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 Table of Contents  
GUEST EDITORIAL
Year : 2021  |  Volume : 36  |  Issue : 2  |  Page : 1-2

Exclusive pediatric trauma emergency services in India: A need of hour


Department of Pediatric Orthopaedics, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission26-Jul-2021
Date of Acceptance26-Jul-2021
Date of Web Publication02-Aug-2021

Correspondence Address:
Ajai Singh
Department of Pediatric Orthopaedics, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_13_21

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How to cite this article:
Singh A. Exclusive pediatric trauma emergency services in India: A need of hour. J Bone Joint Dis 2021;36:1-2

How to cite this URL:
Singh A. Exclusive pediatric trauma emergency services in India: A need of hour. J Bone Joint Dis [serial online] 2021 [cited 2021 Oct 28];36:1-2. Available from: http://www.jbjd.org/text.asp?2021/36/2/1/322948




  Introduction Top


Pediatric trauma is recognized by the WHO and the United Nations Children's Fund as a severe public health issue that requires prompt attention. Pediatric trauma differs from adult trauma in terms of the types of injuries sustained and the treatment required. Children and teens of 1 to 18 years of age die at a higher rate due to unintentional and purposeful injury and homicide than from all other causes combined. Deaths due to trauma, whether done intentionally or unintentionally, lead to potential loss of life in many years under the age of 18 years comparatively sudden death of infants by means of cancer and infectious diseases combinedly. The childhood trauma survivors may be permanently handicapped and take extensive specialized care. To improve the outcomes of injured children, it is necessary to take a public health approach that recognizes childhood injury as a serious public health concern.

According to the 2011 census, Uttar Pradesh has about 9 million children under the age of 18 years out of India's total pediatric population of 41 million. The rural areas account for around 67% of these children. When it comes to road traffic accident deaths, Uttar Pradesh ranks fourth. In 2015, 15,633 children were killed in road accidents in India, which is seven times the number of deaths from any other cause. Injury is claimed to be the cause of up to 25% of hospital admissions and 15% of child fatalities in India. According to the data from the National Crime Records Bureau (2015), about 43 children die in traffic accidents every day in India. About 30–40 children are hospitalized and discharged with varying degrees of disability per every death in India. According to one of the study, the rate of pediatric missing injuries at trauma centers in India is around 30% when both adults and children are hurt at the same time. Every year, one out of every four children in the United States suffers an unintended injury that needs medical attention. Injury to children costs more than $50 billion each year indirect costs. There is no such Indian data to take into account. The Indian government provides public health care, although just 1.1% of the country's Gross Domestic Product is dedicated to it.


  Scope of Paediatric Trauma Emergency Services Top


Starting from the local to national levels, the Pediatric Trauma System works efficiently as a part of an integrated Emergency Medical Services, Trauma System, and Disaster Response System. In an inclusive trauma system, all emergency medical workers, physicians, hospitals, and other caregivers are included in the management of injured patients. The primary components of such a system would be regional adult trauma centers and pediatric trauma centers. These tools enable the early identification of life-threatening injuries, more efficient communication, and ongoing training for trauma and emergency care providers as needed. An inclusive trauma system consists of hospitals capable of providing initial stabilisation in addition to those capable of providing comprehensive trauma care. Such complete pediatric trauma emergency services and specialized pediatric trauma centers do not yet exist in India. It is a common misunderstanding that improving trauma care in low- and middle-income countries would be costly and unfeasible due to a lack of pre-hospital care.


  PreHospital Services: Present Status in India Top


In a 2009 WHO newsletter, the organization stated that providing good and timely pre-hospital care can help to close the gap between the mortality and morbidity rates of injured children in developing and industrialized nations. Because most Indian caregivers are rarely exposed to really ill or damaged children, they may not be as experienced in providing appropriate pediatric trauma emergency care as they are in providing adult trauma emergency care. Teaching training for these care providers, such as to start online and offline courses, may further improve their expertise with pediatric trauma patients.


  Trauma Centres Top


Special care must be made while dealing with an injured child. Minimal diagnostic radiation exposure, presence of family during resuscitation, child life specialists availability, hydration/electrolyte management, as well as blood transfusions are just a few of the issues that are particular to children. It is observed that trauma centers within children's hospitals, or trauma centers that combine pediatric and adult trauma care, enhance outcomes for younger patients and children with more serious injuries. According to Western research, having a pediatric trauma center in a state is linked to lower pediatric injury fatality rates. The criteria for a children's hospital trauma program differ by state.


  Paediatric Trauma Emergency Team Top


It is necessary to have experienced staff with the pediatric medical emergency as well as subspecialties and also surgical specialities, pediatric critical care, pediatric anesthesia, traumatic stress and substance abuse counseling, pediatric rehabilitation, and other specialised trauma care. Nurses who have revealed proficiency in the management of paediatric injured patients are also essential.[6]


  Recommendations Top


  1. Starting from the local areas, followed by regional, state, and national level, the specialized needs of injured children, must be incorporated into trauma systems and disaster preparedness
  2. For injured children care each and every state should identify adequate facilities as well as develop well-operated monitoring systems for their care
  3. Providers with a rudimentary understanding of pediatric trauma care should evaluate and manage the injured kid at the bedside
  4. Providers in prehospital and hospital settings should make every attempt to stay current on breakthroughs in traumatized child emergency management. In addition, providers should take an active role in developing and implementing an injury prevention program within their service area to help reduce child injury
  5. Health-care providers should be aware of available pediatric trauma services in their area and even how to incorporate them into their practice
  6. Pediatric trauma management should incorporate an integrated health approach encompassing everything from preventive and prehospital care through emergency and acute hospital care, rehabilitation, and, as necessary, long-term follow-up
  7. When available, qualified pediatric intensive care transport teams should be deployed to move the severely injured children between facilities
  8. Agreements governing inter-facility transfers should be in place to allow critically injured children to be accepted and transported quickly to an institution that can provide the required level of care
  9. Pediatric trauma focussed national organizations should work together to fight for better care across the country
  10. For critical care, evidence-based strategies for child injury management can be established
  11. Research, especially data collection for best practices in isolated trauma and mass casualty events, should be supported, with a particular emphasis on the needs of children
  12. These efforts must be recognized and supported by the government and policy-makers.




 
  References Top

1.
American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American Academy of Pediatrics Committee on Medical Liability, Task Force on Terrorism. The pediatrician and disaster preparedness. Pediatrics 2006;117:560-5.  Back to cited text no. 1
    
2.
National Pediatric Readiness Project. Guidelines for Policies, Procedures and Protocols for the ED. Available from: http://www.pediatricreadiness.org/PRP_Resources/Policies_Procedures_Protocols.aspx. [Last accessed on 2015 Jun 18].  Back to cited text no. 2
    
3.
Amini R, Lavoie A, Moore L, Sirois MJ, Emond M. Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system. J Emerg Trauma Shock 2011;4:12-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Odetola FO, Miller WC, Davis MM, Bratton SL. The relationship between the location of pediatric intensive care unit facilities and child death from trauma: A county-level ecologic study. J Pediatr 2005;147:74-7.  Back to cited text no. 4
    
5.
Singh A. Whats new in critical illness and injury science: Predicting mortality in trauma! Int J Crit Illn Inj Sci 2015;5:71-2.  Back to cited text no. 5
    
6.
Pal R, Agarwal A, Galwankar S, Swaroop M, Stawicki SP, Rajaram L, et al. The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on “Developing Trauma Sciences and Injury Care in India”. Int J Crit Illn Inj Sci 2014;4:114-30.  Back to cited text no. 6
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  In this article
Introduction
Scope of Paediat...
PreHospital Serv...
Trauma Centres
Paediatric Traum...
Recommendations
References

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