success in management of trauma is not easy to achieve.
having highly trained and experienced trauma surgeon is the pivotal part.
the jig saw puzzle is complete with all the pieces in right place with precision.
in trauma the term "golden hour" is very important. the first hour after injury if well managed saves lives. well trained ambulance staff and attending paramedics are vital.
once stabilised patient is transferred to "accident and emergency" department the trauma team consisting of orthopaedic surgeon, general surgeon, casualty specialist and anaesthetist awaits. the equipment in A&E department and trained nurses make world of a difference.
readiness of emergency operating theatres with appropriate life and limb saving equipment is paramount.
when i returned from england to fortis hospitals this is one of the first things i checked out.
I had been an "advanced trauma life support" provider in England and i adhere to the principles here.
we can quote lots of examples how we made a difference to many lives at fortis.
1. 15 year old girl lost her balance and fell down 9 storeys. i received a call from her doctor. it was sunday morning and i could just drive down to fortis in minutes. this beautiful girl was brought to A&E in a state of shock with multiple limb fractures.
advanced trauma life support protocol was followed. her airway (A) was secured first. Breathing (B) was ensures normal. Circulation (C) i.e blood pressure stabilized with adequate fluid resuscitation.
After above A,B,C were stabilized she was moved to CT scan where the whole body was scanned to check internal organ damage.
When she was shifted back she was reexamined.
this girl was taken to operating theatre after fully stabilizing and she went home smiling in just over a week since this horrendous fall.
2. 23 year old factory worker got his right hand cut off in a machine. he went from pillar to post so seek help. he did not succeed in finding anyone who would agree to repair his hand back to his body.
by the time he arrived in fortis it was almost ten hours since the injury.
i was not very hopeful about the prospects especially because so much time had lapsed. the had tissues may well have started to decompose.
in any case i decided to go by the book and put the machinery into motion.
i requested my esteemed plastic surgeon colleague to come over to do microvascular work to repair his blood vessels.
in the meanwhile i cleaned up all the dirt and provided stabilization to the bones.
this created a stable bed for repair of blood vessels.
after the repair the blood gushed back into his hand after eleven hours.
in a couple of days it was heartening to see that his hand had survived.
we reconstructed his nerves in subsequent weeks and freed up his tendons.
today he can move and feels his fingers and is back to work.
3. 18 years old student was riding pillion on a motorcycle. the bike had an accident and he was ejected off the eastern experss highway mulund flyover.
this boy fell 25 or 30 feet on hard road. he was rushed to fortis hospital where we followed ATLS protocol and resuscitated and stabilized him.
he underwent several surgeries and was finally restored to a completely normal young man.
4. 25 years old junior doctor working as a houseman was knocked down and run over by a truck.
he was taken to a local hospital where he was given initial treatment for a massive soft tissue swelling of his shoulder.
actually the wheel had passed over his shoulder causing rupture of main artery to his arm.
to make the matters worse muscles and nerves in that area had got bruised and stretched out too.
it was five hours since the accident when he was shifted to fortis.
initial stabilization in casualty was really fast tracked. I had to take him to theatre to restore circulation of his limb but he had to be stabilized too. luckily the young man was strong like a bull and stabilized fast.
we operated on him within three hours of him arriving in hospital. his artery was repaired.
he required further reconstructive surgeries to treat shoulder dislocation and nerve injuries. today the young doctor has fully functioning hand and wants to be a surgeon.
