Quality in Health

(b) BreathingAirway patency does not ensure ventilation. One must

look for chest wall, lungs and diaphragm. There could be airor blood in the lung. Intercostal drainage tube should beinserted in the chest and connected to a suction machine.

(c) CirculationBleeding is most common in a roadside accident. It

should be controlled by applying direct pressure through apressure bandage. No tourniquet should be applied.Intravenous fluid should be started immediately.

(d) Disability

Level of consciousness, movement of limbs etc should bechecked to find any injury to the brain and spinal cord.Intoxication because of alcohol or drugs should be checked.

(e) Fractures

One must look for limb fractures. Fractures are usuallyimmobilized by different splints after cleaning and dressingof the wound. Pain must be relieved by analgesics.

TRANSFER & TRANSPORTATION

After the primary resuscitation, the patient should betaken to the receiving hospital in the same ambulance.Transportation should be very gentle. There are modemtypes of flexible stretchers available with various attach-ments. One must make sure that there is absolute immobili-zation of the cervical spine.

CONCLUSIONPre-hospital care is of paramount importance to save

many lives who become the unfortunate victims of road-sideaccidents. It is a coordinated approach of various segments ofsociety. We have to change our attitude and should be moresympathetic and responsive to the victim and help him all theway we can. We must inform the ambulance services, thepolice and should not be scared of their harassment.Immediate response, resuscitation, transfer and trans-portation can save many lives.

One must remember if some one is victim of accidenttoday, may be tomorrow, you yourself could be the victimand need the same kind of help!

PRE HOSPITAL CARE IN TRAUMA

S.S. SanyalFrom the: Visiting Consultant Orthopaedic Surgeon and Traumatologist, Indraprastha Apollo Hospitals,

Sarita Vihar, New Delhi 110 044, India.Correspondence to: Dr. S.S. Sanyal, B-380, Chittaranjan Park, New Delhi 110 019, India.

E-mail: shivsanyal@hotmail.com

PRE-HOSPITAL care in trauma means primary care which can berendered to the victim who had road accident before patientcan be transferred to a hospital.

Trauma remains the leading cause of death in the first fourdecades of life.Delhi has got maximum number of road sideaccident cases. It is more than the sum total of cases inMumbai, Kolkata and Chennai.

The recent concept of Pre-hospital Care started in 1982from Nebruska, USA. Maximum lives can be saved withinfirst few hours of accident and pre-hospital care is the crux ofthe strategy. It consists of

(i) Immediate communication.(ii) On site resuscitation.(iii) Quick and safe transportation.(iv) Good trauma centre.

COMMUNICATIONCommunication is most vital in pre-hospital care. It starts

from the site of accident. One must inform the Ambulanceservices to reach to accident site by dialing 102 or 1099(CATS) through his mobile.The driver of the ambulance inturn should inform the receiving hospital so that the hospitalshould be ready to tackle the emergency on a war footing.Every ambulance should have a mobile or radiophone. Orshould call the police for help. Every ambulance should bewell equipped with oxygen cylinder and mask, ventilator,defibrillator, splints, stretcher, emergency medicines andfluids. It should have atleast one trained paramedical staffapart from the driver.ON SITE RESUSCITATION

On site resuscitation is perhaps the most important way tosave the life of the patient. Quick assessment of the vitalfunctions like consciousness, pulse, blood pressure,respiration have to be recorded and primary treatment to beinitiated. Rapid evaluation and management processconstitutes ABC’s Trauma care. It consists of(a) Airways

Maintenance of airway is essential. One must look for anobstruction, must remove the obstruction. Adequateoxygenation is needed. At times intubation is required, thetube is connected to a ventilator for artificial respiration.

Apollo Medicine, Vol. 2, No. 2, June 2005 152