Dr Arvind Kohli
World Patient Safety Day 2023 is observed on 17 September under the theme “Engaging patients for patient safety”, in recognition of the crucial role patients, families and care providers play in the safety of health care. Evidence shows that when patients are treated as partners in their care, significant gains are made in safety, patient satisfaction and health outcomes. Further the objectives of World Patient Safety Day are to increase public awareness and engagement, enhance global understanding, and spur global solidarity and action to promote patient safety
Keeping in view the upsurge in various incidences of disasters natural and man made, accidents, violence leading to a large number of people getting affected,the patient safety in trauma needs to be highlighted
Patient Safety in setting of trauma
World Patient Safety Day
Trauma is the Greek word for “wound”. Although the Greeks used the term only for physical injuries.Trauma is the number one cause of death all over the globe especially below the age of 45. Trauma is a consequence of an unexpected event, which appears sometime in plain health; that is why, one of the main goals is to return the patient to a level of function as close to preinjury as possible.
The other goals of trauma patient management are to identify and treat first life-threatening injuries and to prevent exacerbation of existing injuries or the appearance of additional injuries The heaviest toll of traumatic deaths occurs within the first hour following trauma, often defined as “the golden hour of trauma. Following the principle of “Time is Essence”, management during the first hour of injury is essential. There is a large consensus that the outcome for trauma patients is improved with a systematic, multispecialty, and interdisciplinary approach from prehospital and hospital care teams.
Patients have unique problems which prevent accurate medication reconciliation-severe or distracting injuries, alterations of consciousness, intoxication, anxiety associated with trauma, and the urgent nature of emergency care. These limitations put this patient population at even higher risk of complications compared to general medical patients. Various specialities are called upon to tackle a major trauma occurring very frequently these days in our scenario owing to major accidents, natural disasters and violence resulting in sudden influx of large number of patients to hospital emergency room setting includes Head and neck trauma,Chest trauma, Abdominal trauma,Vascular trauma. extremity trauma and critical care where multi-disciplinary group team of surgeons, nurses, pharmacists, intensivists, emergency physicians, blood bank officials and hospital administrators and social workers face the challenge in ensuring appropriate Patient Safety to all.
Prehospital Care
Role of Emergency heath care providers start from the time any accident or disaster occurs at the site of the disaster Most important aspect is pre hospita l retrieval.with access to the patients and smooth transfer two types of policies are adapted theat includes Scoop and Run and Stay and Play depending upon type of disaster,terrain distance from tertiary care units etc
Star of life states six stages of high quality prehospital care that includes early detection,early reporting early response good on scene care care in transit while transferring to centre of definite care.
These actions preserve life,prevent further injuries and promotes recovery. The means of transport of patients play an important role in the specific care of these patients, transport being an integral part of the therapeutic attitude toward them.
It is also very important to know that choosing and using an inadequate means of extraction or transportation can compromise the rest of the therapeutic benefits of therapy and hence the chances of patient survival or functional recovery.
ABCDE of Resuscitation Airway Breathing Circulation and Disabilities and Exposure should be handled by the Emergency Health care team during evacuation and transport and in hospital
The release and maintenance of a free airway are priorities in the treatment of any patient sustaining trauma. Providing advanced airway management is one of the top priorities of trauma care. Management of difficult airway requires technical expertise, but also, the decision of when and how to approach airway is equally important, which are the determinants of outcome
Breathing assessment addresses the following major issues: the presence of spontaneous breathing, its efficacity, the respiratory rate, the pathological types of respiration requiring correction or the immediate ventilator support, and the existence of signs suggesting the existence of these highly potential lethal lesions
Blood volume, cardiac output, and active bleeding are major circulatory issues to consider. Active hemorrhage is one of the most important causes of preventable deaths after a trauma event, immediately after tension pneumothorax. Identifying, quickly controlling hemorrhage, and initiating fluid resuscitation are crucial steps in assessing and managing circulation.
Disability (neurologic evaluation)
A rapid neurologic evaluation will establish the patient’s level of consciousness by using Glasgow Coma Score (GCS), will assess pupillary size and reaction to light, identifies the presence of lateralizing signs, and should asses the presence of spinal cord injury and the level of the injury, if it is present.
The control of the spine and especially of the cervical spine is initiated with the primary evaluation of the vital functions, respectively with the opening of the airways, from the first contact with the patient
The number of patients who developed cardiac arrest caused by trauma or accidental injury is increasing, and the number of potentially preventable prehospital deaths produced in traumatic circumstances seems to remain statistically high, despite major advances achieved in trauma care.Hence need for Cardio pulmonary resuscitation(CPR) training for health workers and others in civil society needs to be augumented
Triage
The word triage comes from the French word trier, which means to sort or select. Triage is the sorting and prioritization of injured or sick people as well as disaster survivors according to their need for emergency care. The patients are categorizied as critical who cannot wait. urgent – can wait for sometime less serious injuries. Expectant – survival not likely. According to this categorization the patients are managed
Bystanders
Bystanders witness the event in most of the cases, but while making the call for medical assistance, first aid intervention of any kind is infrequent. It is clear that there exists a time following injury when the bystander has an opportunity to provide first aid before the arrival of the EMS, which could potentially improve outcomes. So as a lay person its very important to be aware of providing first aid to the needy patients.
On this World Patient Safety Day
we must engage policy-makers, health care leaders, health and care workers, patients’ organizations, civil society and other stakeholders in efforts to evolve the policies and practices for safe health care.especially in field of ever increasing cases of trauma arising out of disasters natural calamities accidents and other various reasons leading to large number of injured patients who reach hospital
Let us all ensure safety to these patients in our own territory of work.
(The author is CTV Surgeon GMC Jammu)
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