KARACHI, 02 JAN, (DNA) – Trauma is the leading cause of death for people aged 14-44 years. Most countries of the world are experiencing an epidemic of trauma, but the most serious increase has been in the developing countries.

It is expected that approximately one fifth of the entire universal burden of disease is due to trauma. Trauma results from various forms of violence and modes of injuries. They represent an ever escalating burden of morbidity, disability and death all over the world and in Pakistan as well.

These views were expressed by Dr Saeed Minhas, Associate Professor of Orthopaedics in Jinnah Postgraduate Medical Centre (JPMC) while delivering his presentation on “Accident-Trauma and management” during first public awareness program of PAK-CHINA MEDCONG held here in Pakistan Medical Association (PMA) House.

Other speaker was Dr Seemin Jamali, in-charge Accident and Emergency Department, Jinnah Postgraduate Medical Centre (JPMC).

Proliferation of roads and use of vehicles has led to a rapid increase in injuries and deaths, and many peripheral medical facilities find themselves faced with multiple casualties from bus crashes or other disasters. Severe burns are also common in both urban and rural areas.

A number of important differences between high and low-income countries include: the great distances over which casualties may have to be transported to reach a medical facility, vehicles which are very poorly maintained, the time taken for patients to reach medical care, the absence of appropriate equipment and supplies, the absence of skilled people to operate and service it etc., Dr Saeed informed.

He stressed that efforts in making the health managers capable of dealing with the emerging disease and disability patterns must be directed towards improvement in both qualitative and quantitative term. Such steps should include trauma training, education, National Trauma Registry, pre hospital trauma training, trauma, emergency room specialist, prevention of trauma, up gradation of resuscitation Bay and disaster Plan.

Orthopedic surgery plays a key role in the treatment of the polytraumatised patient.  Gunshot wounds required more orthopedic trauma resources than other surgical areas. The orthopedic surgeon is a member of a team consisting of many specialists, including emergency medicine physicians, trauma surgeons, neurosurgeons, and other surgical subspecialists. Orthopedic surgeon and Pakistan Orthopedic Association can take the lead of improving trauma system in Pakistan, he suggested.

Motorcycle injuries is an emerging public health problem in Karachi and these injuries constitute a major but neglected emerging public health problem in developing countries, and contribute significantly to the overall road traffic injuries.

Motorcycle injuries are among the leading causes of disability and deaths and the main victims are the motorcyclists, passengers and pedestrians in their young reproductive age group. The problem is increasing at a fast rate in developing countries due to rapid motorization and other factors. The injuries related to motorcycles contribute significantly to the number of road traffic injuries in Karachi city, taking out significant resources including consumables and the health worker time, Dr Saeed Minhas shared.

Motorcycle users are vulnerable on the road and represent an important group to target for reducing road traffic injuries. Even in developed countries with low morbidity and mortality rates from motorcycle injuries, the risk of dying from a motorcycle crash is 20 times higher than from a motor vehicle crash. The motorcyclists tend to over-speed and over load their motorcycles for quick returns.

It is because of that recklessness, indiscipline and lack of respect for other road users by the motorcyclists who are mainly youths, are the major cause of road related injuries. The majority of the motorcyclists don’t wear any protective gear, hence aggravating the risks of getting severe head injuries. Road traffic injuries are a deadly scourge, taking the lives of 1.2 million men, women and children around the world each year, he pointed out.

Emergency services and trauma care is a neglected all over the world. The lack of infrastructure, knowledge and initiative leave vast tracts of national highways, roadways, hazard zones unattended and under-served in the case of calamities, accidents and disasters. The accident rate in our country is fearsome-and like most developing countries, the mortality, morbidity rate is even worse. Most if not all victims are in the 18-45 age-group: the most productive segment of our people.

To improve the early management and hence outcomes of Road Traffic Related trauma PTC-Sind has been formed under the guidelines of Primary Trauma Care Foundation – UK. This is a not for profit organization promoting primary management of accident victims globally, he concluded.

Dr Seemin Jamali shared her experiences of dealing with disasters and emergencies. “I have done my house job in Civil Hospital Karachi (CHK) and can think of chaos within hospital to access emergency and other emergency care departments. There is a grave issue of accessibility for patients to get emergency treatment there,” she recalled.

But we have learnt a lot from CHK experience and improved accessibility to access JPMC emergency department. We have attended more than 250 disasters, medical and surgical emergencies in our emergency department. Initial improved management of such trauma cases coupled with good behavior is very vital to save lives, Dr Seemin Jamali stressed.

She told that violence against healthcare workers hinders quality care to victims as during such situations, doctors and other workers stop working. Public awareness programs should be executed to make people realise of this situation and ultimate disadvantage to patients.

VIP movements and traffic jams are another bigger hurdle to hinder emergency access of patients to health facilities which should be addressed, Dr. Seemin Jamali told. =DNA

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