Editorial: Accident Care

October 25, 2018

More needs to be done in response to accidents and mishaps

Imagine a scenario in which a road mishap, say in remote West Sikkim, leaves a group of people injured and in immediate need of medical attention ranging from the routine first-aid to specialist interventions. You do not even have to stretch your imagination if you have been following news on a regular basis and are aware of such accidents in different parts of Sikkim. While accidents cannot be averted with certainty, what can be assured is that accident victims receive the required medical attention sans the red tape and without having to bounce through a circuitous route to medical attention. But that is invariably what happens. 
Continuing with the scenario outlined earlier, the injured will first be rushed to the nearest PHC if they are far from the district hospitals. There can be no qualms with this since trained medical attention is necessary in the early hours to establish the nature of injuries. Of course, it would be ideal if the first responder teams to accident sites included doctors and paramedics so that such diagnosis could be made on the spot. After this, the injured will be taken to the nearest district hospital where  they will be checked again and then, if required, referred on to STNM Hospital in Gangtok and chances are that from here they will be driven onwards to CRH down in Tadong. The more complicated cases will then be referred out of the State to Siliguri or Delhi.
From the time of the accident to their eventual discharge from hospital, the victims (the less injured ones) of a road mishap end up spending more time on the road, moving from one ‘referral’ to the next, than they spend recuperating or coming to grips with their trauma and grief. Sikkim’s roads are a punishment for even able-bodied passengers, the trauma that injured bodies suffer careening from one medical inspection to the other should not be wished on anyone. The doctor with referral powers at the final end of the state is just as capable as the doctor who must have attended to the accident victims first. Why then, should the power to refer patients out of the State not rest with the first doctor itself depending on her prognosis. That would cut down on travel time substantially, and time is of essence in such cases, all will agree. 
There is still more that needs to be done when it comes to handling accident trauma cases. Accidents, as mentioned, cannot be avoided, but what defeats all explanation is the scenario which definitely confounds everyone – the level of medical assistance available for accident victims in Sikkim. This basic facility remains unattained even though by now, speciality wings should have been added to district hospitals and even Primary Health Centres here at least on paper. Given the hilly terrain, poor driving etiquette and unreliable roads, every PHC in Sikkim should have reasonably advanced infrastructure and manpower to attend to accident cases. Tourist destinations in high altitudes [like Nathula and Gurudongmar] should have personnel and equipment to attend to visitors with high altitude sickness symptoms. This facility, one may add here, need not necessarily be provided and maintained by the Government and could even be sponsored by tourism stakeholders; after all, it is tourists who develop complications there, with the residents mostly acclimatized. Agreed the army assists in times of emergencies, but this should still be a service that is more accessible and specifically dedicated to tourist emergencies. These should already have been in place, and yet, one stares at a reality where in the event of a medical emergency, a victim’s fate depends on the presence of mind of the people around, the speed at which the referral can be typed out and the road worthiness of the ambulance which zips the victim from one referral pit-stop to the other. Unfortunate…

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