This is not help
While people meant well when they piled the injured in a truck after the
recent bomb blasts, it points to the sorry state of emergency aid in our
country, says Dr Sanjay Nagral
There were many images of the aftermath of the July 13 Mumbai bombings. But
one photograph stood out for a symbolism independent of the bigger tragedy.
It was a picture of the injured from the Zaveri Bazaar blast site piled up
on each other in a truck.
While it was a well-meaning act by those who only wanted to help, it was a
shocking comment on the poor infrastructure of our medical disaster
management system.
As one involved in treating victims of the 1992 riots, and the 1993 and 2006
blasts, I can’t help pointing out how little has changed on this front over
the last two decades.
Victims are still brought to hospitals in makeshift vehicles without any
first-aid and transport protocol. It’s a tragedy within a tragedy.
It was established decades back that emergency medical measures in the first
few minutes after a grievous injury make a difference between life and
death. The concept of a ‘golden hour’ in trauma care evolved on this
understanding.
Most countries have medical transport systems manned by trained paramedics
who deliver treatment on the way to a hospital. Treatment in this golden
hour comprises maintaining breathing, administering intravenous fluids and
stopping bleeding.
Little has changed since the 1992 riots; victims are still transported
to hospitals without any first-aid and transport protocol
These measures need basic training and equipment and not costly,
sophisticated technology. Transport protocols also prevent worsening of
injury by supporting the spine and fractured limbs.
Even in large metros, all this starts only if you reach a reasonably
equipped hospital. On-the-spot medical help is non-existent and ambulances
are white coloured vehicles with sirens, nothing more.
Mumbai has only a handful of ambulances capable of offering resuscitation.
There is no protocol as to where a victim should to be taken to. These
decisions are made by passers-by or police.
Considerations such as affordability and familiarity play a bigger than
proximity and capability of the medical facility. Thus, an opportunity to
deliver life-saving treatment is lost.
In mass casualties, a system called ‘triage’, in which the injured are
prioritised based on severity of injury, is recommended. Any healthcare
worker involved in treating trauma victims will admit that we are far from
implementing these strategies on the spot, during transport or in hospital
casualties.
Sanjay Nagral is a consultant surgeon in the Surgical Gastroenterology
dept at Jaslok Hospital and Research Centre Ironically, healthcare has grown
hugely in technology and specialisation in the last decade in urban
India<http://cms.mumbaimirror.com/ads.aspx?adid=4>.
In a bizarre dichotomy, you can get a liver transplant in Mumbai, but die of
lack of basic care half-an-hour away bleeding on a road.
The reason can’t be lack of awareness of policymakers, but insensitivity and
bias. It reflects the low priority given to organised public health. While
cardiology and joint replacements attract medical tourism, trauma care does
not. The medical profession shares complicity too. In our infatuation with
speciality medicine we have sidelined emergency medicine.
And it is not only during mass casualties that the system shows utter
disregard for proper emergency care. We see it every day. Thousands of
victims of road accidents don’t get emergency care they deserve on the spot.
Last year, Bombay High Court directed the state to provide medical care at
stations to those injured in train accidents. Victims lie bleeding for hours
for want of a stretcher or an ambulance. If the system is not in place for
everyday accidents, it won’t work during an emergency.
In the debate on the blasts, there was plenty written about prevention
through gathering ‘intelligence’. In the context of modern terror, this is a
long term goal. But the treatment of the injured is a matter of well
equipped ambulances, trained personnel and proper linkages with existing
hospitals. None of these require large money or technology. What’s required
is political will to acknowledge the issue and act on it.
While individual acts of commitment by people present at disaster sites and
doctors are laudable, they are poor substitutes for organised, effective
emergency care. Let there be no picture of injured being carried in a truck
to a hospital when Mumbai faces a disaster again.
http://www.mumbaimirror.com/article/82/2011072420110724024227879db3f99d9/This-is-not-help.html
--
Adv Kamayani Bali Mahabal
+919820749204
skype-lawyercumactivist
*
*
*The UID project i**s going to do almost exactly the same thing which the
predecessors of Hitler did, else how is it that Germany always had the lists
of Jewish names even prior to the arrival of the Nazis? The Nazis got these
lists with the help of IBM which was in the 'census' business that included
racial census that entailed not only count the Jews but also identifying
them. At the United States Holocaust Museum in Washington, DC, there is an
exhibit of an IBM Hollerith D-11 card sorting machine that was responsible
for organising the census of 1933 that first identified the Jews.*
*
*
*http://saynotoaadhaar.blogspot.com/*
*http://aadhararticles.blogspot.com/*
*http://www.facebook.com/home.php?sk=group_162987527061902&ap=1*<
http://www.facebook.com/home.php?sk=group_162987527061902&ap=1>
--
Adv Kamayani Bali Mahabal
+919820749204
skype-lawyercumactivist
*
*
*The UID project i**s going to do almost exactly the same thing which the
predecessors of Hitler did, else how is it that Germany always had the lists
of Jewish names even prior to the arrival of the Nazis? The Nazis got these
lists with the help of IBM which was in the 'census' business that included
racial census that entailed not only count the Jews but also identifying
them. At the United States Holocaust Museum in Washington, DC, there is an
exhibit of an IBM Hollerith D-11 card sorting machine that was responsible
for organising the census of 1933 that first identified the Jews.*
*
*
*http://saynotoaadhaar.blogspot.com/*
*http://aadhararticles.blogspot.com/*
*http://www.facebook.com/home.php?sk=group_162987527061902&ap=1*<
http://www.facebook.com/home.php?sk=group_162987527061902&ap=1>
--
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