Demography, Epidemiology, Current Profile and State of Management of Acute Trauma in Northern Frontier District Kupwara of India, Jammu and Kashmir

Abstract

Trauma is a major problem in India with severe and wide-ranging consequences for individuals and society as a whole, particularly in light of rapid development and increasing motorization. Emergency management of trauma in rural India is at a primitive stage of development. Emergency medical services are yet to be legally regulated. There is lack of trauma care related infrastructure, self-motivation, standard training, education and operating protocols. Results: Males were 155 (77.5%), females 45(22.5%). M: F ratio of (3.4:1). There was significant preponderance of male victims in our study. Patients were of the age group between 3 to 80 years with means age of 36.65 and median 31 years. Youngest patient studied was 3 and eldest 80 years old. 152(76%) were married and 48(24 %) unmarried. Married to un-married ratio was (3.16:1 Educational status of the victims showed that 64(34%) of injured belonged to formally un-educated class Commonest mode of injuries, 93(46.5%) were due to fall from height, 2nd being 62(31%) road traffic accidents (RTAs). Mode of injury had no statistical significance to injury severity or severity of neuro-trauma in our study. Family members accompanied 119 out of 200 (59.5%). 183(91.5%) were transported by common means of local non-ambulance transportation. Time interval from pack and go of the victim from its place near the incident to arrival in our emergency room was considered care delay. Care delay of the study patients showed that only 65(32.5%) patients reported to our hospital within one (Golden) hour and about two third, 135(62.50%) reported after one (Golden) hour. Study of the pre-hospital life support-stabilization showed that only 53(26.5%) out of 200 patients received some elementary first aid before arriving to our hospital. Incidence of accidents was slightly more in country side 77(38.5%). Country side was mostly near to home. Road was second 62(31%) and home third 61(30.5%) location of injury. Poly-trauma and the Injury Severity Score (ISS) showed that 140(70%) out of 200 had 2 and 3 body regions injured, 36(18%) had more than 3 body regions injured and 24(12%) had only one body region injured. Higher scores were associated with worse outcome. Brain injury and neuro-trauma severity scaled by (3–15 point) Glasgow coma scale with severity score (0–4) showed that only 3(1.5%) study patients had severe brain trauma while 30(15%) had moderate brain trauma and 167(83.5%) had only mild to no neuro-trauma. Conclusion: The civilian population in northern rural Indian Kashmir is exposed to high levels of trauma and the principal cause of life-threatening injuries is blunt trauma and fractures. Our study shows that skids and falls from height, mostly falls from trees, buildings and hillocks and RTAs are the predominant causes of acute traumatic injuries. Increasing awareness and proper training of the field staff about pre-hospital management of trauma are the urgent need of the time.