Trauma care systems in healthcare facilities of an Indian District: Assessment and future directions

Abstract

Introduction: With a long-term vision to strengthen the evidence-based trauma care programme in the Kolar district, an objective assessment and grading of the trauma care system (TCS) in public and private hospitals was undertaken. Methods: This cross-sectional assessment used a specifically developed TCS assessment tool to collect data from all Level 2, 3, and 4 hospitals in the Kolar district using a review of records, observation of facilities, and interviews with stakeholders. Data were collected regarding macro areas, human resources, infrastructure, equipment, and drugs in ER, in an objective manner. TCS was scored and compared against criteria set in WHO essential guidelines for Trauma Care. The functioning of TCS was expressed as ‘percentage of expected standards’ and graded accordingly. Ethical clearance and informed consent were obtained. Results: All available and eligible Level 2, 3, and 4 hospitals in the district (39 hospitals) covering the public and private sector were assessed. TCS in Level 2 and 3 hospitals was functioning at 56% and 59% of expected standards, respectively. TCS was better in Level 4 hospitals, at 83% of expected standards. Scores were lower for macro areas and human resources. Conclusion: TCS in the district is functioning sub-par to expected standards. There is a need for comprehensive strengthening of TCS in both public and private healthcare facilities, especially in macro areas and human resources. Systematic monitoring and periodical TCS assessments are recommended at district levels throughout the country for improved outcomes in India.

Keywords

• emergency care
• india
• injury prevention
• system assessment
• trauma care