Trauma-related deaths can be prevented by timely action

Trauma-related deaths can be prevented by timely action

Need for more trauma centres across cities that are up-to-date and organized

New Delhi, 17 October 2017:In India, one person dies of a road accident every minute, indicate statistics. Road accidents account for about 1,50,000 deaths every year. Injuries and the resultant trauma rank fourth in the causes of death across all age groups children, adolescents, and young adults. These are also reasons for more premature deaths than cancer, heart disease or other such diseases.[1]On World Trauma Day, there is a need to raise awareness on the fact that majority of these trauma-related deaths can be prevented through timey action and medical care.

Many deaths occur either within minutes of the injury, at the scene of accident or injury, before the victim is taken to the medical facility, or immediately upon arrival at the hospital. Some of the reasons for death include massive hemorrhage or severe neurological injury.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is still a long way to go in terms of immediate trauma care in India. There are many issues in offering critical care to injury victims. India lacks significant pre-hospital care in most cities with the golden hour concept still an ambiguity for many. This is further exacerbated by poor ambulances services and the lack of a centralized agency to monitor them. Hospitals need to ensure availability of casualty medical officers who can do more than just resuscitation. Add to this the fact that there are no dedicated trauma surgeons in India, which often causes delays in clinical decision making. This is because various aspects are handled by various departments and not a single entity. Last but not the least, there is no central trauma registry in any institute.”

In a survey, it was found that the risk of deaths in injured people can be reduced by about 25% if a trauma victim is treated at a dedicated trauma centre.[2]Trauma centres are classified into four levels based on the available resources and the number of patients admitted.

Adding further, Dr Aggarwal, said, “There is a need to have dedicated trauma centres in cities throughout the country that can provide the best emergency services and have up-to-date trauma systems. This means that such a hospital should have high-quality intensive care ward and an operating theatre, learned and dedicated personnel, and updated and latest equipment. Apart from this, it is imperative to make efforts to prevent injury or reduce the severity of injuries, as this will help in preventing many cases of immediate death.”

Prevention is always better than cure. Trauma can be prevented by staying alert at an individual level.

Some do’s and don’ts to consider with regard to accidents and injuries are as follows.

Follow the road safety rules and be aware of warning signs and traffic signals.
Do not forget to wear a helmet and take a break if you are driving for a long distance.
Do not use the mobile phone while driving or listen to loud music.
Keep a first-aid kit ready at home and in your vehicle.
Do not drive if you are sleepy, tired, or have had drinks.
If you notice a person with head or spinal injury, move the person from the site only with professional help to avoid serious back or neck injuries.
Do not give fluids to any unconscious or semi-conscious traumatized person.
Learn basic life support techniques and help the injured.

Will Dr Deepak Amarapurkar’s death be in vain?

Will Dr Deepak Amarapurkar’s death be in vain?

Are we waiting for another similar event?

On August 29, Dr Deepak Amarapurkar, a renowned gastroenterologist of the country, met an untimely and a very tragic end, when he fell into an open manhole during the heavy rains in Mumbai. His body was found two days later. This was an entirely preventable death, so why did this mishap happen?

This is but one of several examples of non performance of civic bodies.

Abandoned, but open bore wells, several feet deep, have claimed the lives of many innocent children. Low hanging live cables or open cables put lives at risk.

India has the highest number of road traffic accidents in the world. Driver error undeniably is a major cause of road traffic accidents. But, accidents are also caused by poor road quality and poor maintenance. Potholes, uneven road surfaces, lack of traffic signals, poor street lighting, collected water on the road, traffic cones are all hazards that cause road accidents and injuries. Speed breakers on our roads are most often poorly designed. There are no warning signs, no markings on them.

Falling trees, in particular, old trees also take lives. In July this year, the death of a woman was reported from Mumbai after a tree fell on her.

Litter or debris on the roads is also a hazard to drivers, cyclists or even pedestrians. Improper waste management not only has health implications, it is also a safety hazard as was evident in the landfill collapse in Delhi, which also claimed lives. This was and is a disaster waiting to happen.

Maintenance of roads and infrastructure of the city and also keeping it clean is the responsibility of civic bodies.

Why can’t such incidents be controlled or prevented?

Are these civic bodies poor? No. They have adequate funds by way of taxes - property tax, road tax, licensing charges, road parking charges. Every house or parking is contributing to the funds.

Despite this, such unfortunate incidents recur and many people lose their lives each year. Is this not non performance of civic bodies? The civic bodies have failed time and again to resolve these civic issues year after year.

If such an incident, had occurred in a hospital e.g. patient falling from the bed, electrical injury, this would have created uproar and the situation would have been ripe for another episode of violence against doctors, with even damage to hospital property. Criminal cases are being filed against doctors. This criminal prosecution of doctors is unwarranted.

Yet, where is the accountability for state and civic authorities for failure to maintain facilities or penal provisions, for that matter, in these instances of civic negligence? Should not an advisory or alert, cautioning citizens to stay home/indoors been issued in time? Who will take the blame for the death of an eminent doctor of the country?

Are we waiting for another such event to occur?

IMA Mumbai is filing public interest litigation (PIL) in the death of Dr Deepak Amrapurkar.

It’s high time that the state and civic authorities shake off their apathy and proactively act to prevent such tragedies in the future.

Disclaimer: The views expressed in this write up are entirely my own.

Pneumonia a leading cause of death among Indian children

Pneumonia a leading cause of death among Indian children Though progress has been made in combating the diseases, there is still a long way to go New Delhi, 02 June 2017: According to recent statistics, India has the highest number of pneumonia deaths among children around the world. About three lakh children died of the disease in 2016 alone, said a report. The other countries with the highest global burden of child pneumonia include Nigeria, Pakistan, Democratic Republic of Congo, and Angola. Although there has been some progress in combating pneumonia among young children in these nations, they still account for hundreds of thousands of preventable deaths around the world. Pneumonia is a form of acute respiratory infection affecting the lungs. In a healthy person, the small sacs called alveoli in the lungs fill with air while breathing. However, in pneumonia, these get filled with pus and fluid, making breathing painful and limiting oxygen intake. Pneumonia can be caused by viruses, bacteria, and fungi. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The viruses and bacteria commonly found in a child's nose or throat can infect the lungs if inhaled. They can also spread through air- borne droplets such as those during coughing or sneezing. Most healthy children can fight this infection with natural immunity. However, in some children, especially those whose immune systems are compromised due to malnutrition or undernourishment, or no breastfeeding, this infection can become serious. Some other risk factors include indoor air pollution, living in crowded homes, and parental smoking” Some symptoms of this disease include rapid or difficult breathing, cough, fever, chills, loss of appetite, and wheezing (prticularly in viral infections). In severe pneumonia, a child can undergo lower chest wall indrawing, where the chest moves in or retracts during inhalation Infants can experience unconsciousness, hypothermia, and convulsions. Adding further, Dr Aggarwal, said, “Pneumonia can be treated with antibiotics. A large majority of the cases can be tackled at home itself. Hospitalization is recommended only in very severe cases. Pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are. It is All communications intended for headquarters office should be addressed to the Hony. Secretary General a good idea to keep kids away from anyone with stuffy or runny nose, sore throat, cough, or respiratory infection in general”. It is imperative to improve a child’s natural immunity through adequate nutrition and this starts with exclusive breastfeeding for the first six months. Breastfeeding is not only effective in preventing pneumonia, but can also help in reducing the duration of the illness. Some other points to consider are reducing indoor air pollution and encouraging good hygiene in crowded homes.

Preventing electrical deaths in the monsoon season

Preventing electrical deaths in the monsoon season Do not use 2 pin electrical appliances as they can be dangerous New Delhi, August 01, 2016: In countries like India where 2–pin electrical appliances are still used, it is common to see a few people dying every day due to electrocution in major cities. Most of these deaths are preventable, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Even if an electrical death occurs an electrocuted dead body can be revived within 10 minutes by using the conventional principles of cardiopulmonary resuscitation using the Formula of 10 where within 10 minutes of cardiac death for the next 10 minutes, compress the heart of that person at a speed of 100 per minute. Obviously, first the electrical source needs to be disconnected. Most deaths in India are due to misuse of earthing. In India, earthing can be procured either from the city source or made indigenously at home by digging a deep hole in the earth.’ Follow these Dos and Don’ts about earthing to prevent electrocution deaths: 1. Earthing is a thick wire attached to the top hole of a 3–pin electrical socket. 2. In any electrical circuit, green wire is for earthing, black for neutral and red for live wire. Earthing lead by convention is kept green so that it can be identified easily. 3. Normal electricity is generated when the live wire is connected to the neutral wire. Live with earth wire will also give the electrical current. There will be no current when the earth wire is connected to the neutral wire. 4. Earthing is a safety outlet, which allows leaking electricity to be conducted away harmlessly and not through the body. 5. Earthing needs to be checked every 6 months because it deteriorates with time and weather, particularly during the rainy season. A check can be carried out using an ordinary tester on the body of the appliance. 6. A test lamp can also check that earthing is proper. One can light bulb with live and earth wire. If the bulb fails to light while connecting live and earth socket it means the earthing is defective. 7. People tend to take earthing lightly and often misuse it. 8. Live and earth wires are sometimes untied together for temporary connection, which can be dangerous to life. Following are the general precautions, which people should take to prevent electrical hazards: 1. Make sure that you have proper earthing connection in the house. 2. Always remember the green wire, without it, do not use any electrical appliances especially if it is touching any water surface. Water enhances conductivity; extra precautions therefore should be taken, while handling appliances, under wet conditions. 3. 2–pin plugs with no earthing arrangements should not be used and in fact should be banned. 4. While using 3–pin plugs, make sure all 3 wires are connected and the pins are not defective. 5. Do not use matchsticks to hold wires in the socket. 6. Do not touch any wire without ensuring that power supply is switched off. 7. Do not use the earth wire to replace the neutral wire. 8. All joint wires should be properly insulated with proper insulated tapes and not with sellotape or Band–Aids. 9. Before using geyser water, it should be switched off. 10. Do not use heater plates with exposed wire for cooking purpose. 11. Use dry rubber slipper at home. 12. Use mini circuit breaker (MCB) and earth leak circuit breaker (ELCB) facilities at home. 13. Metallic electrical appliance should not be kept near a water tap. 14. Using rubber mats and rubber leggings in the desert cooler stand can insulate electrical appliance. 15. Use only recommended resistance wires and fuses. 16. Earthing should be checked every 6 months. 17. Any ordinary tester can check the presence of leaking electricity. 18. Wrap cloth around the handle of the refrigerator 19. Read the set of instructions attached with every electrical appliance. 20. Accidental electric deaths occur more often in India due to the use of 220 V than in the US, where 110V is used. 21. AC current is more dangerous than DC. An AC current of more than 10 MA causes tetanic muscular contractions making it impossible for a hand grasping an energized object, to free itself. In case of electrocution, proper resuscitation is necessary. The mains should be switched off or wires disconnected using a wooden material and cardiopulmonary resuscitation should be started immediately. In a clinically dead patient, a thump in the center of the chest from a distance of one foot may alone revive a person. In severe electrocution, clinical deaths occur within 4–5 min., therefore time to act is limited. Do not wait for the victim to be taken to the hospital. Act there and then.