LAHORE: There is no level 1 trauma care facility in Punjab, according to report ‘Assessment of Trauma Centres in Punjab’, prepared by the Punjab Economic Research Institute (PERI).

As the World Health Organization (WHO) has declared road traffic accidents a leading cause of death, the world is focusing on trauma centre facilities to bring down the numbers. Pakistan, however, is far behind from the world in terms of providing the facility to minimize traumatic injuries which are alarmingly high in Punjab. The report states that trauma centre facilities in Punjab are the worst. The current trend of increase in road traffic accidents would be the third leading cause of disability adjusted life years lost by 2020.

The report states road accidents not just lead to loss of life but also have both social and economic impact which can impede progress and development. The injuries resulting because of these accidents cause considerable economic losses to individuals, their families, and to nation as a whole.

According to the recent WHO Global Status report on road safety, worldwide deaths due to road traffic accidents have reached 1.25 million per year. The report states the highest fatalities rates are reported in the developing and low-income countries though such countries have only half of the world’s vehicles but they account for 90 percent of the world’s road traffic accidents related deaths.

Quoting the WHO data, the report says road deaths in Pakistan reached 30,310 or 2.69% of the total deaths in 2014. The age adjusted death rate was 20.22 per 100,000 of population therefore with this death rate Pakistan was ranked 67th in the world in road accidents.

Punjab which is the most populous province of the country as per the latest census 2017, has also been suffering from the growing number of road traffic accidents.

“From 2014 to 2017, there were 13,620 lives lost, 1.19 million people were injured in 996,032 road traffic crashes in the province”, the report reveals.

Data showed that 79.38% of the victims were male, of which 51% were ages 21-40 years.

Factors like speeding, drunk and distracted driving, mobile use, unsafe road infrastructure, inadequate enforcement of traffic laws and unsafe vehicles cause road accidents and deaths.

Despite several accidents, the PERI report says, Punjab is blatantly lacking trauma centres. There are only 20 trauma centres in Punjab, among which 12 are partially functional and eight non-functional.

As per available services, district headquarters (DHQ) hospitals are the level III trauma centre (according to WHO guidelines) and are only referral hospitals of traumatic injuries within district premises.

The existing services of independent trauma centres can be classified as level IV trauma hospitals.

Experts found out that there is no level 1 specialized state of the art trauma care facility in Punjab. The biggest constrain in dealing with the trauma patients, according to quantitative and qualitative analyses, is the shortage of human resource as there are no neurosurgeons in any of the trauma centres surveyed so far. However, only 17% of the DHQ hospitals and 63% of the teaching hospitals have neurosurgeons.

The management of trauma patients requires a multidisciplinary approach. After human resources, another resource which is essential for providing trauma care is the medical machinery and equipment.

According to the data, 50% of the trauma centres and 17% of the DHQ hospitals had CT scan machinery. Such chronic shortages led to referral of the patients to other public health facilities.

Another major issue that became a hurdle in effective trauma care was the inaccessibility of health care facility.

The distance from a trauma centre to other nearest public health facility dealing in trauma care was mostly very long such as from Layyah the nearest public health facility was 118 kilometres (KMs), from Gujrat 122KMs and from Chakwal it was 125KMs.

The report says specialized trauma teams are essential for dealing with trauma emergencies. Independent trauma centres such as Phoolnagar, Bhakkar, Layyah, Bahawalpur and Shujaabad did not have any specialized trauma team.

Of them, 62.5% of the trauma centres and 67% of the DHQ hospitals in Punjab have operation theatres. “It was also interesting to note that operation theatre rooms of these trauma centres and DHQs were non-functional due to the lack of human resource and necessary equipment”, reveals the report another drawback.

Similarly, the medical diagnostic test labs are not available in 60% of the trauma centres while 60% of centres have blood banks.

Primary and Secondary Healthcare Secretary Ali Qazi said one of the major factors behind failure of the trauma centres in Punjab was their remote location from teaching and district headquarters hospitals.

“The centres remained dysfunctional owing to lack of back support of the medical staff and other human resource for being far away from the main government hospitals”, he said adding that a new policy has been issued addressing issues of the trauma centres in Punjab.

Under the new policy, construction of new trauma centres from teaching and DHQs hospitals has been banned, Mr Qazi said. He added the PERI report was being discussed by the technical wing of the health department.

Published in Dawn, July 21st, 2018