Why Trauma Care Remains a Challenge in India

By Dr. Sanjeev Kanoria

The concept of adequate trauma care for all continues to remain an aspiration in many Asian countries, especially in India. The country struggles with the highest fatality rate in the road accidents in the world, standing at 25.3 per 10,000 vehicles. Other fatalities from rail and airline accidents are similarly high, although we don’t have comparable data. Not just fatalities, accidents also result in disabilities, loss of income, and livelihood. The tragedy here is that most of these fatalities can be avoided if action is taken at the right time. Hence, establishing a robust trauma care system in India should be a top priority. The main challenges to trauma care in India lie with administration and clinical or operational aspects.

Administrative challenges relate to the dispensation of trauma care at a governmental and private institutional level. Despite one of the worst statistics for accidents and injuries, India does not have a formalised trauma care system, similar to the EMS or Emergency Medical Services in the United States. It can make a critical difference in emergency care as EMS personnel are the first respondents to any accident site. Similarly, there has been a lack of focused approach to address emergency and trauma care at almost every level. It is a multi-tiered operation which requires a synchronous collaborative effort of different organisations, including state and central governments.

There are several operational or clinical challenges as well, starting most immediately with pre-hospital care. Pre-hospital care is the ‘golden hour’ where decisive actions can improve chances of full recovery from an injury. It is virtually non-existent in rural and semi-rural areas. Even in the larger metropolitan cities specialist services for pre-hospital care are largely lacking. There is no standardised approach towards the training of pre-hospital care personnel. With a mix of private and public partners in this field, there is a need for a defined educational system similar to that of medical personnel like doctors and nurses.

Fortunately, the foundations for a well-planned multi-tiered trauma care system are already present. There are highly specialised tertiary health care centres which are equipped to deal with almost any emergency. The private sector is active and involved at multiple levels, from transport to emergency care hospitals. To make these factors more cohesive and effective, there are some areas that need immediate attention:

• A formalised trauma care system with well-defined procedures.
• Mechanism for accreditation of trauma care centres and professionals.
• Thrust on trauma care education for first-responders and the general public.
• Expansion of level 1 trauma care centres which provide definitive care facilities.
• Increased funding and outreach in rural areas.

Clearly there are many challenges that have to be overcome to reduce the unnecessary loss of life due to accidents and calamities. The effort must involve all of us, from the common man to the authorities.

The author is Founder, Suasth Hospital. Views expressed are the author’s own.