Trauma and after

By Nalin K. Rai

LIVING life in the fast-lane with gizmos like cellphones, fast cars and blaster stereos has become a sine qua non for present-day society. A fast car and a cellphone are considered status-symbols these days.

While it may have led to the surface level satisfaction of having been able to achieve all the modern amenities which makes a person attain some kind of social status, it has had serious negative results as well, which are not highlighted.

After the introduction of fast cars which boast of an acceleration from 1 to 60 km in 30 seconds that, on Indian roads accidents have increased. Similar is the case with holding a cellphone while driving. In fact a study report has pointed out that use of cellphones while driving has increased the rate of accidents on the Indian roads by 60 per cent.

In Delhi alone during the first six months of 1998, 2000 people have died in road accidents, while 5000 have suffered various kinds of injuries. This is because while new vehicles have been introduced, roads have not been improved simultaneously. Most of the casualties of accidents are pedestrians, who become victims of these new vehicles.

A study undertaken by the Central Road Research Institute has pointed out that the pedestrians who die are not accustomed to the speed of these vehicles. They are not able to judge its arrival in actuality. Imagine the trauma the families of accident victims have to undergo.

In fact, trauma is now considered to be the third largest killer after malignancy and heart disease the world over. It is, however, not given as much importance in our country as it is in the West.

Trauma is, no doubt, an outcome of the automobile and drug culture being imported from the West. But while the West has been able to create facilities to lessen the trauma arising out of its own creations, nothing is being thought of here. This is so even when statistics are glaring in the face of planners.

The case of Delhi is a good example of insensitiveness which can be sighted. According to Delhi Police records, last year while 300 pedestrians died during the first six months, this year the number has increased to 400. Still nothing is being done to ameliorate the situation. What has been done is that a sign-board has been placed at the ITO crossing (one of the busiest in Delhi). This shows the number of people dying in road accidents, and advises the public to use the roads judiciously. The culprits who perpetuate this atrocity on the common people are rarely brought to book.

The utterances of the government in the light of the Uphaar Cinema Hall tragedy, starkly underlined the need for at least one trauma management centre in the Capital, what to talk of other cities.

Sadly enough, the government pleaded its inability in providing a trauma management centre, citing the lack of the amount needed to create the centre, (about Rs 30 crore). The same amount is, however, spent on shows, events and junckets. It is stark case of eschewed priorities.

Whatever skeletal services exist, are stretched to the limits to cater to the needs of a privileged few. The result is that the trauma victim dies an unnatural death owing to the careless attitude of the authorities.

For a victim of trauma, the number "seven" is important. During the first seven minutes, after a trauma has occurred, basic first-aid has to be provided to the victim. This would enable him to survive the next seven hours when he is transported to the hospital. This can be done only when there is an availability of paramedical vans at crucial junctures of the cities, or people are given basic health care techniques — both of which are non-existent.

The next seven hours are particularly important, because during these seven hours the doctors are able to perform various kinds of tests on the patients of ascertain the extent of injury, and prescribe future course of medication.

These seven hours are however rarely made available to a trauma victim. Out of these seven hours, it so happens that most of the time valuable two to three hours are lost in filing an FIR with the police. Without this the doctors refuse to even lift a scalpel.

The third stage in trauma-care is that of 70 hours, during which the victim’s fate is decided — whether he is going to survive the trauma or succumb to it. This stage is working satisfactorily to an extent. Owing to a lack of the facilities at earlier stages, very few trauma victims are able to reach this stage.

Most metropolitan cities having a population of more than one crore, and a vehicular population of more than 30 lakh. As many as 29 million vehicles on Indian roads contribute to accidents leading to 60,000 deaths every year, or 167 deaths everyday. This is the figure for Britain in a whole year.

For cities of this magnitude and accidents of such proportions, there ought to be a minimum of seven trauma centres in each of the metropolitan cities. Sadly enough, none of the metropolitan cities seem to possess a single trauma care centre, that is of international standards.

Compared to the West, where once one reaches a hospital, only one per cent of the deaths are unpreventable, in India the figure stands at an appalling 41 per cent. This is the comparison between the premier institute in India and a trauma centre in the west. The percentage can rise meteorically if the parameters of comparison are taken at the district level.

To let people understand the importance of trauma and how to cope with it a four-pronged strategy is urgently required. This strategy can be classified in the form of an AIDA model.

The acronym AIDA stands for awareness, interest, decision and then action.

There is very little awareness about the post-trauma effects among the general populace in metropolitan cities, what to talk of rural areas. The government needs to run a sustained awareness campaign about trauma and how to cope with them.

To do this people’s interest has to be created to motivate them to help save vital human lives. However, for making them interested, the perennial police syndrome that accompanies a majority of trauma cases ought to be removed. It is the hassle of being involved with police that deters many a person from helping the trauma victims. As a result, a majority of the victims die unattended.

The government has to take a quick decision to set trauma as a major agenda in health care. It is not possible to prohibit the entry of new technologies, but along with it major decisions have to be taken at an executive level, to provide at least one trauma care centre in all important cities, distance of 100 km — on all the major highways of the country.

Action needs to be taken against erring individuals, be it in authority or the causative factors of trauma, it ought to be severe so that the people do not become devils behind wheels on the roads. The doctors too should not be inhuman, and want documentary formalities before attending to the victims.

If these basic steps are implemented they would go a long way in mitigating trauma and help lot of victims live.