musculoskeletal trauma services in india

Musculoskeletal Trauma Services in India

Prof.Dr.Sudhir Babhulkar

M.S.Orth, D.Orth, PhD Orth, DSc Orth, FAMS

DirectorSushrut Hosp, Research Centre & Postgraduate Institute of Orthopaedics, Nagpur

Accidents is one of the leading cause of Morbidity

and mortality in IndiaNearly 85,000 deaths with 1.2millions morbidity is reported

every year

Musculoskeletal Trauma

A vehicular Accident is reported every 5 minutes and a death every 10 minutes on Indian roads.Involves predominantly males in the ages of 10-50 yrs.

There is disproportionate high death rateDue to road traffic accidents in India, more than the Rate in developed nations



Road Accidents in India are managed by State & Central governments, supported by NGO’s, Corporate hospitals and private practioners

Existing Institutions are not fully equipped to deal with road traffic accidents or to adopt the advances in techniques & technology which promotes Road Safety


Responsibilty towards the victims in term of road safety & its management is diffused and there is no single agency to deal with its multiple problems

In the year 2000More than 80,000 persons were killed and 3,50,000 injured in road traffic accidents

( The actual number might be double)


Commonly the accidents are seen on National Highways & Rural India.Only 15% of total RTA occur in 23 cities of India

Mixed traffic in urban areas

Motorised two wheelers comprise70 % of all Vehicles and constitute about 30% fatalities.


Non motorised traffic on four-laned highways

Nonmotorised road users consisting of Paedestrians, cyclist, slow moving vehicles are more vulnerable accounting for 60-80% fatalities.


Proportion of different types of road users killed in Delhi, Mumbai, National highways in India compared with highly

motorised countries.

Modes of Road Accidents

GOAL OF TREATMENT


Barring Metros & few bigger cities the trauma Care system is in embryonic stage.Very little percentage of Ambulance services have trained & skilled staff for promoting Airway support , appropriate splintage.

The majority of ambulances have only means of IV infusions, BP measurement and most of them serve as a mode of transportation from the site ofaccident to the nearest hospital.


Road traffic fatalities in metropolitan cities of India in 2000

Prof. Dinesh Mohan, IIT, New Delhi

GOAL OF TREATMENT


Despite the beautiful network of Telecommunication.The communication in trauma care system is very Poor.

Only few centres in the cities has dedicated system of central numbers with wireless facility

GOAL OF TREATMENT


Most Govt.hospitals offer free treatment to the Patients, but the quality of care differs from centre to centre. In rural areas there are Primary health centres, Rural hospitals who have to cater to all the medical problems and not necessarily the trauma victims.

There are very few dedicated centres in the periphery, The Central Govt. is planning to set up prehospital trauma care centres on National highways from where the patient may be reffered to nearest District hospital, or General Hospital of Medical college or teaching hospital.

GOAL OF TREATMENT


Spectrum of health care facilities

GOAL OF TREATMENT


District Hospital often lack trained staff, and adequate infrastructure for management of Polytrauma.

Private & Corporate hospitals are equipped withChoosen supportive and injury facilities with ultramodern intensive care units.

However most of the general hospitals & even in tertiary Centres, standardisation of trauma care is not very good.

GOAL OF TREATMENT


There level of training & expertise in providing the support is not uniform. Only about 30% of tertiary hospital have set protocol of Triage & follow the principles of ATLS

The concept & practise of trauma care system isto percolate beyond tertiary hospitals.

There are no protocols for inter-hospital transfers.Most of the injured victims are managed by team headed by Orthopaedic surgeon, though the critical care is mainly managed by Internist &Anaesthesiologist

GOAL OF TREATMENT


Rehabilitation is the integral part of Trauma CareWhich is neglected. It is mainly done in the form of Physiotherapy only.

There are very few centres who practises Psychological counselling & Occupational therapy

There is no central co-ordination for Trauma patients

GOAL OF TREATMENT


WHO Guideline


• Airway management

• Breathing- management of

respiratory distress

• Circulation – Assessment of

shock and control of hemorrhage

• Management of head injury

• Management of neck injury

• Management of chest injury

• Management of abdominal injury

• Management of extremity

injury

• Management of spinal injury

• Management of burns and

wounds

• Rehabilitation

• Pain control and medicines

• Diagnosis and monitoring

• Safety for health care

personnel

Guidelines for Trauma care

Methods of promoting essential trauma care services


Training for trauma care:

Advanced Trauma Life Support (ATLS)

National Trauma Management Course (NTMC)

Definitive Surgical Trauma Course (DSTC)

Essential Surgical Skills (ESS)

Primary Trauma Care (PTC)

Trauma Nursing Core Course (TNCC)

Trauma Team Training (TTT)


Integration of Systems for trauma care management

• Pre-hospital Triage

• Referrals and inter-hospital

transfers

• Communication

• Transport

Thank you

ISO 9001. 2000

GOAL OF TREATMENT


Correct data of injured patients to ascertain the outcome is not properly available,However it is observed that Single system Injury- Musculoskeletal trauma has improved.

Same is not true for Polytraumatised patients, which is attributed to primitive state of Trauma Care syst, Poor facilities or prehospital care, inadequate critical care in most of the parts of the country

No such system exists in rural India & remote places.Fatal accident rate is 7 times more than advanced countries.

musculoskeletal trauma services in india

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