An emergency can strike anyone, anywhere, anytime is an undeniable universal truth where few minutes can be the difference between life and death and the only thing standing between it is timely medical care. Most people do not plan for a medical emergency. The first hour of definitive medical care is called the ‘golden hour’. It is usually this first hour where the patient’s medical fate is sealed and is very important in situations such as trauma, heart attack or stroke.
Trauma is the globally leading cause of death of the population that is under the age of 45 years with majority of victims being young males. Motor vehicle accidents are the major contributor of these types of fatalities; in children too under the age of 18, trauma is the leading cause of death and ranks higher than all other disease conditions combined. Surprisingly, the number of years of life lost before the age of 65 due to trauma exceeds those lost from heart disease and cancer put together. There is a massive additional social burden from disability affecting survivors as well. Majority of deaths occur either at the scene or within the first four hours after the patient reaches a trauma centre. Relatively, fewer patients die after the first 24 hours have passed following the injury. Most preventable deaths are due to excessive blood loss.
Regardless of the cause or type of trauma, the ultimate goal of treatment is to minimise the disability and deaths associated with the injury. It involves reducing the deaths associated with the second peak period which occurs in the hours shortly after the injury.
Suasth Hospital is a Level 1 trauma centre providing a multidisciplinary, extensive emergency medical service to trauma patients with the highest level of care and is capable of offering definitive treatment for any type of injury. Apart from an Accident & Emergency (A&E) department which is manned by emergency physicians who specialise in this field of practice, it also has availability of all surgical subspecialties and advanced imaging capabilities. The hospital operates on a “collaborative team approach” whose staff includes emergency physicians, general surgeons, orthopedic surgeons, neurosurgeons, reconstructive surgeons and anesthesiologists who are experts in treating trauma victims. It also has a 24-hour functioning laboratory, blood availability and a 24X7 radiology department for carrying out emergency X-rays, ultrasound, CT scans and MRI. With its comprehensive trauma care and emergency medical services, it is able to care for the most life-threatening emergencies at a moment’s notice.
The author is part of the Accident and Emergency Department, Suasth Hospital.
Ø Management of trauma is a neglected field in developing nations.
Ø WHO estimates that 5.8 million deaths annually are due to injuries, 90% of which occur in developing countries.
Ø Maximum proportion of these deaths occurs before patients even reach the hospital.
Ø Two thirds of the accident victims belong to the age range of 15 to 45 years.
Ø This is the economically productive age group and major financial support for their families.
Trauma related Deaths – The 3 Peaks
Ø Immediate deaths (1st Peak) - Seconds to minutes after injury, usually unpreventable e.g.: cessation of breathing secondary to high spinal or brain injury, or catastrophic hemorrhage due to great vessel disruption
Ø Early deaths (2nd Peak) - Minutes to hours after injury, usually hemorrhage related, Advanced Trauma Life Support (ATLS) style emergency care specifically targets these patients.
Ø Late deaths (3rd Peak) - Days to weeks after injury, usually due to multi-organ failure or sepsis. Optimal early management may prevent these.