By Dr.

Bashir Ahmed Dar

Chinkipora sopore Kashmir India
Associate prof.of Medicine

Pre hospital care.

Pre-hospital care may be defined as the first aid given to a victim at the site of an accident
before he or she is administered treatment in a hospital. It has to be carried out with speed
and accuracy. Its significance arises out of the fact that in a major accident, there may be
some who will survive no matter what medical care they get, while some may die despite
the care. But the most important group here is those who will certainly die unless proper
medical attention is administered. It is here that the aim of pre-hospital care lies — in
minimising the chances of fatality with immediate medical attention.

Any tragic accident can be construed to be a success or failure within the first 10 minutes
of medical attention as this is the time when the most important decisions are to be taken.
It is here that the concept of the Golden Hour comes into play. .

One has to look to the west to actually see the success of the pre-hospital care facilities.
In the United Kingdom, the support system is very effective. The National Health
Services has well-equipped ambulances with top-class personnel (paramedical) to
manage accident victims throughout the country under a single umbrella. These
ambulances rush to the spot and effectively avert any tragedy within the early minutes of
assessment and quickly transport the victims to the nearest hospital. By the time the
victim reaches the hospital he or she is nearly saved and it becomes easy for the
execution of definitive treatment.

In India, the situation is different. whenever an accident occurs, the focus of saving a life
is diluted either due to a fear of subsequent legalities or due to a paucity of people with an
awareness of pre-hospital care, to succeed in pre-hospital care, the most essential
requirements are:

A well maintained, state-of-the-art ambulance with oxygen, intravenous infusions, life

saving drugs, splints, defibrillators,ventilators, and well-trained paramedical staff
available in the ambulance.

Unfortunately, India does not have such advanced training for paramedical staff who are
exposed to major accidents and poly-trauma., there is a dearth of qualified or trained
paramedical personnel who can assess/assist a victim. Efforts must be made to start
paramedical courses with a curriculum of primary assessment, resuscitation methods,
basic life support, and transportation methods. More oftent we find a simple case being
transformed into a more complex case. For example, a spine injured patient may be
shifted with his knee and back flexed which will only damage the hitherto uninjured
spinal cord !

Transportation must fall under a single nodal agency, which may even be the state
government. The reason is that victims may be injured in different locations in a State.
Pre-hospital care should be uniform, optimal and fruitful. Protocols for shifting to the
nearest equipped hospital should be clear. Quality of the referral hospital dealing with
such emergencies must be ensured. Policies dealing with the legalities, compensations
and expenses for treatment should be worked out. .

Some medical associations have already taken steps in this regard to target schools and
colleges to create an awareness in pre-hospital care.