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Emergency Care Lessons from Karnataka

Road Safety and Emergency Care Programme of Karnataka is among few attempts by State governments to understand the critical healthcare issues related to road safety. The important lessons learnt from this programme will prove to be of immense help in ensuring quality road accident emergency care in India, writes T Radha Krishna of Elets News Network (ENN).

Failure to adhere to road safety norms, like non-communicable diseases, is emerging as a major cause of concern in India as it leads to disability, morbidity and increased mortality. To take on the challenges posed by road safety, there is a need for inter-sector coordination among stakeholders. One of the important pillars of road safety management is the post-crash care, which includes hospital care, trauma care and rehabilitation.

Karnataka Health System Development and Reform Project (KHSDRP) was a World Bank-aided project under the Department of Health and Family Welfare, Government of Karnataka, which aimed to improve health service delivery and public-private collaboration for the benefit of underserved and vulnerable groups in the State.

The Road Safety & Emergency Care Programme was taken as a component of KHSDRP in its additional financing phase, which came into effect on January 22, 2013 and closed on March 31, 2016. It was decided to conduct a pilot programme on the two road safety corridors in collaboration with Karnataka State Highway Improvement Project (KSHIP) to determine how State-wide investment contributes to the States overall road safety strategy. Two state highways “ Belgaum to Hunagund (186 kms) and Maddur to Mysore (53 kms) “ were proposed and approved. Three district hospitals and 22 taluka hospitals were taken up in this project.

The component included activities related to:

(i) enhanced capacity on the strategic direction for road safety initiatives within the health sector in Karnataka; (ii) improved pre-hospital services for road traffic injury (RTI) emergencies; (iii) improved post-crash services in hospitals for road accident emergencies; and (iv) improved monitoring and uation.

The initial step was to understand the situation on these two corridors. There was no reliable information regarding emergency care which has always been a part of healthcare delivery in all levels of government hospitals. Hence, the first activity decided was to conduct a situational and baseline survey on the corridors. The situational analysis would infer the current status and initiatives on road traffic injuries, existing emergency care and rehabilitative services available.

The baseline survey would give an insight to what resources might be required to scale up services in hospitals, training necessity, the present private and public health care services, availability of transport and utilisation of services. Taking the help of local medical colleges of the districts of Mandya, Belgaum and Bagalkote the baseline and situational analysis was done which also included black spots as recognised by the department personnel in the casualty. The mapping of blood banks, ambulances, police stations, private hospitals in Mandya, Bagalkote and Belgaum was done.

The Programme activities were considered under three titles:

Pre-hospital “ Improving transportation by providing well equipped ambulances and Surveillance of drink and drive.

Hospital “ Recognising the levels of trauma care and essential needs procurement of equipment; preparation of trauma care guidelines; capacity building; introduction of injury reporting system.

Post-hospital “ Rehabilitation – District programme coordinators were hired to collect data of manpower and equipment at district and taluk hospitals, details of road traffic injuries and deaths from the police and compared them to the hospital data. On analysis, it was found the figures did not match, as the department was not able to collect data from private agencies.

To improve the pre-hospital care, 112 casic and 48 advanced life support ambulances were procured and handed over to EMRI 108 (emergency response service). They were strategically placed at points where black spots were identified and the personnel being trained for emergencies ensured the victims were handled appropriately to avoid further injury. Seventy-five breath analysers with printer were procured and distributed to the corridor districts to improve enforcement of No Drink and Drive.

The department had no comprehensive precise guidelines to treat emergencies at different levels of healthcare facility. It was proposed to develop the baseline of number of personnel at each level of institutions, infrastructure, kind and number of equipment, type of service to be provided at each level of care. Preparation of guidelines meant it had to be adaptable to the resources available in a Government Hospital. Dr Manjul Joshipura, the co-author of WHO trauma care guidelines and the Director of Academy of Traumatology, Ahmadabad, was hired to develop Essentials for Trauma Care and Clinical Trauma Care Guidelines. In a well-organised system, referral criteria for transfer to a higher centre were defined and staff trained to quickly identify such patients and arrange transfer so that the patient outcomes are improved.

Trauma care training is given by only few institutions across the country. The project had to train 678 doctors and specialists, 1,309 staff nurses in advanced life support training and 320 lab technicians in basic life support training. This training was conducted by MS Ramaiah Advanced Centre for Learning in Bangalore. Only five batches of ATLS and three batches of BTLS could be conducted. Meanwhile, trauma care equipment were procured for district and taluka hospitals of Mandya, Bagalkote and Belgaum depending on the level of services provided and the specialists available at the hospitals.

The baseline survey and the observations of the consultants had shown that the quality of injury description and entry in the casualty register is of poor quality. Each hospital followed different type of format making it difficult to compile and analyse. The injury reporting system format was prepared after brain storming of different level of doctor groups and agreed upon. New registers were procured and provided to all taluk hospital and district hospitals of Mandya, Bagalkote and Belgaum. It was compiled in an excel sheet. The Injury Reporting System was started from October, 2014.

Name of
the District
No. of Admissions No. of Injuries No. of RTA attended in Gov. Hospitals* Falls Burns Drowning Poisoning Animal bite Assault Others
Mandya 51207 20065 9984 974 142 37 1769 2483 4829 348
Bagalkote 31458 5697 837 645 126 28 481 942 1401 281
Belgaum 65784 16323 3872 1145 331 22 1599 5170 4121 2047

The Injury reporting system in three districts. * March 2015-Jan 2016

After completion of the activities, it was found that the government sector health department plays an enormous role in trauma care. The data proved that mild to moderate injuries were missed out as they attend outpatients and maybe sometimes compromises between parties of the accidents fail to give exact figures on morbidity. Additional budget needs to be allocated for consumables and drugs for health care facilities on the highways. Health care personnel trained in emergency care on the highways have to work as a team which improves the outcome of victims. Harisha Mukhyamanthri santhwana Scheme a pioneer scheme under Suvarna Arogya suraksha scheme empanelled health care facilities which provides financial assistance for the treatment given during the golden hours is justified.

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