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Trauma Care in India and Germany

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status.

Questions/purposes

We compared India and Germany in terms of (1) vehicular infrastructure and causes of road traffic accident-related trauma, (2) burden of trauma, and (3) current trauma care and prevention, and (4) based on these observations, we suggested how India and other countries can enhance trauma care and prevention.

Methods

Data for Germany were obtained from federal statistical databases, German Automobile Club, and German Trauma Registry. Data from India were available from the Ministry of Road Transport and Highways. We also performed a standardized literature search of PubMed for India and Germany using the following key words: “road traffic accidents”, “prevention”, “prehospital trauma care”, “trauma system”, “trauma registry”, “trauma centers”, and “development of vehicles.”

Results

The total number of registered motor vehicles increased 473-fold in India and 100-fold in Germany from 1951 to 2011. The number of road traffic deaths increased in both countries until 1970, but thereafter decreased in Germany (3606 in 2012) while continuing to increase in India (142,485 in 2011). The differences between Germany and India relate to the relative sizes and populations of the countries (1:9 and 1:15, respectively), and differences in prevention and prehospital care (nationwide versus big cities) and hospital trauma systems (nationwide versus exceptional).

Conclusions

Improvement requires attention to three major issues: (1) prevention through infrastructure, traffic laws, mandatory licensing; (2) establishment of a prehospital care system; and (3) establishment of regional trauma centers and a trauma registry.

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References

  1. ADAC Luftrettung. Available at: http://www.adac.de. Accessed January 10, 2013.

  2. Advance Trauma Life Support® International. Advance Trauma Life Support® (ATLS®) course of American College of Surgeons–India program. Available at: http://www.atls.in. Accessed August 29, 2012.

  3. Advance Trauma Life Support® International. Advance Trauma Life Support® (ATLS®): Deutsche Gesellschaft für Unfallchirurgie. Available at: http://www.atls.de. Accessed July 10, 2012.

  4. Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J. [The importance of Advanced Trauma Life Support (ATLS) in the emergency room] [in German]. Unfallchirurg. 2004;107:844–850.

    Article  PubMed  CAS  Google Scholar 

  5. Bundesanstalt für Straßenwesen. Entwicklung der Unfallkosten. Available at: http://www.bast.de. Accessed January 10, 2013.

  6. Bundesverband Güterkraftverkehr Logistik und Entsorgung (BGL) eV. Available at: http://www.bgl-ev.de/images/daten/bestand/alle_tabelle.pdf. Accessed April 22, 2013.

  7. Cales RH, Ehrlich F, Sacra J, Cross R Jr, Ervin ME. Trauma care system guidelines: improving quality through the systems approach. Ann Emerg Med. 1987;16:464.

    Article  PubMed  CAS  Google Scholar 

  8. Deshmukh VU, Ketkar MN, Bharucha EK. Analysis of trauma outcome using the TRISS method at a tertiary care centre in Pune. Indian J Surg. 2012;74:440–444.

    Article  Google Scholar 

  9. Deutsche Gesellschaft für Unfallchirurgie [German Society of Trauma Surgery]. TraumaRegister DGU®. Available at: http://www.traumaregister.de. Accessed July 8, 2012.

  10. Deutsche Gesellschaft für Unfallchirurgie [German Society of Trauma Surgery]. Weißbuch Schwerverletztenversorgung [Whitebook on the Care of the Severely Injured]. 2006. Updated 2012. Available at: http://www.dgu-online.de/qualitaet-sicherheit/schwerverletzte/weissbuch-schwerverletztenversorgung.html. Accessed July 10, 2012.

  11. Gupta A, Gupta E. Challenges in organizing trauma care systems in India. Indian J Community Med. 2009;34:75–76.

    Article  PubMed  Google Scholar 

  12. Gururaj G. Road traffic deaths, injuries and disabilities in India: current scenario. Natl Med J India. 2008;21:14–20.

    PubMed  CAS  Google Scholar 

  13. Hofman M, Sellei R, Peralta R, Balogh Z, Wong TH, Evans JA, King K, Pape HC. Trauma systems: models of prehospital and inhospital care. Eur J Trauma Emerg Surg. 2012;38:253–260.

    Article  Google Scholar 

  14. Hulka F, Mullins RJ, Mann NC, Hedges JR, Rowland D, Worrall WH, Sandoval RD, Zechnich A, Trunkey DD. Influence of a statewide trauma system on pediatric hospitalization and outcome. J Trauma. 1997;42:514–519.

    Article  PubMed  CAS  Google Scholar 

  15. Indian Society for Trauma and Acute Care. Indo-Israel Trauma Education Initiative. Available at: http://traumaindia.org/indoisrael.htm. Accessed August 29, 2012.

  16. Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, Raju K, Reddy KS, Lopez A, Neal B. Chronic diseases now a leading cause of death in rural India—mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol. 2006;35:1522–1529.

    Article  PubMed  Google Scholar 

  17. Joshipura MK. Trauma care in India: current scenario. World J Surg. 2008;32:1613–1617.

    Article  PubMed  CAS  Google Scholar 

  18. Joshipura MK, Shah HS, Patel PR, Divatia PA. Trauma care systems in India—an overview. Indian J Crit Care Med. 2004;8:93–97.

    Google Scholar 

  19. Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM. Trauma care systems in India. Injury. 2003;34:686–692.

    Article  PubMed  CAS  Google Scholar 

  20. Kane G, Wheeler NC, Cook S, Englehardt R, Pavey B, Green K, Clark ON, Cassou J. Impact of the Los Angeles County Trauma System on the survival of seriously injured patients. J Trauma. 1992;32:576–583.

    Article  PubMed  CAS  Google Scholar 

  21. Kühne CA, Mand C, Sturm J, Lackner CK, Künzel A, Siebert H; Arbeitskreis Umsetzung/Traumanetzwerk in der DGU-AKUT, Ruchholtz S. [The Trauma Network of the German Society for Trauma 2009] [in German]. Unfallchirurg. 2009;112;10:878–884.

  22. Lefering R. AG Polytrauma der DGU. Jahresbericht für das Jahr 2010. Cologne, Germany: Lehrstuhl für Unfallchirurgie/Orthopädie der Universität Witten-Herdecke, Klinikum Köln-Merheim; 2011.

  23. Ministry of Road Transport and Highways. Basic road statistics of India 2008–09, 2009–10, and 2010–11. Available at: http://morth.nic.in. Accessed August 31, 2012.

  24. Ministry of Road Transport and Highways. Road accidents in India 2011. Available at: http://morth.nic.in. Accessed August 31, 2012.

  25. Ministry of Road Transport and Highways. Road transport year book (2009–10 and 2010–11). Available at: http://morth.nic.in. Accessed August 29, 2012.

  26. Mohan D. Seat belt law and road traffic injuries in Delhi, India. Proceedings of Eastern Asia Society for Transportation Studies. 2009;7:1–7.

    Google Scholar 

  27. Mullins RJ, Mann NC. Population-based research assessing the effectiveness of trauma systems. J Trauma. 1999;47:S59–S66.

    Article  PubMed  CAS  Google Scholar 

  28. Oestern HJ. [The health-political significance of trauma surgery in Germany and the social and economical consequences]. In: Oestern HJ, Probst J, eds. [Trauma Surgery in Germany] [in German]. Berlin, Germany: Springer-Verlag; 1997: 2:63–79.

  29. Royal Flying Doctor Service. Available at: http://www.flyingdoctor.org.au. Accessed January 13, 2013.

  30. Ruchholtz S, Mand C, Lewan U, Debus F, Dankowski C, Kühne C, Siebert H. Regionalisation of trauma care in Germany: the “TraumaNetwork DGU®-Project.” Eur J Trauma Emerg Surg. 2012;1:11–17.

    Article  Google Scholar 

  31. Rutledge R, Fakhry SM, Meyer A, Sheldon GF, Baker CC. An analysis of the association of trauma centers with per capita hospitalizations and death rates from injury. Ann Surg. 1993;218:512–521.

    Article  PubMed  CAS  Google Scholar 

  32. Santana MJ, Stelfox HT. Quality indicators used by trauma centers for performance measurement. J Trauma Acute Care Surg. 2012:72:1298–1303.

    PubMed  Google Scholar 

  33. Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma. 1986;26:812–820.

    Article  PubMed  CAS  Google Scholar 

  34. Shackford SR, Hollingsworth-Fridlund P, McArdie M, Eastman AB. Assuring quality in a trauma system—the Medical Audit Committee: composition, cost, and results. J Trauma. 1987;27:866–875.

    Article  PubMed  CAS  Google Scholar 

  35. Shackford SR, Mackersie RC, Hoyt DB, Baxt WG, Eastman AB, Hammill FN, Knotts FB, Virgilio RW. Impact of a trauma system on outcome of severely injured patients. Arch Surg. 1987;122:523–527.

    Article  PubMed  CAS  Google Scholar 

  36. Singh RB, Singh V, Kulshrestha SK, Singh S, Gupta P, Kumar R, Krishna A, Srivastav SS, Gupta SB, Pella D, Cornelissen G. Social class and all-cause mortality in an urban population of North India. Acta Cardiol. 2005;60:611–617.

    Article  PubMed  Google Scholar 

  37. Sreedharan J, Muttappillymyalil J, Divakaran B, Haran JC. Determinants of safety helmet use among motorcyclists in Kerala, India. J Inj Violence Res. 2010:2:49–54.

    Article  PubMed  Google Scholar 

  38. Staemmler M, Walz M, Weisser G, Engelmann U, Weininger R, Ernstberger A, Sturm J. Establishing end-to-end security in a nationwide network for telecooperation. Stud Health Technol Inform. 2012:180:512–516.

    PubMed  Google Scholar 

  39. Statistisches Bundesamt. Available at: https://www.destatis.de/DE/ZahlenFakten/TransportVerke/. Accessed January 8, 2013.

  40. Stelfox HT, Khandwala F, Kirkpatrick AW, Santana MJ. Trauma center volume and quality improvement programs. J Trauma Acute Care Surg. 2012:72:962–968.

    PubMed  Google Scholar 

  41. Sturm JA, Lackner CK, Bouillon B, Seekamp A, Mutschler WE. [Advanced Trauma Life Support (ATLS)] [in German]. Unfallchirurg. 2002;105:1027–1032.

    Article  PubMed  CAS  Google Scholar 

  42. Suresh DS. Trauma systems in India: the CMC Vellore experience. Asian Arch Anaesthesiol Resusc. 2000;XLXII:21–23.

    Google Scholar 

  43. Tepas JJ, Pracht EE, Orban BL, Flint LM. High-volume trauma centers have better outcomes treating traumatic brain injury. J Trauma Acute Care Surg. 2012:74:143–147, discussion 147–148.

    Google Scholar 

  44. WISQARS™. Years of Potential Life Lost (YPLL) Reports. Available at: http://webappa.cdc.gov/sasweb/ncipc/ypll10.html. Accessed January 8, 2013.

  45. World Health Organization. Metrics: disability-adjusted life year (DALY). Available at: http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/. Accessed January 3, 2013.

  46. World Health Organization. Prehospital trauma care systems. Available at: http://www.who.int/violence_injury_prevention/publications/services/04_07_2005/en/. Accessed January 3, 2013.

  47. World Health Organization. WHO road traffic injuries. Available at: http://www.who.int/mediacentre/factsheets/fs358/en/. Accessed January 3, 2013.

  48. World Health Organization India. Report of a 2 day National consultation on Pre-hospital Trauma Care in India on 26th and 27th October 2006 at NIHFW, Munirka, New Delhi. Available at: http://www.whoindia.org/LinkFiles/Disability,_Injury_Prevention_&_Rehabilitation_Pre_hospital_trauma_care.pdf. Accessed August 28, 2012.

  49. Zulick LC, Dietz PA, Brooks K. Trauma experience of a rural hospital. Arch Surg. 1991;126:1427–1430.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank Andrew Evans MD for careful review of the manuscript and language editing.

Author information

Authors and Affiliations

  1. Department of Traumatology, Orthopaedics, and Neurotraumatology, AO Foundation, Schubertstraße 12, D-29223, Celle, Germany

    Hans-Joerg Oestern MD

  2. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

    Bhavuk Garg MD & Prakash Kotwal MD

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  1. Hans-Joerg Oestern MD
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  3. Prakash Kotwal MD
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Correspondence to Hans-Joerg Oestern MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at Department of Traumatology, Orthopedics and Neurotraumatology University Hospital of Hannover Medical School (Celle, Germany) and Department of Orthopedics, All India Institute of Medical Sciences (New Delhi, India).

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Oestern, HJ., Garg, B. & Kotwal, P. Trauma Care in India and Germany. Clin Orthop Relat Res 471, 2869–2877 (2013). https://doi.org/10.1007/s11999-013-3035-2

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