Related Resource: The EMS1 2008 Year in Review special coverage
Mumbai, previously known as Bombay, is the largest city in India. Once considered an underdeveloped country, India has made significant progress. One sign of this is the recently completed Golden Quadralateral, the only highway crisscrossing India and connecting all its major cities. But development comes at a cost, as evidenced by the increased number of motor vehicle crashes along the Quadralateral.
The good news: in response to this problem, Mumbai has plans for developing an EMS system in their area to initiate early care and rapid transport of trauma patients to area hospitals. Currently these victims are delivered via common carrier or by a Good Samaritan.
The bad news: unfortunately this planned trauma system was not in place during the recent large scale terrorist attack in Mumbai that left more than100 dead and even more injured. This disaster was perpetrated by inhumane individuals using small-arms fire and explosives.
Historically, most man-made disasters produce injury, generally from explosions and/or small-arms fire. Chemical, nuclear or biological forces have been infrequently involved. Natural disasters such as hurricanes, tornados, tsunamis, earthquakes, etc., also generate injuries, at least initially. For these situations a systematic approach to injury care should be universally available.
By definition, a system is a group of interacting or interrelated or interdependent elements forming a complex whole. For trauma systems that are successful, this translates into a group of dedicated health-care providers and medical facilities who interact regularly, are clearly related in their commitment to treating trauma, and are dependent on the contributions from each provider and facility to achieve the optimum patient outcome. And we’re not just talking about the large trauma hospitals. The system must be inclusive; everybody plays, from the field first responder to the trauma surgeon and all the trauma-treating providers in between. And all facilities participate, from the isolated clinic to the Level I trauma center. This trauma system model has a proven track record for improving the care and survival of the severely injured patient.
The connection between trauma systems and disaster response capability is obvious and it should be considered a fundamental component for achieving disaster preparedness. Fortunately, the number of trauma systems has increased in the United States over the years despite a decrease in federal funding. Yet, as 2008 passes, there are still communities that go un-served by this organized response to injury. In a country that has to color code the terrorist threat level and spends billions on disaster preparedness, perhaps we should channel some of those resources to further propagate a structure of care that serves the injured patient day-in and day-out, thus keeping skills sharp and at the ready to provide service in the unfortunate, but certain event of future disaster.
