• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

Pre-hospital and trauma care for road accident victims

Accidents and trauma on the rise

Trauma has been a leading cause of death and deficits throughout the world in almost all age groups. WHO (World Health Organization) has declared 2011-2020, the Decade of Action for Road Safety. The aim of this step is to reduce the number of deaths caused by road accidents. Road accidents can lead to permanent injuries, disability or psychological trauma to the patient. That is why, it is important that the victim or victims get all the psychological, physical, financial and legal assistance they need.

Road traffic injuries kill more than 1.5 million people every year. It is also the number one cause of death among 15 to 29 year olds. In non-fatal cases, the victims are often left permanently incapacitated, which causes a huge financial burden on the victim’s family.

Among the five pillars of the Action for Road Safety agenda, the fifth pillar focuses on elements of post-crash response. From properly trained medical responders to providing psychological and legal support to the families.

The golden hour of trauma

In many countries including India, the golden hour is the most important hour for a trauma patient. It is described as the first hour after the event of a trauma. During this period if timely first aid is offered; the life expectancy can increase by a significant percentage. Prompt action can reduce the severity of injuries. It is a commonly accepted that blood loss is the leading cause of death for accident victims. That is actually a myth.  It is actually the loss of oxygen supply that puts the patient at more risk.

What is trauma care?

Trauma care demands provisions for appropriate medical equipment and personnel to deal with road accident victims. It is an organised and coordinated effort to deliver a full spectrum of care to an injured person. From injury through transport and post-hospital care, this system consists of three major steps, which are:

  • Pre- hospital
  • Acute care and
  • Rehabilitation

Pre-hospital care includes quick assessment of the person’s injury and triage by medically approved protocols. Acute care deals with diagnosing and treating the injuries at a deeper level. The key however lies in taking the injured person to a dedicated trauma centre approved by the government healthcare department. Doing so will give the person the best possible prognosis. Rehabilitation includes physical therapy and providing them with professionals who will help them settle back into their pre-accident life as comfortably as possible.

What to do in case you witness an accident?

  • The first and foremost step should be contacting the emergency services as soon as possible if you have just witnessed an accident.
  • As soon as you have contacted the EMS, it is important for you to remain calm so that you can help the crash victims.
  • If the person involved in the crash is responsive, make sure you help them keep calm and check for ventilation. Make sure they are breathing and frequently check their pulse till the professionals arrive.
  • Remember that only a few things can be fixed on the scene, the rest needs a trauma centre. Interventions on the scene include a quick head to toe exam for penetrating injuries, checking for proper ventilation and controlling excessive external bleeding. Unless the person is trapped under the crash debris, most of these exams are done on the way to the centre.
  • Apply pressure to stop external bleeding. External hemorrhage is controlled by applying pressure to the wound with a dressing. Hold the dressing firmly on the wounded blood vessel/injury.

The needs of an injured person are divided into three broad aspects by the WHO guidelines as:

  1. Life threatening injuries should be treated promptly in order to maximize the likelihood of survival.
  2. Disabling injuries should be treated appropriately so as to minimize functional impairment.
  3. Pain and psychological suffering are minimized.

Special considerations for children:

  • For airway management the paramedics should be equipped with paediatric sizes for nasal and oral cannulas as well as they should know the difference between the anatomy of an adult to that of a child.
  • Management of shock needs proper knowledge in baseline vital for different ages and varying physiological signs of blood loss and shock. The paediatric doses for baseline fluids for treatment of shock.
  • In case of spinal injuries, the personnel should be well versed with varying anatomy of a child’s spine. C-collars in paediatric sizes should be at hand ready for use.
  • For burns the percentage of body surface area affected should be taken in consideration and should be closely monitored.
  • Pain medication should be well monitored by the paediatrician to ensure proper administration of the medicines and its side effects.
  • For rehabilitation in children, the physical therapist should ensure milestones are met as closely as despite the impairment.

Trauma care is a matter of life and death. Knowing the basics of trauma care management and emergency response can help save lives.

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