Prevention
The accident could have been much worse!
Yusuf was wearing full protective gear while riding his power bike. He had on a helmet which protected his head and the riding suit which protected his spine and prevented certain neck and back injuries that may have led to paralysis. The accident was also witnessed and help was immediately available to extricate him from the bush and transport him to the nearest hospital.
That Yusuf had some self-protection was vital to his survival. So, wearing a seat belt in cars and a helmet when out riding can save lives.
Emergency treatment
Maybe there would have been no beds!
The nearest hospital seems to have been NISA Premier Hospital. NISA Premier Hospital is renowned for pediatric and obstetric care and does not have capacity for trauma care. Therefore, early recognition of the dire needs of Yusuf was paramount in making the decision to refer him onward with the support required on the journey. From reports available, he had emergency treatment and early referral to another facility for expert care and attention.
It is a fact that many of our ‘other’ hospitals would have no qualms saying, ‘Go away, we have no beds’ and care less of how you actually, ‘go away’. No ambulance and certainly no assistance in safe transfer, onward to another facility.
Not even a telephone call to warn them of your imminent arrival!
Early resuscitation
The Golden hour rules!
The first hour in emergency care is called the ‘Golden Hour’. This is the most critical period in the management of a trauma patient. Manage this hour well and the patient is likely to survive. The management includes recognition of the immediate life-threatening issues and correct management of those issues. These are the airway, breathing, circulation and disability.
Is the airway clear and the person breathing? Are they bleeding, whether outwards or internally? Are they injured with a broken neck or a broken spine? The care during the Golden Hour therefore saves lives by controlling the airway, breathing for the patient (if necessary) and stop bleeding/ replace blood loss as necessary. Preventing further injuries to the brain and spine is vitally important in the first few hours.
In this regard, Cedarcrest Hospitals provided exemplary care in the management of Yusuf.
Expert Management
Call in the experts to provide definitive care!
Resuscitate, resuscitate and resuscitate. Problems identified in the primary and secondary survey (examination) of the injured person will highlight the experts required to provide definitive care. The anesthetist is vital in controlling the airway and breathing of the patient. They must be on hand immediately if death is to be avoided. In the case of Yusuf, he had also injured his head and broken a leg. So, a neurosurgeon (we have about 80 in Nigeria) and an orthopedic surgeon were required.
This led to early operations to fix the broken bones and an operation on his head!
Intensive care
What happens next is very expensive!
Intensive care is very expensive in Nigeria and only available in a few hospitals. Real intensive care that is, and not just a ramshackle room with an old, used ventilator. In fact, the equipment is actually not as important as the presence of skilled nurses and doctors: manpower! They make the intensive care and without the right people, people die! Yusuf was managed in a real intensive care ward with all the required gadgets and gizmos. He was reviewed on the hour, every hour and by the minute.
Suffice to say that we do not have many intensive care beds in Abuja. However, it is very important to know where the quality and well-staffed units are. It is also important for collaboration and cooperation to exist between hospitals with intensive care units: whether private or public.
The lives of all Nigerians depend on it!
Rehabilitation
Rehab, for short!
Yusuf has now been transferred to a rehabilitation centre outside the shores of Nigeria for continued management. This is really because we do not have a recognizable high-quality rehabilitation centre in Nigeria. Okay, we have the NKST hospital, Nka, Gboko, Benue State where many of my patients have been treated.
However, it is a closely guarded secret!
Back to the beginning
Going back to the future!
It is imperative that we restructure our health care system in Nigeria and spend real money in prevention, effective response, with an ambulance service (with trained paramedics), upgrade of secondary and tertiary centres and the training of truly committed, passionate healthcare practitioners.
Yusuf may have died if he was an ordinary citizen and many do die daily if they were unlucky going to the wrong place! The wrong hospital, the wrong personnel with an ‘I don’t care attitude’, the wrong time (anesthetist doing school run) and the wrong social status (no money available). Therefore, things need to change.
We owe it to all Nigerians to be our brother’s keepers.
