| | | HEAD INJURY:A major killer | | | | | Posted Date : 14 Aug 2008 | | | |
by: Dr.G K Prusty
The WHO has projected that motor vehicles related injuries would be the third major killer of mankind by 2020. Twenty percent of the burden of death and disability are expected to be injury related worldwide. Trauma related deaths will be third leading cause of death for all age groups. For India road traffic accidents would be a major killer accounting for 5, 46,000 deaths 1, 53, 14,000 disability adjusted life years with an estimated economic loss of around 2% of GDP.
As a “disease,” trauma represents a major public health problem. It is the principal cause of death during the first half of the normal life span. There occurs one death every 1.9minutes in India due to trauma. Most common cause of trauma is road traffic accident. As per World Report on Road Traffic Injury Prevention, World Health Organization/World Bank 2004, road traffic injury is the 5th leading cause of death account for 2.1% of all deaths globally. Lives of 1.2 million men, women and children around the world are lost each year, 20-50 million are injured or disabled per year, 12,000 disabled throughout life.
On India's roads, 95,000 persons died in 2005. On an average one person dies every 6 minutes; 10 are injured in the same time frame [BBC; Sep 2005] In 70% the are due to head and spinal injury. India has just 1% of total vehicle in the world but India's share of global car accidents is nearly 10%. [Daily Telegraph Sep 06] of the total road accidents. Annual Social costs of Road accidents is estimated at Rs. 55,000 crores (12.7 billions) 3% of the GDP. (3rd United Nations Road Safety Collaboration Meeting, 14 & 15th November 2005, London)
The accident rate of 35 per 1000 vehicles in India is the highest in the world. The mortality has increased from 30 per lakh (1970) to 50 per lakh (2002)
According to State Transport Authority (STA) sources, as many as 7567 road accidents were registered across the State of Orissa in the year 2005 and 7628 in 2006. While 2528 persons died and 10,147 were injured in 2005, the year 2006 saw 2563 persons killed and 10,200 left injured in road accidents. While 26 persons died in every hundred accidents in 1995, the fatality rate increased in the State of Orissa to 33 in 2006...
Of the hundreds of thousands injured on our roads vast majority pedestrians, motorcyclists and users of public transport, many of whom would never be able to afford a private motor vehicle. Parents of teenagers worries about lots of things – drugs, sex, poor choice of friends. But the activity that causes the most harm to the teenagers is none of the above. Motor vehicle crashes are the leading cause of death for 16 to 20 years olds. Most if not all victims are in the 18-45 age-group: the most productive segment of our people. In persons under age 30, trauma is responsible for more deaths than all other diseases put together.
Following accident more than 50% die within first 15 minutes of the accident. This is the first peak, the immediate deaths, represents patients who succumb to their injuries before reaching the hospital. The injuries accounting for these deaths include major brain or spinal cord trauma and those resulting in rapid exsanguinations.
Second-peak deaths are commonly caused by such things as air or blood trapped in the pleural cavity, airway obstruction, intracranial hemorrhage, and acute blood loss following major fractures or abdominal injuries.35% among them die within next 1-2 hours. Most of them are treatable. If basic life support, first aid and replacement of fluids can be arranged within first hour of the injury (the golden hour), many lives can be saved. The key principle for this category is to provide initial stabilization to the injured within the golden hour. However, in most cases, salvage requires prompt and definitive operative care of the sort available at a trauma center, i.e., a specialized institution that can provide immediate resuscitation and access to a ready operating room 24 hours a day.
The third peak- Complications arising from the injury kill another 15% over the next thirty days. Sixty-one percent of these are caused by sepsis and multiple organ failure.
Road accidents are preventable but not all deaths due to accident. What is more tragic is that as many as 40% of all trauma deaths could be avoided by preventive measures and by the establishment of regional trauma systems that would expedite the evaluation and treatment of seriously injured people. Road safety is not a transportation issue, but a public health issue, and most road-traffic injuries can be prevented.
Emergency services and trauma care is a neglected area in India. After road traffic accident (RTA) chaos has come to be expected and usual rescue efforts are by the passers by and sometimes, bystanders. The fate of unconscious patients who are helped out by the invariably untrained by standers is better left to one's imagination. Many developed countries have realized this shortcoming that the Emergency Services / Physicians presence is limited and have instead started training their citizens to respond to an emergency until advanced help gets to the incident site.
There is a high mortality rate amongst those with multi-system injuries (poly-trauma), which can be attributed to the primitive state of trauma-care systems, lack of pre-hospital care and inadequate critical care. It is established that the mortality in serious (ISS > 16) injuries is six times worse in a developing country such as India compared to a developed country.
In India 1 out of 6 serious trauma victim dies, in USA the figure is 1:200.
India is ranked third in the world in terms of motor vehicles population, with about 7 crore vehicles and a growth of 7-8% per annum. But it also ranks second in the number of road accidents. About 4 lacs accidents were reported in India in 2004 itself. A senior NHAI official says that road users are equally responsible for the accidents on the highways. He added that there have been over 3000 accidents on the Delhi-Gurgaon controlled expressway between March 2003 and December 2006. “Out of this, about 50% of accidents are due to mechanical failure, in 15-20% cases drivers were found drunk and about 35% of them are due to other reasons including poor road conditions.
Industrialized cities, rural towns and villages coexist, with variety of health care facilities and almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure.
There is no doubt that trauma is a major public-health problem with high morbidity and mortality. Its issues need to be addressed. These include Pre-hospital Care, communication System like toll free call centre, disaster Preparedness, definitive Trauma Care Facilities, rehabilitation, information Systems, training of paramedics training as a vocation, to increase discipline and road safety standards & preventive aspect of Road Traffic Accidents.
Despite significant overall progress in many other fields, trauma systems in India continue to remain at a formative stage for various reasons. A concerted effort from all the parties involved, as well as the society, is the need of the hour.
As a result, many countries put far less effort into and preventing road traffic injuries than they do into understanding and preventing diseases that do less harm.
National Health Policy 2002the Government has committed to enhance the public spending on health from 0.9% to 2-3% of GDP with focus on primary health care including establishing trauma centers. Various Projects for Trauma Care along National Highways are going on since 1999.The aim is to develop a network of trauma care centers along Golden quadrilateral 5,846 kms connecting Delhi-Kolkatta-Chenni-Mumbai-Delhi, North-South-East-West Corridor
7,300 kms connecting north to South-Kashmir to Kanyakumari and East to West - Silchar to Porbandar comprising of:
Basic life support ambulance every 50 kms
L-III Trauma center every 100-150 kms to stabilize victims
L-II centers every 300 kms to provide specialised trauma care
L-I Center at least one in each state as a super specialty trauma center
NHAI (National Highway Authority of India) has developed a system of insurance by which it will foot the bill for those accident victims who cannot meet their own expenses.NHAI will empower its project directors to disburse money even to private Hospital for providing emergency services.
The author is President elect, Neurotrauma Society of India
(The 17th annual Scientific Conference of the Society is being held at Bhubaneswar during 22nd and 24th Aug,2008)
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