Trauma Care in Pakistan

Abdus Salam Khan, MD FACP
January, 2017

As a nation we have faced more than our fair share of trauma.  Whether it is natural or manmade, we were exposed to calamity after calamity and still we are struggling to be proficient in the care of our trauma patients.

When accidents happen, usually first responders who come for the rescue are non-trained and non-technical individuals who are willing to help. It results in immediate action but putting patients at enormous risk of bad outcome. It is mostly because of lack of understanding regarding initial management of trauma.

Healthcare in Pakistan is not geared toward injury prevention or appropriate trauma care. Our prehospital system is not developed and first responders are not trained. The gap is very wide and chances are there that the situation will not improve in the near future as it does not seem to be the priority of either the government or the private institutions.

A common understanding about trauma is lacking in the general public as well as among decision makers of healthcare. Mostly when people talk about trauma they think that it is broken bones on big wounds. It usually is portrayed as work of surgeons mainly orthopedic or neurosurgery. Although these two specialties have the most to offer to trauma patients, but trauma care is not just the work in operating rooms. Initial stabilization of the trauma victim requires an integrated approach and most important aspect is the complete and immediate evaluation of the extent of the injury and best way of stabilization. This aspect of care is mostly mastered by the emergency physicians.

The emergency physicians are trained to do primary survey of patients to exclude life-threatening issues and deal with those injury issues in collaboration with the surgical specialties. Once they stabilize patients then they perform secondary survey, to obtain the full knowledge regarding patients after checking systems and evaluating the whole body. By the end of secondary survey examining physician should have clear information regarding injury and should be able to formulate the working plan regarding definitive care.

A good physician works by prioritizing the care and dealing with those injuries that cannot wait and then starting the survey again from the first step. This ensures that any change in the parameters of patient is not neglected and it leads to better outcome.

The trauma care requires initial stabilization and protecting secondary injury by utilizing the famous ABCDE approach which takes into account commonly affecting areas in trauma and stabilizing them. Thus airway and C-spine needs immediate stabilization in all cases except when there is obvious bleeding that need to be secured and then to start ABCDE approach again. Any treatable surgical cause is identified and surgical specialty is asked to provide definitive care as needed. If no surgical intervention is required then monitoring, fluid volume management and infection control becomes mainstay.

From above it is obvious that the initial trauma care is very important for a good patient outcome and we need to create this atmosphere of trauma care among our first responders. Hemorrhage control, C-spine immobilization and volume resuscitation are of primary importance. Similarly quick transportation to a specialized care area is equally important to obtain the good patient outcome. It is also important to establish a system of early warning to the receiving hospital regarding trauma victim so the team at receiving hospital should be assembled and be able to provide the required care.

I am hopeful that one day this dream of taking care of injured to the best of our abilities will turn out to be a reality. I can be reached at askhan65@yahoo.com.

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