Advanced Trauma Life Support: How can lay people save lives of accident victims?

Our Bureau
  • The author of this article is Dr Kaushal Malhan, Director-Orthopedics and Joint Replacement, Fortis Hospital, Mulund

A total of 151,113 people were killed in 480,652 road accidents across India in 2019, an average of 414 a day, or 17 an hour, according to a 2019 report published by the Government’s Transport Research Wing.  India has the maximum number of deaths due to road accidents highlights the report. Apparently, Maharashtra ranks on the 6th position with 32,295 accidents, but saw the second-highest number of fatalities (12,788).

India continued to have the most road fatalities in the world, followed by China, a distant second at 63,093 deaths in 2,12,846 road accidents, a report revealed. The United States of America (USA) reported the most road accidents at 2,211,439, and witnessed 37,461 deaths in 2019. According to the report, speeding was the leading cause of deaths, while, in terms of vehicles, two-wheelers were involved in most road fatalities.

Among metro cities, Mumbai ranked 9th with 447 people being killed in road accidents in 2019. The World Report on Road Traffic Injury Prevention, indicates that road traffic accidents are a major killer accounting for half a million deaths and 15 million disability adjusted life years lost. It has been seen that victims of major road accidents in India have a much higher risk of death as compared to developed nations.

SIGNIFICANCE OF THE GOLDEN HOUR: Accident victims deteriorate quickly after injury, delay in treatment has shown to significantly increase mortality. The first 60 minutes, also called the ‘Golden Hour’ is crucial and affects chances of survival for trauma victims.  The golden hour rule can be summarized by ‘3R rule of getting the right patient to the right place in right time’. The role of good and swift emergency medical transport with trained paramedics or medics cannot be over emphasized. This is because appropriate trauma-centers may not always be nearby and the medical team can provide trauma care at the scene and on-route to hospital.

HOW CAN THE COMMUNITY CONTRIBUTE IN SAVING LIVES? Emergency medical transport may not be always available on time and therefore the community at large along with Police, Fire Fighters etc., should be trained to provide on-site first aid. This is based on the principles of ATLS-Advanced Trauma Life Support. The primary role is to cause no harm and call for help. Emergency on-site care by lay public should follow the following protocol:

A-Airway maintenance with cervical spine protection – Check if there is any removable obstruction to breathing. Prevent aspiration by correct positioning. Avoid moving the neck and stabilize it in place using some supporting object on either side. Do not forcibly remove a helmet and cause unnecessary neck movement

B-Breathing and ventilation – Give oxygen if available and mouth to mouth resuscitation for victims who are not breathing in spite of a clear airway

C-Circulation with hemorrhage control – provide external cardiac massage in pulseless patients. Stop bleeding by applying direct pressure on bleeding area, apply splint to broken limbs

D-Disability – Gross assessment of state of consciousness, power and sensation in the limbs will be useful later to decide about progress and clinical worsening

E-Exposure – Cover the patient and protect them from cold and transfer safely without unnecessary movement

All attempts should be made to quickly transfer patient to an appropriate facility with prior intimation to the medical center. It would also be helpful to have nearby emergency aid numbers handy.


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