Source: http://archives.dawn.com/weekly/dmag/archive/080113/dmag12.htm By Dr Rashid Jooma and Dr Sabeena Jalal Khan There is a golden hour between life and death.

If you are critically injured you have less than 60 minutes to survive. Deaths caused by injuries are on the rise in Karachi. The current health policy formed by the government of Pakistan makes no mention of injury prevention. The focus of our health planners is on provision of hospital care. Theres a lot of talk about trauma centers being built along motorways and in urba n areas, but there is little consideration for trauma systems. Modern trauma cen tres should be focused on a system of injury management rather than a being just a structure. Over the ages, most concepts of modern trauma care have been derived from battle field medicine. The practice of triage was developed by the French during the Na poleonic Wars where those with less serious injuries looked after those who need ed critical attention. The mobile field hospital reached its apogee during the K orean War and it was the Vietnam conflict that refined the concept of rapid evac uation to specialist facilities. It was this continuum of pre-hospital care by w ell trained emergency medical technicians, timely evacuation from the site and e mergent and definitive care by teams of specialists available at all times, that is the model for trauma systems existing in developed countries. The Mecca of contemporary trauma centres is the Raymond Adams Cowley Shock Traum a Centre in the US city of Baltimore. It is named after the pioneering trauma sp ecialist who enunciated the popular concept of The Golden Hour in the following words: There is a golden hour between life and death. If you are critically injur ed you have less than 60 minutes to survive. You might not die right then; it ma y be three days or two weeks later, but something has happened in your body that is irreparable. One of the prominent landmarks in dealing with trauma-related illnesses was the development of Birmingham Accident Hospital in 1941. It was established to deal with the rapidly increasing road traffic and industrial accidents. The hospital looked after all sorts of injuries, including air raid victims during the times of war. The hospital provided continuous cover with a fulltime consultant surgeo n, 24-hour radiography and blood transfusion, and a mobile operating theatre (su rgical unit) based at the hospital. Founded in 1847 in Bath Row, it became Birmi ngham Accident Hospital in 1941 and closed in 1993(because of the lack of funds. ) The need Trauma centres are equipped to perform as a casualty receiving station by provid ing the best possible medical care for injuries 24 hours a day, 365 days a year. Trauma centres were established as the medical establishment realised that some injuries often required immediate and complex treatment to save the patient. In order to qualify as a trauma centre, a hospital must have a number of complex capabilities, including a well-stocked emergency department, a high-quality int ensive care ward and an operating room staffed around the clock. A trauma servic e is led by a team of specialists. The team has immediate access to advanced dia gnostic equipment such as a CT scanner. Most important are surgical specialists who can help the patient stop bleeding and stem the spreading of infection. Surg eons are the main component in trauma centres to save lives through surgery and inpatient critical care.

What is a trauma system? A trauma system is an organised, coordinated effort in a defined geographic area that delivers the full range of care to all injured patients and is integrated with local public health system. The true value of a trauma system is derived fr om the seamless transition between each phase of care, integrating existing reso urces to achieve improved patient outcomes. The success of a trauma system is la rgely determined by the degree to which it is supported by public policy. A trauma system is a pre-planned, comprehensive and coordinated state-wide and l ocal injury response network that includes all facilities with the capability to care for the injured. Trauma team: A trauma team is a group of healthcare workers who attend to seriou sly ill or injured casualties that arrive at a hospitals emergency department. Th e team is composed of a number of specific roles with a typical team consisting of: Team leader -- a senior surgeon doctor who takes command An emergency department doctor Anesthesiologist Orthopedic surgeon Nurses Radiographer Trauma care: A trauma care delivery system consists of an organised approach to facilitate and coordinate a multidisciplinary system response to provide care fo r those who sustain severe injuries. The system encompasses a continuum of care that provides the injured with the greatest likelihood of returning to their pri or level of function and interaction within society. This continuum of care incl udes intentional and unintentional injury prevention. The goal of the trauma sys tem is to extend the limit of survivability by having expertise and facilities: To decrease the incidence and severity of trauma; To ensure optimal, equitable and accessible care for all persons sustaining trau ma; To prevent unnecessary deaths and disabilities from trauma; To contain cost while raising efficiency; To implement quality and performance improvement of trauma care throughout the s ystem. Location: Trauma centres should not be located along highways on the outskirts o f a remote city. They should be planned on the outskirts of big cities like Kara chi and Lahore.