and resources but do not require the research and residency components. Volume requirements are 350 major trauma patients per year.

Level III trauma centers are smaller community hospitals that have services to care for patients with moderate injuries and the ability to stabilize the severe trauma patient in preparation for transport to a higher level trauma center. Level III trauma centers do not require neurosurgical resources.

Level IV trauma centers are able to provide initial care and stabilization of traumatic injury while arranging transfer to a higher level of trauma care.

The major component that differentiates a regular hospital from one that is a trauma center is the requirement for 24-h availability of a team of specially trained healthcare providers who have expertise in the care of severely injured patients. These providers may include trauma surgeons, neurosurgeons, orthopedic surgeons, cardiac surgeons, radiologists, and nurses. Specialty resources may also include 24-h availability of a trauma resuscitation area in the emergency department, an operating room, laboratory testing, diagnostic testing, blood bank, and pharmacy. Hospitals who pursue trauma center accreditation must comply with the Standards of Accreditation. An aggressive trauma care accreditation process required to assure trauma care is delivered according to the established standards of care. Smaller hospitals or hospitals without a dedicated trauma center are not capable of treating serious trauma alone, and modes such as subsection consultation and subsection treatment easily result in delayed treatment, thus missing the best opportunities for trauma rescue; hence, it is essential to establish a scientific and effective trauma treatment system to improve the success rate of treatment.[1],[3]

It is very well known that the first peak of increased mortality in disasters, local wars, or accidents occurs within the first hour after a traumatic injury. The death toll accounts for 50% of the total trauma-related deaths. The causes of death include severe craniocerebral injury, high-level spinal cord injury, ruptures of heart, aortic or other large vessel, and airway obstruction. The second peak of increased mortality occurs in 2–4 h after injury and the number of deaths accounts for 30% of trauma-related deaths. Causes of death are mostly massive blood loss resulted from brain, chest, or abdominal blood vessels or solid organ rupture, severe multiple injuries, and severe fractures. The third peak of posttraumatic death occurs within 1–4 weeks after trauma, accounting for 20% of traumatic deaths, mostly due to severe infection, septic shock, multiple organ dysfunction syndrome, and multiple organ failure.[5],[6]

The Ministry of Health and Family Welfare, Government of India, set up certain operational guidelines in 2012 in regard to “capacity building for developing trauma care facilities on national highways.” The overall objective of the scheme was to bring down the rate of preventable deaths due to road accidents to 10% by developing a pan-India trauma care network in which no trauma victim needs to be transported for more than 50 km and a designated trauma center is available at every 100 km.

As per the “Accidental Deaths and Suicides in India-2012, National Crime Record Bureau, Government of India,” 440,042 accidents occurred in 2012 and 139,091 persons died due to road accidents.[7] India has the highest number of road deaths globally and the mortality rate in India is 11.6 per 100,000 population (MoRTH 2013) compared to 10.3 in Europe and 16.1 in the US (WHO 2013). The number of fatalities has been steadily increasing with the growth in vehicle population. In terms of mortality per 10,000 vehicles, the rate in India is as high as 10.5 (MoRTH 2013), compared to less than 2.0 in the developed world. Should the correlation between fatalities and vehicle growth continue, the number of fatalities in 2030 could be staggering.[8]

The main strategies of the scheme were as under (1) ensure definitive treatment for the injured within the golden hour; (2) basic life support ambulances at every 50 km along the highways; (3) designated trauma care facilities, viz., Level I, II, and III – at every 100 km on the highways by upgrading the existing government healthcare facilities to the appropriate level in terms of infrastructure, equipment, and workforce; (4) advanced life support ambulance at trauma care facilities for inter-facility transfer; (5) integrated communication network to enable the public to reach the trauma care system and for the various components of the system, viz., trauma centers and ambulances to interface with each other; (6) appropriate skill training to various human resources, viz., doctors and paramedics, working in the trauma care system; (7) to develop a National Injury Surveillance System and Trauma Registry; and (8) to spread awareness regarding injury prevention and road safety.



 
  References Top

1.
Hu PY, Chen XY, Chen XH, Chen YM. Trauma care construction under the guidance of county-level trauma centers. Chin J Traumatol 2018;21:256-60.  Back to cited text no. 1
    
2.
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. Anational evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78.  Back to cited text no. 2
    
3.
Nerli RB, Metgud T, Patil S, Guntaka A, Umashankar P, Hiremath M, et al. Severe renal injuries in children following blunt abdominal trauma: Selective management and outcome. Pediatr Surg Int 2011;27:1213-6.  Back to cited text no. 3
    
4.
Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al. Asystematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma 2006;60:371-8.  Back to cited text no. 4
    
5.
Rajendra BN, Sharma V, Basavaraj MK, Neeraj SD, Nitin DP. Grade V renal injury – Short and long term outcome. Open J Trauma 2017;1:20-5.  Back to cited text no. 5
    
6.
Zhao ZX, Liu ZM. Continue to play the role of comprehensive public hospital in emergency rescue: At 2014 second academic annual meeting of Disaster Medical Branch of Chinese Medical Association in Fuzhou. Chin J Disaster Med 2015;3:57-8.  Back to cited text no. 6
    
7.
National Crime Records Bureau. Accidental Deaths and Suicides in India; 2012. Available from: http://www.ncrb.gov.in/StatPublications/ADSI/ADSI2012/ADSI2012. [Last accessed on 2018 Dec 14].  Back to cited text no. 7
    
8.
Ministry of Road Transport and Highways. Specification for Road & Bridge Works. Fifth Revision. New Delhi: Ministry of Road Transport and Highways, Indian Roads Congress; 2013. Available from: http://www.manuneethi.in/FILES/IRC%20CODES%20&%20MORTH%20SPECIFICATIONS/MORTH%205th%20REVISION.pdf. [Last accessed on 2018 Dec 14].  Back to cited text no. 8
    




 

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