Pre Hospital Care

By Dr.Bashir Ahmed Dar Chinkipora sopore Kashmir India Associate prof.of Medicine

Pre hospital care. Pre-hospital care may be defined as the first aid given to a victim at the site of an accident before he or she is administered treatment in a hospital. It has to be carried out with speed and accuracy. Its significance arises out of the fact that in a major accident, there may be some who will survive no matter what medical care they get, while some may die despite the care. But the most important group here is those who will certainly die unless proper medical attention is administered. It is here that the aim of pre-hospital care lies — in minimising the chances of fatality with immediate medical attention. Any tragic accident can be construed to be a success or failure within the first 10 minutes of medical attention as this is the time when the most important decisions are to be taken. It is here that the concept of the Golden Hour comes into play. . One has to look to the west to actually see the success of the pre-hospital care facilities. In the United Kingdom, the support system is very effective. The National Health Services has well-equipped ambulances with top-class personnel (paramedical) to manage accident victims throughout the country under a single umbrella. These ambulances rush to the spot and effectively avert any tragedy within the early minutes of assessment and quickly transport the victims to the nearest hospital. By the time the victim reaches the hospital he or she is nearly saved and it becomes easy for the execution of definitive treatment. In India, the situation is different. whenever an accident occurs, the focus of saving a life is diluted either due to a fear of subsequent legalities or due to a paucity of people with an awareness of pre-hospital care, to succeed in pre-hospital care, the most essential requirements are: A well maintained, state-of-the-art ambulance with oxygen, intravenous infusions, life saving drugs, splints, defibrillators,ventilators, and well-trained paramedical staff available in the ambulance. Unfortunately, India does not have such advanced training for paramedical staff who are exposed to major accidents and poly-trauma., there is a dearth of qualified or trained paramedical personnel who can assess/assist a victim. Efforts must be made to start paramedical courses with a curriculum of primary assessment, resuscitation methods, basic life support, and transportation methods. More oftent we find a simple case being transformed into a more complex case. For example, a spine injured patient may be

shifted with his knee and back flexed which will only damage the hitherto uninjured spinal cord ! Transportation must fall under a single nodal agency, which may even be the state government. The reason is that victims may be injured in different locations in a State. Pre-hospital care should be uniform, optimal and fruitful. Protocols for shifting to the nearest equipped hospital should be clear. Quality of the referral hospital dealing with such emergencies must be ensured. Policies dealing with the legalities, compensations and expenses for treatment should be worked out. . Some medical associations have already taken steps in this regard to target schools and colleges to create an awareness in pre-hospital care.