Published
September 15, 2011 By 1 Comment
On the 27th of August, a huge bomb ripped through part of the United Nations (UN) building in Abuja causing significant injury and multiple deaths. The UN building is home to more than 400 employees. The total number of injured or dead has not been officially confirmed. In July, at least two people were killed after a powerful blast triggered by a suicide bomber struck the headquarters of the Nigerian Police in Abuja. Many policemen were injured in the stampede that followed the blast. The injured were taken to various hospitals. Apart from these recent events, road traffic accidents cause multiple car pile ups and significant injuries and deaths on our roads. Nigeria is ranked 191 out of 192 countries in the world with un-safe roads and she records 162 deaths per 100,000 population from road traffic accident.
The World Health Organisation (WHO) estimates that over 1.3 million people are killed annually in road accidents while over 50 million people sustain different degrees of injuries from such crashes. Mr. Osita Chidoka, Corps Marshal and Chief Executive of the Federal Road Safety Commission (FRSC), said in Benin recently at the national launch of the United Nations Decade of Action on Road Safety, that “WHO had predicted that if nothing was done by countries to stem the tide, death by Road Traffic Accidents (RTA) would overtake deaths from malaria and tuberculosis”. Moreover, we also have injuries and deaths resulting from ethnic and religious clashes, oil blasts, fires, domestic violence and from buildings collapsing in different parts of the country. Nigeria is under siege from trauma to limbs, head and neck and abdominal injuries.
Trauma
Trauma is a strong word, used by doctors to describe a catastrophic event that has had an adverse effect on either the physical, physiological or mental makeup of the human body. In the context of this article, trauma causes physical damage to the body with significant wounds, shock, pain, disability and a high potential for death to occur. This definition is often associated with trauma medicine practiced in emergency rooms. And traumatology is the branch of surgery dealing with trauma patients and their injuries. Trauma is now recognised as a disease entity; the 5th leading cause of death in all ages and, the leading cause of death in those less than 30 years of age. Therefore, it is decimating the young; society’s potentially most productive people. We need to gear up, ready to confront this endemic menace. Trauma is predictable. It happened yesterday, it is happening today, and it will happen tomorrow. The time to act is now.
The Golden Hour
In emergency medicine, the golden hour is the first 60 minutes after the occurrence of a major multisystem trauma. It is known that the victim’s chances of survival are greatest if he or she receives definitive care within the first hour. The first aid can be provided at the site of the injury by members of the emergency medical services, the police and other trained personnel. The golden hour can be summarized by the 3R rule of Dr. Donald Trunkey, an academic trauma surgeon, “Getting the right patient to the right place at the right time.” For this, you need the emergency medical services.
Emergency Medical Services
All trauma care is emergent but not all emergency care is trauma. Emergency rooms and departments treat ill and injured people, while dedicated hospitals handle the most severe, life-threatening blunt force and penetrating injuries. Emergency medical technicians and specially trained paramedics transport complex injury victims to centres where a sophisticated and highly trained interdisciplinary team of health care professionals provides the services needed to save that person’s life and prevent further disability or physical deterioration. The Federal Road Safety Corps (FRSC), the Civil Defence Corps, the Police and other members of the armed forces have been doing a great job in the absence of real paramedics in Nigeria. They need to be commended and now trained further, so they can respond even better.
Ambulances
The average hospital ambulance in Nigeria is used to carry corpses rather than the sick. They also ferry nurses and doctors and run errands. Most of our ambulances are not equipped to save lives during transportation of the sick or severely injured. Proper ambulances must be equipped to provide intensive care support to the patient. Air ambulances are also only available to some private organisation in Nigeria. We should introduce this service once trauma centres are available.
Rescue workers assisting victims after a bomb blast at the UN House in Abuja on August 26.
Trauma Centre
We do not have one designated trauma centre in Nigeria. Our suggestion for Nigeria to mitigate major trauma due to natural or manmade disasters include the setting up of trauma centres.
Trauma centres were outcomes of the emergency medical service system (EMS) built by the United States (US) military in Vietnam in 1970. Trauma centres play a critical role in saving the lives of those seriously injured in everyday accidents and assaults. Further, trauma centres are uniquely positioned to respond to emergencies of mass scale, such as another terrorist attack, when compared to general hospitals based on their resources, constant state of readiness, extra capacity, and strong healthcare facility connections with the local and regional emergency care community.
Below some UN Staff grieving over the incident many of them yet to recover from the trauma.Who is providing trauma care for them??
Pix:Femi Ipaye,PM News
Trauma centres are specialised medical facilities that are specially equipped and staffed by suitably trained personnel to manage all forms of trauma. They reduce death rate and so many countries are increasing their number of trauma centres. Trauma centres dedicate extensive staff, physician and faculty resources 24/7, sothat seriously injured patients have the best possible chance of survival and least residual disability. They provide support to other health care providers in their region to optimize the initial care of the injured patient prior to transfer. So, there must be prompt action by government and the private sector to set up regional trauma centres to cover the whole country, especially the ‘hot spots’ such as Abuja, Maiduguri, Jos and Bauchi.
Categories of trauma centres : There are different types of trauma centres designated as Levels I, II, III to level V. The different levels indicate the specific needs of the local area and trauma centres can even be in a local government level. A level I category is the highest and most sophisticated trauma centre and can be located to cover a whole geopolitical zone.
Trauma Team
The Federal Minister of Health, Professor Onyebuchi Chukwu is a professor of Orthopedics and a trauma surgeon. He would be one of the key people responsible for managing trauma cases coming to his hospital. Other surgeons such as neurosurgeons, general surgeons, plastic surgeons and other doctors including anaesthetists are part of the trauma team. This team also includes nurses and other paramedical staff to ensure a good outcome for the patient. They should all interact seamlessly and effectively in the hospital setting of a dedicated trauma centre or facility. There are specialised services critical for managing the trauma patient.
National Blood Transfusion Service
This service is in existence in Nigeria but not widely known. The organisation must create wide awareness and links with public and private hospitals so that it can be called upon in a simple and effective way. A concerted effort must be made to attract donors to ensure a robust service delivery. They also need a special reserve of personnel, funds and resources (blood and blood materials) in a major emergency.
Trauma Training and Simulations
There cannot be a trauma centre and excellence in trauma care without the training of staff. These people including the first responders to the scene of a disaster, the emergency services and the trauma centre staff need training appropriate to their levels. The type of training includes the following: first aid, basic life support, advanced trauma life support, definitive surgical trauma course and specialist training for particular conditions such as brain and spine injuries.
Trauma Incident Plan
Every hospital or medical facility treating trauma patients must have a Major Incident or Trauma Incident Plan. This is also called a Disaster Plan. It helps with protocols and guidelines in management so that they are not caught unawares when a sudden disaster occurs and patients start piling up. Major disaster plans such as these are multifaceted but include the following: triage, management and command structure, information systems, list of emergency personnel to call, access to extra equipment and specialist materials, extra funding, etc. The command structure is vital for effective coordination. Also individuals have ‘action cards’ to assist them in carrying out their specific roles during the disaster management. Simulations and dry runs are carried out regularly to test the readiness and understanding of staff of their specific activities and responses during an accident. The Federal Government must create a PRESIDENTIAL TASK FORCE that will design a blue print, break through bureaucratic red tapes and make trauma centres available and operational in the country as a matter of urgency.
About the authors
Dr. Biodun Ogungbo, is a Consultant Neurosurgeon and a member of Editorial Board, Nigerian Health Journal; Dr. Elijah Miner is a Consultant General Surgeon and Dr. Felix Ogedegbe is a Consultant Orthopedic Surgeon. They are all practicing in Abuja and can be reached through this journal.
©NIGERIAN HEALTH JOURNAL
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