Setting up of accident-trauma centers in Karnataka will go a long way in checking the alarming rise in the number of deaths due to road accidents, suggests Ramesh G jethwani Bangalore.

The number of fatal road accidents in Bangalore and not only increased but the nature and severity of the cases has become complex leading to an increase in the sufferings of the accident victims.

There is a crying need for the setting up of a well managed Centralized Trauma and Accident Service (CTAS) under a dedicated Service (CTAS) under a dedicated authority in the state, particularly so, when there is a lack of accident trauma service, right from the spot of the accident. Inadequate number of equipped ambulances to transport accident victims under medical Guidance victims under medical guidelines and a dearth of specialized accident trauma centers functioning round the clock have cost several lives in the state.

The large number of road accidents are due to a combination of problems like increase in population, vehicular boom on our roads, and inadequate traffic management. There were 622 cases of fatal road accidents in Bangalore alone which cost 655 lives during 2000. There are about 1.4 million vehicles in Bangalore and a majority of these are two wheelers.

Today with the exception of some hospitals, most other lack facilities to handle trauma cases besides lacking the basic facilities to provide life saving support to accident victims. In fact many I lives are lost due to untimely medical assistance during the most crucial first hour. Often, due to inadequate trauma-accident services, specially near the state highways, it takes several hours to shift accident victims to a hospital. In the meantime precious lives are lost.

In most developed countries there is a network of trauma-accident centers which are linked to highly equipped trauma centers with a network of ambulances with modern communication facilities stationed at strategic locations. In case of a road accident the victim is rushed to the nearest trauma accident center and if the injury is major the patient is sent to a major center. All this is done quickly in the crucial first hour.

The death rate due to road accidents is about 1.5 percent in developed countries as compared with the alarming 41 percent in India. There is a need for well equipped ambulances with trained paramedical trauma staff for safe shifting of accident victims, rendering first aid, giving IV fluid, etc , and these trained personnel should be able to decide which type of trauma center the patient has to be shifted to and when the victim reaches the hospital, arrangements should be made for immediate treatment.

The focus of a project like the centralized accident and trauma service should be to save the lives of accident victims by providing timely medical assistance.

In India about 75,000 (At Present about 1,50,000) lives are lost every year due to road accidents. Unfortunately in our country due to the lack of such effective trauma-accident services a large number of lives are not only lost but there is also an increase in the trauma associated with road accidents and the victim has to live with it for the rest of his life.

Infrastructure
To check this trend, it is imperative to develop at least 4 major trauma – accident centers in Bangalore with a supportive network of 8 minor centers The major trauma centers can be developed at any of the four places like Bowring, Victoria, M S Ramaiah or Malaya hospital. Trauma services are already being rendered by the Hosmat and Sanjay Gandhi hospitals. All these places have the required infrastructure and medical personnel. Wherever required, some facilities can be upgraded. Also, exclusive trauma facilities with at least 10 beds reserved for trauma cases and round-the-clock duty by doctors drawn from medical faculties like Orthopedics, Neuro, Cardiology and Vascular should be made available The service should be extended to all the districts, particularly those near the state highways.

Ambulances
Starting with Bangalore we need to station at least 15 fully equipped ambulances with trained paramedical personnel and some 15-tonne cranes to carry the accident vehicle in order to clear the road and rush in the shortest possible time to a hospital.

The ambulance must be equipped with global satellite positioning system for locating the spot of accident and to guide the ambulance driver to rush to the spot by an alternative shorter route in case of a traffic jam on the state highways.

The most important aspect of trauma management is the post accident scenario. Shifting the victim under proper medical guide-lines prevents further complications.
Measures
Strict orders must be issued to the police against harassing those members of public who render services to society by shifting the victims to hospital. Often, eye witnesses hesitate to shift the victims to hospital due to the fear of harassment by the police, thereby resulting in the loss of many lives.

It is high time efforts were intensified to identify accident prone spots in Bangalore and all state highways especially dangerous stretches prone to serious accidents, besides applying correctives like better regulations of traffic at these vulnerable spots. Well placed and clear sign boards warning drives, providing better lighting on the highways and ensuring better road conditions should be the priority areas. A toll free telephone booth should be provided at strategic points.

Traffic management with contiguous monitoring of driving practices and enforcing strict guidelines for driving will go in a long way in reducing road accidents.

Sir, The Karnataka Government should immediately revamp accident and poly-trauma services in Bangalore and other parts of the State. As these services are woefully inadequate the incidence of trauma moralities are very high in and around Bangalore. Accident victims are left and dry and shifted to the hospital only when police arrange an ambulance. As the victim does not get medical, aid in the first 60 minutes — the Golden Hour —he/she either dies or is disabled.

I have a few suggestions which, if implemented after proper studies by the Traffic Police and medical fraternity, will help save accident victims.

One, the Government, with the help of City-based corporate banks, should organize 10-15 fully equipped ambulances like the Hosyala with trained Para-medical staff and latest equipment to give the victim life-saving support till he reaches the trauma center.

Two, these ambulances should be stationed 24 hours in different parts of the city within easy ,reach of the victims. The ambulances should have radios connected to the central control room. Accident monitoring can be done by the latest global-satellite position system (GPS) so that victims can get help in the shortest time. The ambulance staff can inform the trauma center about the gravity of the accident. In case of heavy traffic, the control room can guide the specific route of the ambulance with GAPS help.

Three, in each hospital, at least 5-10 per cent beds must be reserved for poly-trauma cases. Also, technical up gradation of Government trauma centers is a must including skilled surgeons and equipment like stretchers, laboratory, CT scan and other services for 24 hours.

Four, the Government should negotiate with cellular phone operators to allow toll-free number so that the passersby(using cellular phones) can in-form the police promptly. The general public, who help accident victims, should not be harassed by the police. And finally, the Government should amend rules so that victims of trauma cases are not turned away by private hospitals/ nursing homes irrespective of the victims' financial status. For this, private hospitals should he allowed to collect mandatory Rs.10 assess per bed which should go towards the fund for trauma victims.

As I have seen in the Gulf, where like US and other Western countries, trauma cases are very promptly attended to. With better medical services, ambulance and modern communication facilities a large number of accident deaths can be prevented if medical help is given in the first Golden Hour of the accident.

Sir,It was a noble step by the government to establish ‘108 ambulance service’ to provide timely emergency medical help to accident victims, seriously-ill patients and pregnant women. However, the very purpose of this 108 service is defeated, as the 108 ambulances often find themselves in traffic jams when they receive a distress call. I have a few suggestions which can make this service more effective,

1.Connect 108 call center with the police communication center. Whenever the 108 control room receives a distress call, it should immediately alert the police control room which will coordinate with traffic police personnel to ensure that the patients reach the hospital on time.
2.The government should install emergency public warning systems with sirens blaring at the time of an accident.
3.In cease the number of ambulances and place them at strategic locations.
4.All stakeholders should work together diligently to make the 108 ambulance service a successful service provider. Also, the government should issue order to all hospitals to provide medical help whenever 108 ambulances bring in patients.

Sir, When the 108 service came into effect, it was expected to provide speedy medical care and first aid during emergencies. However, the very purpose of it is defeated with the on going strike, causing great inconvenience to the public.

It is saddening that the service is deteriorating day by day. The state needs to address grievances and revamp 108.

Sir, Apropos “Save accident victims” (DH, Jun 28), it is sad that road accident deaths are not taken seriously by authorities. Provision of timely medical aid to victims in the “golden hour” through improved accident and trauma services by stationing more 108 ambulances is vital.

While the police needs to publicize that good Samaritans will not be called for any enquirer, the government must direct hospitals, especially private ones, to reserve beds for accident victims and to provide compulsory medical help, regardless of their financial capacity.

According to a source, this kind of delay does not happen and within the city limits, ambulances reach within 10-15 minutes.

Even after a second call was answered the ambulance took close to 45-50 minutes to reach the location of Mansukhani who had suffered a heart attack.

BENGALURU: Ramesh Jethwani, a senior citizen residing in Frazer town, was heartbroken as all his efforts to save a friend, who had a heart attack, went in vain as the ambulance arrived after nearly 50 minutes.

“Mansukhani had come to the city with his grandson and son, for a treatment for his grandson. He himself was healthy and fit, hence it was shocking to actually see him in the mortuary,” Ramesh said.

Ramesh and Mansukhani’s relatives tried to call the ambulance, but in vain. “At first call, I was put on hold for 25 minutes. As an emergency service provider who does that?” he quipped.

Even after the second call was answered the ambulance took close to 45-50 minutes to reach the location. “I was so helpless looking at his situation,” he added.

Sadly, they lost Mansukhani at 2 pm on Wednesday afternoon, as after calling a nearby doctor who even tried to resuscitate him, declared him dead. “If only the ambulance had arrived on time we might have been able to take him to the doctor within the golden hour,” he said. It was only after the relatives had called a private ambulance, it arrived, but it was too late. “They came when the body was being taken to another ambulance,” he informed.

When Deccan Chronicle tried to reach out to the EMRI ambulance service, the calls went unanswered. According to a source, this kind of delay does not happen and within the city limits, ambulances reach within 10-15 minutes.