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---------------------------------------------------- Holes in Goa's emergency care system ----------------------------------------------------
by Dr Vithal Kamat
The death of Sameer Naik, a young man who sustained head injury from a fall, during his transportation from Sanguem to the GMC, and the subsequent public agitation and doctors' counter-protest made me think: why do death of patients with serious injury occur during transportation from rural government hospitals to the GMC?
Many more questions arise in my mind: one, are the rural government hospitals equipped to handle serious injury cases? Two, are the doctors, nurses and other staff there trained to handle cases of serious injury? Three, are there proper equipment in these hospitals to treat or handle at primary stage such injury cases?
Four, are the ambulances equipped with instruments and gadgets to help the injured person on the way to the GMC? Five, is the GMC casualty department equipped to respond in a few seconds to handle such cases? Six, is there a wireless communication between the transporting ambulance and casualty of the GMC for proper communication, and for the latter to be ready to handle the required case?
Recently, a young lady, on whose face acid was thrown, died during transportation from Mapusa to the GMC, a distance of hardly 15 km . Why did her death occur? Has any government agency conducted an inquiry? Why not? I am talking about inquiry not to blame somebody but to find out the causes and lapses for the death, so that we can prevent future deaths in such cases.
In my opinion the girl must have died of choking due to swelling of air passage which occurs within a few minutes due to inhalation of toxic fumes. This swelling of air passage blocks the air flow resulting in death.
In acid injury cases, the medical personnel at the rural health centre should conduct a tracheotomy or do a hole in the windpipe for keeping the breathing passage open. They should maintain proper pressure by I V Fluids and give emergency medicines to reduce swelling and other acute side-effects of acid and then only shift the injured person to the next required hospital.
The death of young lady could have been prevented if proper action was taken at the first medical centre. But here the question arises: are the staff at these centres trained to handle such cases?
Similar is the story of most of the head injury cases. Most of them die due to choking of breathing, due either to vomit or the blood blocking the breathing passage, rather than the head injury per se. So in all cases of head injury what is primarily required is to see that breathing passages are open, if required, by making a hole in the breathing pipe, and through other measures to maintain the blood pressure.
Many a times other major injuries in abdomen and lower abdomen and thighs are missed when people concentrate on head injury only. In such cases, a person may lose vital amount of blood through these injuries during his transportation. I feel that the staff of the primary health centres should be trained in these subjects.
The transporting ambulance should be provided with required gadgets and instruments and a trained doctor or a paramedic should accompany the injured person. There is no use merely a nurse accompanying the injured person as he or she will not be in any position to help the patient if required on the way.
The GMC's so-called Trauma Unit should be quite early prepared and ready to receive the injured person. This can only be done if there is communication between the ambulance and the GMC Unit.
In most cases of injury vital time is lost in referring the injured person from one hospital to other. If the primary health centres are not equipped to handle such cases, the government should advise the people to take the injured person directly to the GMC, rather than wasting precious life-saving time of 5 to 8 hours in shifting the injured person from the PHC to the GMC. The injured person would have reached the GMC quicker and saved his or her life.
The government, instead of wasting its time, energy and money on controlling private clinics and hospitals, should give more time to see that proper equipment and facilities are provided and working conditions are improved in government hospitals. Private hospitals and clinics depend on their existence on public opinion. If they are good and have proper and affordable facilities only then will people come to them.
Government hospitals do not much care for public trust, in spite of the fact that they run on public money. The government must transform them with equipment and training, so that more people are saved and more of them visit its hospitals. If that happens, private hospitals will cease to mushroom. If better facilities and good doctors and other staff available in government hospitals, then fewer people will visit private hospitals or clinics.
My visits to the GMC, even though they may not be frequent, leave me with a feeling that even the GMC is not well-equipped, nor its staff well-trained to respond in a few seconds to handle serious injury cases and do all the necessary things, like intubation and making a hole in the air pipe at the receiving point. I have noticed that much precious time is spent on calling this or that resident on duty.
It pains me to see educated and well-behaved people of Goa tarnish their name through such recourse as agitation, rather than using their intellect to find solution to prevent such deaths in the future and work collectively to create better facilities at primary and secondary health care levels. I think all the agencies, government and non-government, should work in this direction, rather than agitating and accusing one another.
(The author is a private doctor in Panaji.) ------------------------------------------------ The Navhind Times 12/10/04 page 1 ------------------------------------------------
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