Nepal first trauma centre: For specialized medical care

In Nepal, trauma is the 3rd common cause of death and 4th common cause of physical disability. Trauma meaning bodily injury is best prevented. But preventive programs are needed at the national level. These need to be formulated, developed, implemented and monitored for optimum results. Of all modes of injury, road accidents top the trauma list. To minimize the deaths and disabilities from trauma, the concept of trauma care has undergone a radical change.

The present concept has two operative parts: pre-hospital care and hospital care. Pre-hospital care comprises para-medical staff and ambulance services, including helicopter pick-up. The basic management of any emergency care is the treatment of shock, and maintenance of airway

and circulation. In USA, the pre-hospital care is provided by trained para-medics

and Emergency Medical Technicians (EMTs). Hospital care is provided by

a specialized hospital facility for injured victims in a trauma centres instead of a general hospital.

Historically, in the 1980s, North America, realized that trauma victims had the best chance of survival if they were treated in a specialized centre. In 1993 a trauma center was started at Quebec. Since then by 2002 their audit showed that the death rate from severe trauma had dropped to just 8.9% from 50 % prevailing before 1993. This set the example of how a specialized trauma centre can make an incredible difference in the treatment of severely injured victims. Thus, a trauma center is a specialized hospital facility distinguished by the immediate availability of trauma team comprising of specialized surgeons, anesthetists, nurses, paramedics with resuscitation and life support equipment on a 24 hour basis to care for severely injured patients or those at risk of severe

injury. Statistics have shown that 70-80% of injuries are musculoskeletal. Hence, orthopedic surgeons take the lead mostly.

Why do we need it? In Nepal, according to the Roads Department, 900 people died and 12,000 were injured in road accidents last year. Now, trauma is the No. 1 killer of those below 40 years of age. It is a cause of high morbidity, disability and economic loss to the country. Many countries have trauma centers to provide specialized trauma care to prevent deaths and disabilities from injuries. It has now been accepted that one level I trauma centre is required for one million population.

In India, two trauma centers are running in New Delhi and Lucknow, and more are in the pipeline.

Nepal is also going to have its first trauma centre at Kathmandu. The Government of India is in the process of handing it over to the Nepalese authority.

It is expected to come under National Academy of Medical Sciences. Preparations are already underway to receive and run it.

The major objectives of this centre would be to make it a Level I trauma center (Centre of excellence for providing comprehensive trauma care), with multidisciplinary approach for providing holistic trauma care services, networking of available resources, training for specialists, medical officers, technical and paramedical staff, Trauma Information Division, and protocol for development for national trauma care system.

This trauma centre aims at providing trauma care to the patients in accordance with international standards, to have full range of specialists (surgical and non-surgical) and equipment available 24 hours a day, and be capable to admit high volume of severely injured patients. It should become a referral centre for patients from neighboring regions and the rest of the country, who require specialized trauma management and rehabilitation. It will formulate guidelines and protocols for management of acutely injured patients; it will be a leader in trauma education and will run ongoing teaching programs for medical and paramedical professionals in trauma care and management in the country. This would include establishment of simulation centers for training personnel in all aspects of trauma care from pre hospital care to rehabilitation. It will serve as the apex research institute in the field of trauma surgery and management. This will include periodic evaluation and also run programs for injury prevention and act the role model for trauma management to other regional trauma centers and units.

Budget wise, the capital cost of equipment and machinery, estimated at 211.2 crores is being footed by the Government of India. The average operational expenditure is expected to be Rs. 3500/- per bed per day excluding staff salary with the requirement of an annual budget between of 50-100 crores .Because of the huge running cost of this centre vision is needed for its financial sustainability in the long run. Funding sources may be identified as donations from the Government of India, other governments, local sources like road taxes, vehicle taxes, municipality taxes, taxes from alcoholic beverage etc, fee for service from: transportation entrepreneur organizations, patients, and medical insurances.

Prof. Dr. Bajracharya is HOD, Orthopedics, Bir Hospital