Trauma Management Chandra Bhushan, Chandra Sekhar Mone
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IntroductionChapter 1

A Paramedic by definition is a person trained in giving First Aid or Emergency medical care. Paramedics are usually deployed to take care of emergency pre-hospital medical care. They are also known as Emergency Medical Technicians (EMT).
The role of a Paramedic is very important. As time is precious in the care of a medical emergency, the availability, in time, of a trained, skilled and properly equipped paramedic is invaluable. He or She can deliver the same type of medical care as what would be expected in a standard hospital set up.
Injury (trauma) is the biggest killer of the young people aged below 40 years. Trauma is caused by road accidents, industrial accidents, natural calamities, riots, terrorism, etc. Every year eighty thousand trauma victims die and lacks of people are injured on the roads in India. The number of vehicles, plying on the roads, is increasing astronomically every year and the roads are getting congested. The number of road traffic accidents are increasing every year despite the widening of roads and imposing safety traffic regulations like wearing helmet and seat belts, speed restrictions, etc. Trauma is a serious medical and social problem of our society. Trauma is also called as a Neglected Disease of Modern Society.
In the west, it has been shown that high quality pre-hospital ambulance services and Specialized Trauma Centers can reduce the mortality rate by 400%. The key to this is the Golden Hour concept where the resuscitation 3measures have to be started in the first hour after the injury. This led to the development of Advanced Trauma Life Support (ATLS) system, by the American College of Surgeons, where doctors are trained for rapid assessment and resuscitation of trauma victims. This is accepted and practiced worldwide for treating trauma patients.
In India, we do not have a proper body or structure to deal with the large amount of trauma patients. Except for a few Metro cities, there is no organization to run high quality pre-hospital care ambulance services and trauma centers to treat the severely injured patients. We have the highest number of fatalities following automobile accidents in the world. Studies done by various organizations like the World Bank, National Academy of Sciences and the World Road Association have shown that the death rate is 2 people per thousand vehicles in USA and 140 people per thousand vehicles in India. The concept of Paramedics, who are trained, skilled and equipped, who can easily be made available at the site of accident at the earliest, is catching up in large cities. This involves lot of investment, infrastructure and management. In Andhra Pradesh, the government has started a unique Public–Private partnership scheme, called AP Emergency Medical Services, where a coordinated effort is called for from the Government Institutions like Director of Medical and Health Services, Major Government Hospitals and Private Corporate Hospitals. This was launched on 21st March 2004. The government has created a central coordinating 4office for accidents for the whole state with a single four-digit phone number 1056 and the major highways are adopted by the Corporate Hospitals to give Free First Aid to trauma victims on the road.
Global Hospitals, Hyderabad, has introduced a unique project consisting of ten Two–Wheeler Ambulances called Global Accident Rescue Team, G—ART. These two-wheeler ambulances are well equipped for immediate resuscitation of a trauma victim and also carry mobile phones for immediate communication. These are run by Paramedics who are trained at Global Hospitals. These two-wheeler ambulances keep roaming in the city in preselected routes. During heavy traffic times, these ambulances have been the first ones to reach at the accident site to start resuscitative measures on the trauma victims and mobilize them to the nearest Trauma center or Hospital. At many times, they have been at the accident site in less than five minutes (Figs 1.1A to C).
On 15th of August 2005, EMRI, Emergency Medical Research Institute was launched by Satyam Foundation in Public-Private Partnership with Government of AP with a three digit number 108. It has started with 30 Ambulance vehicles covering 5 cities in AP and plans to cover other parts of AP and also extend to other states.
This book is written as a part of the training structure for paramedics, keeping in view the Indian perspective. The objective is to make available a concise and comprehensive handbook with training program scheme.
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Fig. 1.1A: Two wheeler ambulance
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Fig. 1.1B: Flagging off G—ART
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Fig. 1.1C: EMRI
The book starts with a basic knowledge of Anatomy and Physiology of important systems of the body. Separate topics are included on Types of Injuries and Patient Evaluation at accident site. Special topics are given on Resuscitation and First Aid at the accident site. A handy Algorithm is included for quick management of a trauma victim. The Algorithm and Resuscitation are based on the principles of ATLS.
The awareness about the importance of paramedics in trauma management has to spread a lot in our country. The government has to come out with some legislation that all the ambulance drivers need to be Paramedics and that each major hospital in the cities and District General Hospitals should have at least six paramedics attached to casualty department (two per each 8 hour shift). More paramedic training centers need to be opened up. This way we can expect to raise the standards and efficiency of pre-hospital care of trauma patients.