Infrastructural shortfall need an overhaul before setting Trauma Centers in each district

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The recent order by the supreme court for setting up of trauma centers in each district raises a question, whether states like Uttar Pradesh and Bihar, are equipped enough infrastructurally to set up these care units in their districts? More on the issue by Smrity.

India globally tops the list of deaths due to road accidents. The number of deaths in Road crashes both in absolute terms and per  1,00,000 population is increasing exponentially. There is one serious road accident occurring every minute and 16 individuals die every hour due to these accidents in India, reports the NCRB and Ministry of Road Transport & Highway. There are around 60 individuals who are injured and 80 others who die daily due to road accidents in UP alone. These lives could have been saved had the hospitals been better equipped to handle trauma-related emergencies.

Source: NCRB report 2015

The total number of districts in India were 707 as of 2016. There is an assured availability of Primary Health Centres and Community health Centres but the major loophole lies in the availability of medical professionals. According to the statistical division of the Ministry of Health and Family Welfare, the total number of sub-centers were 153655, Primary Health centers (PHC) were 25308, and 5396 Community Health Centres (CHC) were functioning in the country as on 31st March 2015.  Though these health centers have increased in number during 2014-2015, they are yet not sufficient in order to meet the requirements of the population.  A huge shortfall was witnessed in the number of healthcare professionals especially surgeons (83.4%), physicians (83.0%).

The RHS (rural health statistic report) revealed striking data about the unavailability of doctors in PHCs. The total number of Doctors required was 3497 and the availability was 2209. The stats reveal lack of accountability as well as workers absenteeism.

Source: RHS, rural health statistic report

A closer study in this regard for Lucknow city revealed that though Sanjay Gandhi Post Graduate Institute of Medical Sciences has an emergency receiving station, it is of little help as no emergency medical officers and orthopedicians are posted there. It doesn’t even have an emergency operation theatre. The only thing that they can do is grade the type of emergency of the patient and refer him/her to the other center. So the notion that ‘time will be wasted at PGI’ stands correct. The institute has now constituted a committee to develop a plan so that optimum emergency services can be started. A couple of government hospitals also have up to six-bed trauma units, but the shortage of specialists ruins the effort.

There is a staggering rate of patients coming to the hospitals and equally less are the number of caregivers. It may not even be right to expect the hospitals to outdo their capacity as they are already fighting a crunch. There aren’t enough skilled healthcare professionals in India despite recent increases in MBBS programmes and nursing courses. As per official data, there is  50% shortage of nursing sisters. Ideally, a high dependency unit like the trauma center should have one nurse for every four patients. In addition, it needs 40% more paramedic staff, ward boys and sweepers to ensure smooth functioning and cleanliness. Most of the patients who come here have open wounds with blood oozing out. It poses risk to other patients by breeding hospital infection hence there is an urgent need for more number of cleaning staff.

Adding more cleaning staff thought would make a small contribution to the effort of minimising hospital infection. The entry of attendants is unavoidable due to the shortage of nursing staff. Except for the intensive care units, two attendants per patient can go anywhere. Unavailability of a proper reception counter to counsel or guide the attendants about key sections like  blood bank, pathology, x-ray etc is another shortfall.

The Supreme Court on 30th November 2017 issued a slew of directions on road safety and asked all states and the union territories (UTs) to set up a trauma center in each district of the country and make road safety norms a part of school curriculum.

The apex court has given all the states and Union territories a deadline of 31st March 2018, for formulating the road safety regulations. The directions of the supreme court also include installation of location tracking devices in public service vehicles. It has asked the states and the UTs to give due publicity to the Universal Accident Helpline number – 108- provided by the National Health Mission so that an ambulance can be activated at the earliest whenever necessary.

Earlier on April 22, 2014, the Supreme Court constituted a committee on road safety, headed by former Supreme Court judge Justice K S Radhakrishnan, which so far has submitted 12 reports. A lukewarm response was noted from several states and UTs in preparing road safety action plan as suggested by the Ministry of Road Transport and Highways (MoRTH).

Trauma care is a widely accepted strategy for providing basic life support, first aid and replacement of fluids within the first hour of the injury, to save the lives of road accident victims.

World Bank-supported “Uttar Pradesh Health system strengthening project” carried out by Morsel Research and Development team in Uttar Pradesh came out with the solution of community-driven intervention. Under this project researchers aimed at informing healthcare consumers about the quality of healthcare services so that they are able to demand better services.

It should be once again emphasized that the establishment of innumerable trauma centers with heavy financial burden should not be the goal of policymakers. Instead, upgrading existing hospital infrastructure to treat severely injured patients should be undertaken. Training of manpower in acute care and pre-hospital services should be a priority. Proper organization and administration of trauma services along with legislative backup will go a long way in strengthening India’s essential trauma care services.

All the direction issued by the supreme court would play a role only when the cities and the districts are infrastructurally developed and are all set for holding a trauma center with the full-fledged facility, where all patients could get prompt medical attention. It’s time the administration wakes up to this.

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