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Musculoskeletal Trauma Services in India

Musculoskeletal Trauma Services in India. Prof.Dr.Sudhir Babhulkar M.S.Orth, D.Orth, PhD Orth, DSc Orth, FAMS. Director Sushrut Hosp, Research Centre & Postgraduate Institute of Orthopaedics, Nagpur. Musculoskeletal Trauma.

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Musculoskeletal Trauma Services in India

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  1. Musculoskeletal Trauma Services in India Prof.Dr.Sudhir Babhulkar M.S.Orth, D.Orth, PhD Orth, DSc Orth, FAMS Director Sushrut Hosp, Research Centre & Postgraduate Institute of Orthopaedics, Nagpur

  2. Musculoskeletal Trauma Accidents is one of the leading cause of Morbidity and mortality in India Nearly 85,000 deaths with 1.2 millions morbidity is reported every year

  3. Musculoskeletal Trauma There is disproportionate high death rate Due to road traffic accidents in India, more than the Rate in developed nations • A vehicular Accident is reported every 5 minutes and a death every 10 minutes on Indian roads. • Involves predominantly males in the ages of 10-50 yrs.

  4. Musculoskeletal Trauma Road Accidents in India are managed by State & Central governments, supported by NGO’s, Corporate hospitals and private practioners Existing Institutions are not fully equipped to deal with road traffic accidents or to adopt the advances in techniques & technology which promotes Road Safety

  5. Musculoskeletal Trauma Responsibilty towards the victims in term of road safety & its management is diffused and there is no single agency to deal with its multiple problems In the year 2000 More than 80,000 persons were killed and 3,50,000 injured in road traffic accidents ( The actual number might be double)

  6. Musculoskeletal Trauma Commonly the accidents are seen on National Highways & Rural India. Only 15% of total RTA occur in 23 cities of India Mixed traffic in urban areas

  7. Musculoskeletal Trauma Nonmotorised road users consisting of Paedestrians, cyclist, slow moving vehicles are more vulnerable accounting for 60-80% fatalities. Non motorised traffic on four-laned highways • Motorised two wheelers comprise70 % of all Vehicles and constitute about 30% fatalities.

  8. Musculoskeletal Trauma Modes of Road Accidents Proportion of different types of road users killed in Delhi, Mumbai, National highways in India compared with highly motorised countries.

  9. Musculoskeletal Trauma Barring Metros & few bigger cities the trauma Care system is in embryonic stage.Very little percentage of Ambulance services have trained & skilled staff for promoting Airway support , appropriate splintage. GOAL OF TREATMENT The majority of ambulances have only means of IV infusions, BP measurement and most of them serve as a mode of transportation from the site of accident to the nearest hospital.

  10. Musculoskeletal Trauma Road traffic fatalities in metropolitan cities of India in 2000 Prof. Dinesh Mohan, IIT, New Delhi

  11. Musculoskeletal Trauma Despite the beautiful network of Telecommunication.The communication in trauma care system is very Poor. Only few centres in the cities has dedicated system of central numbers with wireless facility GOAL OF TREATMENT

  12. Musculoskeletal Trauma Most Govt.hospitals offer free treatment to the Patients, but the quality of care differs from centre to centre. In rural areas there are Primary health centres, Rural hospitals who have to cater to all the medical problems and not necessarily the trauma victims. GOAL OF TREATMENT There are very few dedicated centres in the periphery, The Central Govt. is planning to set up prehospital trauma care centres on National highways from where the patient may be reffered to nearest District hospital, or General Hospital of Medical college or teaching hospital.

  13. Musculoskeletal Trauma GOAL OF TREATMENT Spectrum of health care facilities

  14. Musculoskeletal Trauma District Hospital often lack trained staff, and adequate infrastructure for management of Polytrauma. GOAL OF TREATMENT Private & Corporate hospitals are equipped with Choosen supportive and injury facilities with ultramodern intensive care units. However most of the general hospitals & even in tertiary Centres, standardisation of trauma care is not very good.

  15. Musculoskeletal Trauma There level of training & expertise in providing the support is not uniform. Only about 30% of tertiary hospital have set protocol of Triage & follow the principles of ATLS The concept & practise of trauma care system is to percolate beyond tertiary hospitals. GOAL OF TREATMENT There are no protocols for inter-hospital transfers. Most of the injured victims are managed by team headed by Orthopaedic surgeon, though the critical care is mainly managed by Internist & Anaesthesiologist

  16. Musculoskeletal Trauma Rehabilitation is the integral part of Trauma Care Which is neglected. It is mainly done in the form of Physiotherapy only. There are very few centres who practises Psychological counselling & Occupational therapy GOAL OF TREATMENT There is no central co-ordination for Trauma patients

  17. Musculoskeletal Trauma GOAL OF TREATMENT WHO Guideline

  18. Musculoskeletal Trauma Guidelines for Trauma care • Management of extremity • injury • Management of spinal injury • Management of burns and • wounds • Rehabilitation • Pain control and medicines • Diagnosis and monitoring • Safety for health care • personnel • Airway management • Breathing- management of • respiratory distress • Circulation – Assessment of • shock and control of hemorrhage • Management of head injury • Management of neck injury • Management of chest injury • Management of abdominal injury

  19. Musculoskeletal Trauma Methods of promoting essential traumacare services • Training for trauma care: • Advanced Trauma Life Support (ATLS) • National Trauma Management Course (NTMC) • Definitive Surgical Trauma Course (DSTC) • Essential Surgical Skills (ESS) • Primary Trauma Care (PTC) • Trauma Nursing Core Course (TNCC) • Trauma Team Training (TTT)

  20. Musculoskeletal Trauma Integration of Systems for trauma care management • Pre-hospital Triage • Referrals and inter-hospital • transfers • Communication • Transport

  21. ISO 9001. 2000 Thank you

  22. Musculoskeletal Trauma Correct data of injured patients to ascertain the outcome is not properly available, However it is observed that Single system Injury- Musculoskeletal trauma has improved. Same is not true for Polytraumatised patients, which is attributed to primitive state of Trauma Care syst, Poor facilities or prehospital care, inadequate critical care in most of the parts of the country No such system exists in rural India & remote places. Fatal accident rate is 7 times more than advanced countries. GOAL OF TREATMENT

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