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Majority of trauma fatalities preventable: experts

DUBAI/AJMAN - The majority of trauma fatalities, most of which are the result of road accidents, are preventable if patients are properly resuscitated during the "golden hour" and transferred to the nearest hospital trauma centre.

Dr R. Adams Cowely, was the first to coin the term "golden hour" in the 1970s in the United States, the term refers to the first hour after injury as shock sets in and bodily functions uncouple, simply put: the process of people dying. If this cycle could be broken in the first hour, the trauma victim could survive.

Colonel Ali Al Sayed Ibrahim, Director of Dubai Civil Defence, said that there is a big vacuum in emergency service coverage in the country, pointing to three separate traffic accidents in Dubai alone in which people were burned alive in their cars because emergency units could not get to them fast enough.

For this reason, Civil Defence in Dubai launched a volunteer training programme last week in conjunction with Emarat, that aims to create a cadre of qualified private citizens that would complement the role of existing emergency services.

At a one-day conference on the management of trauma held yesterday at Gulf Medical College, Ajman (GMCA), Dr Najib Al Khaja, Head of the Cardio-Thoracic Surgery Section at Dubai Hospital, said road accidents are the most common cause of death in individuals under 44 years of age, pointing to the sad fact that such accidents are taking the lives of the most productive segments of UAE society.

"Trauma can involve many parts of the body, from head to toe, the spine, extremities, the airway, the head and brain, some cases may require surgical intervention. Chest injury is the second leading cause of trauma death, 25 per cent of trauma deaths involve airway obstruction and chest injury, such injuries are dynamically rapid, but 85 per cent can be treated conservatively without surgical intervention," Dr Khaja said.

According to Col. Ibrahim, it is far better for an injured person to be attended to and stabilised within a second of sustaining an injury at the site of an accident by someone who does not know what he/she is doing, rather than have the injured person wait for several minutes until the ambulance arrives, by which time resuscitation may be useless.

"In some accidents we had people who were trapped in burning cars and there would have been no way for civil defence to have arrived in time to save them, but passing motorists could have stopped and used their fire extinguishers, which by law must be available in their cars, to put out the fire and save those people's lives," Col. Ibrahim said.

He said that even trained volunteers would not be required to intervene in cases when the volunteer feels he/she is in over his/her head. In fact trained volunteers would have the discretion to refrain from intervening in such cases. Some may fear legal action brought against them in the event the person they are trying to save dies while in their care.

Dr K. Mohanasundaram, Assistant Professor of Orthopaedics at GMC Hospital and Research Centre, Ajman, explained, in his presentation at the conference, that trauma to limbs, although primarily cause functional limitations in varying degrees, can be life threatening at times.

He highlighted three causes of death following trauma to limbs, one is from an open amputation, another is injury to a proximal major blood vessel and yet another cause of death is the crushing of a limb. He said pre-hospital care in the event of trauma to limbs, begins at the accident site with stopping any bleeding, aligning limbs, splinting fractures, restoring the distal perfusion, covering wounds with sterile pads, alerting the hospital and ensuring safe transport of the injured person. Col. Ibrahim has suggested dividing Dubai city into several easily manageable zones and have teams based permanently in each zone ready to respond to any accident.

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