People who work in the emergency department know the Value of pre-hospital Care. In fact the best outcome in trauma victims is when they receive timely and appropriate pre-hospital care. Unfortunately Pakistan does not have a good and established pre-hospital Care System.
I would like to share the story of a newly married young female who was in Murree area on her honey-moon. She was enjoying and the couple decided to take a ride on Chairlift’ No one had any idea that it will be the last independent physical activity for this young energetic and new wed bride. While trying to nap into the chairlift she missed and fell. She received a non-displaced fracture on the Spine.
She was in pain and needed immediate medical attention, which included immobilization of the Spine. She was lifted in the same dangerous way that we lift other people and taken to one hospital then another one and finally she landed in our ER. By this time she had developed signs of spinal cord injury and X-ray showed displaced fracture which was clearly due to improper handling of the fracture. The life that she has to live now is totally dependent on others and is full of depression. I am trying my best to think positively about this patient. Someone is responsible for her disability and it is not only her loss, but also a national loss and loss to her family.
This incidence and other similar incidences are neither new nor easy to prevent. But this does not mean that we do nothing and leave our patients at the mercy of careless and untrained and hope that it will miraculously change.
We need to do work in collective way to deliver a system of care for our patients after any injury or accident. That means that we have to build a stepwise approach to create a system of emergency response. This requires improving the understanding of the first responders and equipping them with the required gears to deal with the challenges.
Developing the human caliber is the most important step especially in a resource poor country like Pakistan. So first we should provide people with basic skill and slowly advance the caliber while working on the ways to equip them with the tools that they need. One place to start this massive campaign should be the drivers of the current ambulance system. Although by default they are only drivers but when needed they also help lift the injured and transfer them. Being part of the first responder team it is highly logical to utilize this human resource and make it ready to deliver the care when needed. We should ensure through all means possible that the people who are at the forefront know how to provide the basic life support and basic trauma life support. They should also know how to safely transfer a patient. If this can be mandated through the help of the legislature, then it will cause immediate improvement into the system.
The skills that needed to be taught to these people should be basic and can be easily taught. These should not require presence of high end equipments till we are ready for the next level. It can be summarized in the form of a course that each paramedic or the driver has to attend before they could be hired into any rescue jobs.
I feel that this is the time that we seriously look into the level of emergency care and put any improvement that we could in it and work collectively. For that likeminded people has to come and team together to work for the betterment of this system. Emergency care and pre-hospital care are the two areas that have been neglected long enough and needs most input now.
I can be reached at erdoc@shifa.com.pk