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Introduction

Management is always a very sophisticated thing for the all fields of life. Management plays a key role in success or failure of any activity whether it is work or life. A properly managed process is a surety of success of its successful completion. Management is nothing but a good planning of any work from initiation to finish. Life is very uncertain and sometimes things do not go as per our expectation and in such a situation we have no plan. Keeping in mind of such worst situations many departments are made like National disaster management Force (NDRF), Rapid action Force (RAF), Fire fighting Department, Accident and trauma care department etc. Whenever a calamity, accident or any kind of unfortunate incident happens these all departments has to perform a joint relief mission to help people and minimize the losses. Every individual department has a specific role to perform during the relief mission.

Accident and trauma management is such department which has to play and active role in our day today life. They are real life heroes and 24 hours on duty. They are the primary life saver actually because treatment depends on in which condition and how quick they take the injured person to the trauma centre. A trauma care centre is a specially trained team of professionals. The trauma ambulance drivers to the last technicians or professional who take perfect care till the person get discharge after cure is equally important part of the team. Their work did not finish just by reaching reach the accident place but actually begins.

Accident and trauma centre are always equipped with the latest equipments specially the portable type, advance life support systems and all necessary emergency medicines. Here we are going to discuss each and every aspect of the Accident trauma centre to understand it importance in our life in better way.       

Trauma Center

Trauma centre is a like a urgently needed life support system to a city. In today’s fast running life on the roads where nobody knows that what’s going to happen the next moment even if one is following all the safety precautions. Trauma centre is made to take care of all of us day night.

Trauma center vs. Emergency department

The emergency department and trauma centre are generally used in place of one another without much explanation. Trauma centre and Emergency department more or less looks and perform in a same way but actually there are a few specific differences between the two. In the event of an accident, it is essential to know whether you should be taken to the emergency room or trauma care. Making the right choice can save lives.

Emergency department

Emergency department is an essential part of any hospital. In case of any medical emergency or injury we rush to the emergency department of the hospital nearby to us. Actually Emergency department can handle everything like sprained ankles, broken bones, less severe burn, fainting or loss of consciousness, severe stomach pain heart attack, severe vomiting or diarrhea and strokes etc. They have the facilities, expertise doctors to deal with almost anything that occurs suddenly. 

Trauma Center

Trauma centers are usually located within the Emergency department of Specific hospitals. Trauma centers aren’t often discussed singularly because they are part of the emergency Department system. Trauma centers is meant to take of the extreme cases with an issue of immediate survival. Highly-specialized surgeons work with the most advanced equipment to increase the likelihood of survival in the patients that are sent there. When There is major life threat needed to be taken special care immediately like gun shot or stabbed wounds, Major high level burns, traumatic vehicle accident injuries, Blunt trauma, brain injuries etc. are few of such cases where life threat is very high. The patient’s who need extreme immediate care are brought to these centers as they are equipped to handle life-threatening and critical injuries where immediately any kind of surgery or most critical situations can be handled. The highly advanced levels of trauma centers have access to specialist medical and nursing care, including emergency medicine, trauma surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology, and radiology, as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment.

Paramedics play a very crucial role often to make a decision where the injured should be taken after evaluating the incident. Hence paramedics are specially trained to handle all type of critical situations.

Pre-Trauma management of patient

Trauma centre has a unique role in the emergency system of any medical unit. Working in a trauma centre team is a very challenging task. Most of person of the team are multitasking mean expert of more than one expertise field. Also they are highly trained to handle all kind of medical equipment in all the emergency situations. The moment they receive the call from the accident spot their work begin. Each and every second than onwards are important and crucial for them. Every second they save during transit to reach the accident spot increase the survival possibilities. The most crucial work is the pre-trauma management as it is very much responsible for the success rate of the survivor of the accident. The primary survey and decisions which the paramedics took after reaching the accident spot is solely decide the survival of the patients.

There is a fixed protocol of training module of the paramedics i.e. first things first there is particular sequence of steps they follow. In the very beginning they ensure the airflow circulation and the oxygen content around the patient. After clearing the segment and ensuring the airflow they check the patients breathing status. If the patient is feeling any uneasiness in breathing they correct the posture and if necessary arrange the oxygen supply equipment. When the consciousness and breathing is ensured they immediately check for any blood loss means any active rupture wound of any kind of damage resulting in blood loss. If there is any found they try to stop the blood flow by pressure bandage etc. Just after ensuring the safely followed ABC airway, breathing, and circulation issues they look for damage to skeleton portion like head, limbs, spinal, chest stomach or any such injuries. If found any than follow the safety measures for it with minimum movements and avoiding any more further damage.

Completing the initial guidelines give the emergency medication if any needed like pain killer etc. They in general carry the all necessary stuff required on the spot to ensure the maximum safety of the patient. Once they shift the patient to their ambulance now their more challenging part of the system begins. They have to reach to the nearest trauma centre in the least possible time. They not just take the patient to the trauma centre but also ensure the right and timely treatment to be given by the medical team there. Their responsibility becomes more important there as generally they are the best person to brief all things like a relative to the team. Also they the best physical condition of the patient.

The pre- trauma management of patient is the most important phase of the whole procedure which largely decides the survival of the victim with maximum safety minimum loss.        

Primary survey after an accident (Advanced Trauma Life Support ATLS)

Trauma services have very clear and specific modules to follow at every step of the process. The training module gives a very clear guideline to the professionals working for the trauma unit. Primary survey after an accident is an important module. In technical terms it is called- ALTS logarithm i.e. Advance Trauma Life support. First things first (assess and treat in the following sequence) is a thumb rule instruction to ensure maximum safety of the victims.  

Airway assessment

A universal rule for this is Identify and treats threats to life first. In general air way circulation around the person is prime concerns to check. If there is crowd all around or any hurdle which may blocking the fresh air circulation near the person than it should be clear as soon as possible on the priority basis. The airway, breathing and circulation (ABC) are the first steps In the initial assessment of any critically ill patient. A proper approach for the response to any acutely ill or injured patient the airway should the first priority. The steps to clear the airway for the patient to establish a patent airway and ensure adequate ventilation and oxygenation of the patient, are essential.

Breathing

The breathing is the second most parameter to be checked. If possible the ability to assess a patient for respiratory distress and adequacy of ventilation is essential at all levels of the health care system. With thwe help of a stethoscope very simply it could be ensured.

The administration of oxygen to trauma patients in respiratory distress is essential if needed. This would be useful at all levels of the health system. At the basic health care level, recognition of tension pneumothorax and temporary relief with a needle thoracostomy could be considered desirable in settings with the possibility of rapid evacuation to a site of definitive treatment.                    

Circulation

After checking the proper breathing of the patient the blood pressure and any external bleeding should be checked. Control of external haemorrhage through manual pressure and through the application of a pressure dressing is essential to ensure the safety. These steps in most of the cases initially ensure the safety of the patient.

Disability

After checking basic parameters of ABC i.e. airway breathing and circulation the limbs and the rest body should be checked for any fracture or muscular damage. While checking separate parameter to be followed as there could be different kinds of injury like head injury, neck injury, spinal injury, chest injury, abdominal injury, multiple injury etc. All such type of injury should be accessed and should be dealt with extreme precaution as per the guideline with minimum movement to avoid any further damage.

Exposure

After completion of the above basic procedure the emergency medicine should be give like pain killer etc. Take the temperature vital and remove the clothes to ensure the proper wounds analysis. Cover most of the wounds to avoid exposure to environment. Reach the nearest trauma centre as early as possible.

Diagnostic tests

The treatment is a kind of procedure which cannot base on assuming only. It has to work on some reliable information about the actual status of the patient. A diagnostic test plays a very important in it. It decides which treatment has to be started and when to be. Diagnostic gives complete and concrete information about the amount and intensity of damage done to the patient in the form of trauma injuries etc. It is for the medical team taking care of the patient to take quick and appropriate action to prevent further damage. Diagnostic test provide authentic information which help to decide the medical team more accurate line of treatment. Diagnostic tests are the reliable pillar of the trauma centre.  

Portable X-rays

In diagnostic tests Radiology is the very first tool to be used. X-Ray provide the complete assessment of the wear and tear to bones during the trauma injury.

Specially portable unit of the X-Ray are great helps in trauma centre. The patient in most of the cases is not in a condition to move even from the stature. It is necessary to have abject information about the fractures and injuries before moving. In case of skull damage, spinal damage or multiple fracture moving the patient without precaution can increase the intensity of the injury. 

Focused Assessment with Sonography for Trauma exam

Radiology tools are the very important one at the trauma centre. Sonography is one of the specific diagnostic which helps to have a focused analysis of the internal organs especially when trauma patients are concerned.

Sometimes in special case trauma pregnancy the sonography provides the life saving information. In other cases also it is very important to know proper information about the internal organs damage which helps in case of surgery and other treatment procedures. 

CT scans

Radiology has various type of diagnostic test tools which are very useful in complete analysis of various typical cases. CT scan is such very important diagnostic test which gives very detailed and minute information about the extent of damage done. In trauma head or spinal injuries it is very important to have a detailed CT scan report to do appropriate surgery.

CT scan is proven to be very useful in specific surgical cases to reduced the mortality rate and providing better recovery from severe injuries.    

Diagnostic peritoneal lavage (DPL)

There are certain diagnostic test which is replaced in time by certain other test even though they seems to be more accurate. One of them is Diagnostic peritoneal lavage. In some specific trauma injuries like stabed abdominal injury etc. DPL was used for a more accurate assessment.   Diagnostic peritoneal lavage (DPL) is an invasive, rapid, and highly accurate test to check for intraperitoneal hemorrhage or a ruptured hollow viscus. First described in 1965, DPL replaced the four-quadrant abdominal tap, boasting a higher sensitivity and specificity in identifying intra-abdominal injury. Now a days DPL is replaced by focused abdominal sonography for trauma (FAST) and helical computed tomography (CT). Yet, each of these diagnostic modalities has unique advantages and disadvantages.

Laboratory tests

All the diagnostic tests have specific role to access the intensity of injuries. Laboratory tests are the best way to the check damage and also the after effect of the damage on the different body systems of the patients.

It shows the real time vital perimeter of the patient and also help to analyses post recovery progress of the patient. It is done with minimum risk and without disturbing the physical postion of the patient. Laboratory test provide a great support in surgery. Laboratory test also guide to plan for the further line of treatment in terms of medicine and follow up.

Trauma Surgery

In most of the trauma cases after the initial assessment of the injuries and other damages a very important step is to take decision of surgery. Surgery is never an easy task to perform even in normal circumstances. In case of trauma surgery it is more crucial as the wounds and fractures are of more severe intensity. In most of the injuries multiple fractures are the specific challenge during the surgery.

During the trauma surgery various specific implant fixation have to be done like nailing the bones, implanting plates and several other modules. All of them are very complex in implanting and has be in perfectly done.     

Nailing

In case of trauma injuries if the bones have multiple point damage and bone parts are within the body intact then surgery is performed to keep them in their natural position to heal itself or in some cases have remain with support. The surgeon will usually insert titanium rods (nails) through the bone. The rods will maintain the bone’s position. In most cases, a cast or brace will be required post-surgery. The patient will therefore be able to move the affected side after a safe recovery period. The joints will remain flexible with good  muscle strength.    

Compression Plating

In trauma injuries joints get damaged in most cases. It is only possible to restore joint by putting the supportive implant. The compression plate is a new implant used for the minimally invasive surgery of pertrochanteric hip fractures. It might reduce blood loss, wound problems and prevent devascularization of bone fragments. An operation with minimal blood loss is better in the older patients. PCCP has significant advantages for blood loss, soft tissue healing and operation time.

Locking plate fixation

In case of trauma surgery the revolution in todays  surgical implants a great hope is found. The locking plate has progressively but especially very recently become part of today’s orthopaedic and traumatology surgeon’s arsenal of osteosynthesis techniques.

The journey from the conventional nail to the locking nail was a revolution. This is an evolving implant but one that remains within the same conceptual framework, extending its indications. However, the move from a conventional plate to the locking plate is not truly an evolving implant, but rather a change in concept.

Minimally invasive fixation (Small incision)

Trauma surgery is itself a very typical when injuries caused anatomic damages. The minimally invasive fixation (small incision) has a great support in such cases. Anatomic reconstruction and stabilization of the articular surface, length, axis and rotation with minimal soft-tissue trauma is possible with the minimal invasive surgery. This review article highlights the surgical evolution and discusses recent advances in techniques and technology implementing minimally invasive approaches as the gold standard of treatment in the near future

External fixation

Trauma surgery always deals with complex inuries. There are many methods to fix the fractured limbs. External fixation is a technique used in some specific cases only. External fixation is done by placing pins or screws into the bone on both sides of the fracture. The pins are attached together using a series of clamps and rods known as the external frame.

External fixation is performed by a surgeon and is done under a general anesthetic. The procedure itself typically follows the following steps: Holes are drilled into the undamaged areas of bones around the fracture. Special bolts are screwed into the holes. Outside of the body, rods with ball-and-socket joints are joined with the bolts. Adjustments can be made to the ball-and-socket joint to ensure the bone is aligned properly with as little, if any, shortening of a bone.

The areas of skin that have been pierced by the procedure need to be cleaned regularly to prevent infection. In some cases, a cast may need to be applied. The removal of the bolts and external frame can usually be done with no anesthesia.

llizarov fixation (Ring fixation)

For the trauma surgery IIizarov fixation (ring fixation) is an external fixation technique for the fractures. External fixation is a process used for fracture fixation in this pins or wires are inserted into bone percutaneously and held together via an external scaffold. External fixation was proposed as an alternative to immobilization in plaster cast etc. The circular external fixation with thin wire fixation was known to be the Ilizarov technique. It was further evolved into hybrid fixation systems using both thin wires and standard half-pins.

Special cases

Trauma patient’s care is always a challenging task to perform. In most of the cases the instant decision is to taken by the case handling doctor and staff. It becomes more difficult when the patient is some special case like pedantic trauma or trauma during pregnancy. Both the cases are very complicated to deal with.

Pedantic Trauma

Trauma patients have many complications during and after the treatment. Pedantic trauma is also one such condition.

Trauma during pregnancy

Trauma during pregnancy is a never easy to handle. In such cases the fatal rate is very high. The biggest challenge is to save both or any one possible. The general pregnancy-related traumas are minor incidents, Including motor vehicle crashes and mild blunt abdominal trauma. Clinical judgment is required about the extent of maternal and fetal assessment. The trauma can result in fetal injury or demise, fetal monitoring recommendations for pregnant women with minor or major trauma is the same. An assessment for depression and suicidality should accompany for safety.

I case of trauma during pregnancy once the primary assessment has been completed, a secondary assessment should include obstetric and non obstetric injuries and fetal well-being.

Generally a placental abruption may become apparent shortly after the injury. It is found in observation whether eight or more contractions per hour were present in the first four hours of monitoring in 100% of patients with an ultimate diagnosis of placental abruption. If at least six contractions per hour are detected during the four-hour initial period, or the mechanism of injury presents a high degree of fetal risk, then 24 hours of monitoring is indicated. Before viability (23 to 24 weeks’ gestation), the fetal heart should be monitored, and after viability, continuous fetal monitoring should be performed.

To the save the life of the fetus when performed after 23 to 24 weeks’ gestation perimortem cesarean delivery is done. Due to the delivery increases of venous return and cardiac output by 25% to 30%, which may lead to a clear survival benefit for the mother. It has not been shown to be harmful. Sometimes the professionals recommend considering perimortem cesarean delivery if ACLS has not returned spontaneous circulation within four to five minutes of cardiac arrest.  It’s really a challenge to save both lives.

Trauma patient discharge and care

Trauma care centre are a very specialized units and having less number of bed availability. As soon as the patient gets recover they are kept under strict observation. They are supposed to get a discharge as soon as it is possible. On daily basis new patients come to the centre and they need to be admitted. Generally trauma patient have very sever kind of injuries and taken a special care of them at the centre. After a span of time when the patient is in a better condition the centre has to discharge the patient. Out of the maximum patient only a few are in a condition to go back to their home and are advised to take a proper care and follow up treatment in a nearby medical facility to their house under full guidance of the professional. Most of the patients are still need special medical care as not recovered 100 percent they are then shifted to either rehabilitation centre or other hospital for further care. It is not a simple procedure to discharge like any medical facility. The doctor had counseling sessions with the families to discuss actual status of the patients and the best options available to them. The professionals at the centre are very well aware of the post traumatic stress disorder with which the patient and the family members could be affected. In most of the cases it is never easy for them to deal with this.

Most of patients are not in a condition to understand the need of so early discharge for those wards staff preparation efforts; establishing effective care continuity; and, adequate emotional support is provided. This process is very tedious and never an easy one.

The trauma patient discharge and transition is taken proper care by the staff. Many improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients face complex barriers to quality discharge that likely require a comprehensive, multimodal intervention. It is a complex matter to be taken care on humanitarian ground on behalf of the trauma patient. Keeping in view of the post traumatic stress disorder which is a hard fact associated with most of the patients.

Post-Traumatic Stress Disorder (PTSD)

Trauma is such word who’s meaning is enough to define its effects on any body’s life. Whenever a disastrous accident or incident occurs in life it not only disturbs physically but also has deep impact on the mental health. In most of the cases the person recovered physically but the impact on the brain leaves terrible effect. Sometimes the people lost their self confidence forever while some recover up to some extent after having a series counseling sessions with proper medicines. This condition is called post traumatic disorder. This traumatic stress has a different effect on different individuals.

After a traumatic experience, it’s not easy to become normal again. In most of the cases person feel frightened, sad, anxious, and disconnected. If this continues too long one may be suffering from post-traumatic stress disorder (PTSD). PTSD can develop feeling the fear for one’s safety. Most people associate PTSD with rape or battle-scarred soldiers and military combat is the most common cause in some person. Any event that disturb the person with feelings helplessness can increase the effects of PTSD.

PTSD can affect people who personally experience the traumatic event, those who witness the event, such as emergency workers and law enforcement officers. Whatever the cause for your PTSD, with treatment and support, one can learn to manage your symptoms, reduce painful memories, and move past the trauma.

Post traumatic stress disorder can disrupt person’s normal activities and the ability to function. Words, sounds, or situations that remind of trauma can trigger the symptoms. Symptoms of PTSD fall into four groups like Intrusion, flashbacks where you feel like you relive the event over and over, vivid, unpleasant memories of the event, intense mental or physical distress when you think about the event. Avoidance, as the name implies, means avoiding people, places, or situations that remind you of the traumatic event. Arousal and reactivity trouble concentrating, startling easily and having an exaggerated response when you’re startled, a constant feeling of being on edge, irritability, bouts of anger, Cognition and mood, negative thoughts about yourself, distorted feelings of guilt, worry, or blame, trouble remembering important parts of the event, reduced interest in activities you once loved. People with PTSD may experience depression and panic attacks. Panic attacks can cause symptoms like, agitation, excitability, dizziness, light headedness, fainting, a racing or pounding heart, headaches.

It is possible to overcome the PTSD by proper guidance and counseling with proper medicine follow up. 

Conclusion

Emergency centre are there in each and every hospital many of us seen and visited them at some time of life but not aware of trauma centre. Trauma centers are most essential part of the Emergency Department but are always hidden. Life in any city cannot be even imagined without the Trauma centre. The team of the trauma centre is the hidden warriors of the society. Emergency and Trauma both are such words that just mention of which could create panic and kiosk in the mind. These words could disturb all the healthy parameter of a healthy person. It is really very painful to even just imagine very sight of any accident for a normal person. The trauma centre team who really be dealing with such incidents day and night to save life of people whom they don’t even recognize. It’s really a great sense of responsibility to work just to ensure the safety of all. We should be really thankful to the real heroes who work in the extreme conditions for the sake of safety of everyone. If we learn and understand the whole procedure or even a little of it. We possibly could save someone’s life if we are present at some sight of emergency situation. The role and responsibility of every individual are always defined in our society. We should always follow the rule and regulation in the life and teach our children also for the same. Sometimes we knowingly or unknowingly become careless and do break the law while driving or even walking on the road. We don’t understand the consequences of our carelessness. It could lead to a serious accidents and sometime put life on stack. We should know the fact that every year the death in road accidents are increasing day by day in the whole world. We can play a key role to change the scenario and these death could be avoided. This could be the real tribute to all the teams working in any emergency task force to save our life by risking their life for the sake of nation. On behalf of the whole humanity a big salute to all the emergency task force warriors.               

FAQs

Q.1 When to Go to The Trauma Center?

Ans. When to go to the trauma center will not be decided by us. In traumatic event like accident etc and severe injuries that require an immediate medical care are often brought to the hospital via ambulance. Paramedics make a decision where the patient should be taken after evaluating the intensity of the injuries.

Q.2  What medical facility is available in trauma centre ?

Ans. The trauma centre in general provides specialised services like,General Surgery, Neuro-Surgery, Orthopaedics, Blood Bank, Radiology, Lab Diagnostic Facilities and almost all the specialized needed facility.

Q.3 Whether blood bank is available at the Trauma centre?

Ans. Yes the blood bank is available in the trauma centre as in a case of emergency blood transfusion could be needed any time.

Q4 what can a person do to support a Trauma centre?

Ans. Everybody can support the trauma centre by taking specific steps to ensure that you and your family are as safe as possible, Wear seatbelts, use child car seats correctly and avoid drinking and driving. Do blood donation regularly.

Q.5 What is The Emergency Department?

Ans. The emergency department is a department of a hospital where people go when they need emergency assistance. The emergency department can handle anything from smallest sprained ankles to heart attacks. They have the facilities, doctors and expertise to handle almost every possible medical emergency.

Q.6 What is a Trauma Center?

Ans. Trauma centers are usually located within the Emegency department. They aren’t often discussed singularly because they are part of the emergency department system. Trauma centers handle the extreme cases where there is an immediate survival situation. Highly-specialized surgeons work with the most advanced equipment to increase the possibility of survival in the patients brought there. The word “trauma” best describes what brings people to these centers as they in a life-threatening and critical injuries.

Q7.  Where should one go in case of severe diarrhea or vomiting?

Ans. If one is having severe diarrhea or vomiting these conditions can be warning signs of many illnesses and other problems. They can also cause serious dehydration issues. The person should go to the emergency department.

Q8. Where a person with possible broken limbs should go?

Ans. If a person is having a broken limb, look for bruising, loss of normal function and numbness in the area that is suspected of being broken. The limb should be given an support to avoid further damage. One should be carefully and immediately go to the emergency department.

Q9. When a person get discharge from trauma centre?

Ans. When a patient is going to get a discharge is decided by the doctor of trauma centre looking after the case depending upon the kind of damage and recovery of the patient.

Q.10. what is post traumatic stress disorder (PTSD) ?

Ans. After a traumatic experience like a severe accident etc. it’s not easy to become normal again. In most of the cases person feel frightened, sad, anxious, and disconnected. If this continues too long one may be suffering from post-traumatic stress disorder (PTSD).

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