Improving Quality of Emergency Care in India by Implementing Trauma Registries

Introduction

Injuries continue to kill 5 million people each year. Road traffic injuries claimed approximately 3,700 lives each day in 2015, about three-quarters of whom were men and boys. The Global Status Report on Road Safety 2018, launched by World Health Organization in December 2018, highlights that the number of annual road traffic deaths has reached 1.35 million. Road traffic injuries are now the leading killer of people aged 5 to 29 years and are the eighth leading cause of death. Fifty-four percent of deaths are pedestrians, cyclists, and motorcyclists, and every 24 seconds someone dies on the road.[1] Two of the three leading causes of injury deaths are road traffic injuries and falls. In India, the mortality and morbidity for the same injury severity is 16 times higher as compared with western data.

Trauma care systems in India are in primitive stages of development or are mostly nonexistent. There is a dearth of dedicated prehospital care providers and absence of trained manpower in prehospital, in-hospital acute trauma care, and rehabilitation. There is a complete lack of trauma-related hospital data (registry) and trauma quality improvement programs. There is a need of a broad framework of policies and protocols in a given geographical area for the seamless transition between each phase of care, integrating health resources. A well-coordinated team work between various agencies is needed to achieve the ultimate goal of care of the severely injured on the criteria based on “getting the right patient to the right place at the right time for the right care.”[2]

The organization of a trauma system has four impact pillars—organization of prehospital care facilities, hospital networking, communication systems, and organization of in-hospital care (acute care and definitive care). An efficient trauma care system demands integration of three critical elements—human resources (staffing and training), physical resources (infrastructure, equipment, and supplies), and the process (organization and administration).

At present, there is no systematic linkage system of information available from various entities involved in trauma response, like police, emergency services, and hospitals. Also, a variation in the format of data collection is observed across states, even different hospitals have different formats of recording data in trauma cases. Most registries are limited to patients treated in trauma centers but exclude those who die at the scene or those with minor injuries who do not require hospital treatment. It is essential to set up reliable data collection and analysis procedures to move from experiential to evidence-based safety policies and strategies.[3] Quality data on road traffic injuries can be maintained with adequate training and a data linking mechanism between the police, hospital, and transport departments.[4] An integrated robust data platform needs to be established to guide all policies, programs, and interventions in the area of road safety.[5] Successful deployment of trauma care systems, including the use of trauma registries, has played a significant role in the substantial decline in death and disability rates from injuries.

• References

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