According to the WHO Global Status report on road safety 2015, the worldwide deaths due to road traffic accidents have reached 1.25 million per year. This report further highlights that the highest fatalities rates were reported in the developing and low income countries. These low and middle income countries have only half of the world’s vehicles but they account for 90 percent of the world’s road traffic accidents related deaths. Moreover, a person living in the South East Asian countries has a higher chance of dying in a road traffic accident, 17 percent, as compared to a person living in the European countries where one has 9.3 percent chance of dying this way while for those in South African countries it is even higher at 26.6 percent. These statistics show that the developing countries need to efficiently and effectively deal with this growing public issue if the economic and social losses are to be reduced.

As it has been already mentioned that the low and middle income countries have a higher rate of deaths caused by road traffic accidents, Pakistan being a developing country has not been able to stay protected from this menace. According to the WHO data published in May 2014, RTA deaths in Pakistan reached 30,310 or 2.69% of total deaths. The age adjusted death rate is 20.22 per 100,000 of population therefore with this death rate Pakistan is 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 (RTA). In 2016, total 238785 Road Traffic Accidents and 22767 Mortalities occurred in Punjab, the majority of RTA victims were male in their most productive years i.e.11-40. This age group is economically very valuable therefore any such trauma incidence is not just loss to the family but the economy also. The high incidence of RTA in this age group imitates their high level of involvement in risky activities such as careless driving/riding, one-wheeling, over speeding, and driving without wearing any protective gears (helmet etc.). The share of Road Traffic Injuries (RTI) in overall injuries in Punjab is around 75%. After road traffic accidents the second major type of injuries is fall from height, which is 11%. Among all trauma injuries that occurred from January to December 2016, 10% were reported as head injuries, 17% leg fractures, 5% multiple fractures occurred. The vehicle which has the highest mode of accidents is motor bike as it caused 63% of the RTA in 2016. Rickshaws caused 12% RTI the third most common vehicle involved in RTI is car which has 8% share in total RTI, 3% trucks, 4% vans, 1% bus and 8% all other vehicles. Among RTA, over speeding is the major reason, around 43% of the road traffic accidents are due to over speeding. The second largest reason for road traffic accidents is carelessness in driving and it accounts for 34% of the road traffic accidents. The data recorded by Rescue 1122 for year 2016 indicates that, on average males are around 3.8 times more likely to suffer a road side accident than females.

Keeping in view these growing figures of road traffic accidents and their related injuries and deaths it is imperative to determine not just the causes of these accidents but also examine the existing available trauma care in the province of Punjab. There is no documented data on trauma care facilities, as per best of our knowledge, in Punjab which therefore becomes a hurdle in understanding the existing situation and devising associated policies. Punjab on injury burden and pattern to cure the injuries are the biases of delivery of acute trauma care. Well established pre hospital care after first few hours of injury may decline trauma mortality. It is an acknowledged approach of trauma care that by providing first aid, initial life support and replacement of fluids, within first hour of the injury (the golden hour) increases the chances of saving the life of accident victim. The most important factor of this strategy is to establish a network to provide initial treatment to the victim within the golden hour. By doing so, the chance of disability and death followed by road accidents are avoidable up to some extent.

In India, there are more than one hundred trauma centres almost all on national highways. In England, there are twenty seven trauma centres located at different places. In Singapore, there is emergency response system, the Singapore Civil Defence Force (SCDF), comprising of: Police, Fire, Ambulance, Disaster and Rescue Teams (DART) are co-located. Co-location of emergency response organizations is an economic and geographic necessity to ensure that valuable space is utilized well. In Hua Hin city of Thailand there are public and private hospitals dealing with emergency cases. So, one may conclude that well equipped independent trauma centres are internationally practiced in many develop and developing countries.

According to a survey conducted by PERI team, there are only 20 trauma centres in Punjab, among which 12 are functional and 8 are non functional. The existing services of independent trauma centres can be classified as level IV trauma hospitals. There is no level 1 specialized state of the art trauma care facility in Punjab till date. How among existing facilities, none of the trauma centre had a neurosurgeon, radiologist or plastic surgeon. Only 8. 25% had anesthetist, 62% had orthopedic surgeon and 75% had general surgeon. Furthermore 9. 50% trauma centres in Punjab had no CT Scan machinery. Blood bank is the first and foremost need of trauma patients but 40% of the trauma centres has no Blood Bank facility. Similarly, 87.5% had no Ventilator and 87.5% had no ICU facility. The independent trauma centres which are built specially for the purpose to treat the trauma patients but due to lacked a number of medical and human resources, they are treating 80% the common ailments and were therefore failing to provide good trauma care. Without basic trauma care facilities, it is more obvious to call it “drama centre” rather than a trauma centre.

Besides focusing on combating with the major reason which caused a high number of accidents, it is a dire need to fully equip the existing independent trauma centres.

 

Asima Ihsan is Associate, Bushra Fatima and Muhhamed Nadeem are Assistant Research Fellow at Punjab Economic Research Institute (PERI).