Most trauma cases are predictable, preventable and curable with simple measures, integrated approach-Prof. Saeed Minhas

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 Symposium on Emergency Medicine & Trauma at Ziauddin University

Most trauma cases are predictable, preventable
and curable with simple measures,
integrated approach-Prof. Saeed Minhas

Ziauddin University has so far trained 192 postgraduates
in different specialties-Prof.Ejaz Ahmad Vohra

KARACHI: A large number of trauma cases in Paksitan are predictable, preventable, easily manageable and curable by adopting simple measures and integrated approach. We do not need to build high rise buildings to house Trauma Centers but we must concentrate on prevention and training the human resource. This was stated by Prof. Saeed Minhas, Prof. of Orthopaedic Surgery at Jinnah Postgraduate Medical Centre and a trainer in Trauma Care. He was speaking at the symposium on Emergency Medicine and Trauma Management organized by Ziaudidn University on January 13th, 2018. It was very well attended by healthcare professionals interested in emergency medicine and trauma care besides students of Ziauddin Medical University.

Contrary to most of the other speakers who showed slides taken from net showing overseas setting, Dr. Saeed Minhas depicted the real scenario that we see every day on our roads and hospitals and how trauma victims are mishandled making their life further miserable. The topic of his presentation was Integrated Trauma Care System. Location of the trauma center, he opined, is very important. It should be easily accessible because time is very important after any trauma and it can significantly affect the ultimate outcome. He discussed in detail the basic management techniques, how to practice triage,  working and functioning of the trauma centre, facilities at the operation room, management of the patients in the intensive care unit. Unfortunately in Paksitan we have no systems and no controls despite the fact that we have the best trained surgeons. Most of the trauma centers are not functioning properly. He laid emphasis on prevention, following the traffic rules we can prevent a large number of road traffic accidents and thereby reduce the trauma cases considerably. He also talked about pre-hospital co-ordination, poor rehabilitation services, and hazards of rapid urbanization. We even do not know how to celebrate happiness and many people lose their life through gun short injuries at festive occasions. He also talked about the importance of occupational health. Most of the trauma cases, he reiterated are predictable, preventable and curable. He showed slides of over half a dozen people travelling on a motorcycle, overloaded transport carrying goods which result in numerous accidents. Many of the motorcycle riders and others sitting on motorbikes do not use helmets and in case of accident suffer from head injuries some of which prove fatal. We need to train the paramedics, nurses and doctors working in emergency as well as taking care of trauma. Not only that, we also need to take measures to retain the trained manpower of emergency specialists, he remarked.

Earlier in the inaugural session Prof.Abbas Zafar Dean Faculty of Health Sciences welcomed the speakers and participants. Prof. Ejaz Ahmad Vohra Director Postgraduate Studies in his address gave details of postgraduate programmes at Ziauddin University. Tracing the history he pointed out that it all started with a Clinic in Nazimabad in 1957 and later a hospital was built at Goal Market in Nazimabad in 1959. In 1975 Ziaudidn Hospital was built in North Nazimabad while Ziauddin Postgraduate Institute was established in 1994. In 1995 Ziauddin Medical College was established. In 1997 KDLB Campus was established and in 1999, Clifton Campus started functioning. It was in 2004 that after getting Charter, Ziauddin University was established.

At present Ziaudidn University is offering degrees in Medicine, Pharmacy, Biomedical engineering, Allied Health Sciences, Media and Communications, Physical Therapy, Nursing, Dentistry, Speech Language and Hearing Sciences while many other programmes are currently in the pipeline. He also gave details of various postgraduate training programmes at Ziaudidn University which included FCPS in Medicine,  Family Medicine, General Surgery, Pediatrics, Obstetrics and Gynaecology, Radiology, Microbiology, Haematology, Chemical Pathology, Histopathology, Anaesthesiology, Neurology, Gastroenterology, ENT, Oral and Maxilla Facial Surgery, Orthopaedics Surgery, Ophthalmology, nephrology, MRCOG in Obstetrics and Gynaecology.  The university also offers postgraduate programmes leading to MD in Internal Medicine, Emergency Medicine, Nuclear Medicine, Critical Care Medicine, Radiology, Paediatrics, Radiotherapy, MS programme in Obstetrics and Gynaecol0gy, General Surgery, Urology, Orthopaedic Surgery. It also offers MRCP-II in Medicine, MCPS in Ophthalmology, ENT, Paediatrics, and Anesthesiology besides Diploma in Anaesthesiology, Paediatrics, Dermatology, and Dip Card.

Continuing Prof. Ejaz Ahmad Vohra said that so far the university has trained 23 MD/MS, 71 FCPS, one MRCP, two MRCOG, 95 Diploma holders in various subjects. Hence the total number of postgraduates trained to date is 192. He also talked about history of Emergency Medicine programme which started in 1790. Dr.Asim Hussain had the vision to start Emergency Medicine programme and Prof. Mahmod Jilani and his team was doing a commendable job and they have trained two postgraduates in 2017. FCPS in Emergency Medicine consists of five years of training. Shifa International Hospital Islamabad and Aga Khan University are training postgraduates in Emergency Medicine while CPSP conducted its first Exit Examination in Emergency Medicine in December 2015. A few interesting informative videos of trauma care and Emergency Medicine were also shown to the participants. Ensuring Airway, Breathing, Circulation, referral to other hospitals, initial assessment of fluids, intubation, how to remove helmet, how to secure head and neck, how to cover the face were all demonstrated in detail.

Prof. Raza Rizvi from JPMC gave details of pattern of head injuries seen at JPMC. The total number of admissions in Neurosurgery at JPMC he stated was 4591 in 2015, 4712 in 2016, 5649 in 2017. The number of deaths was 330, 917 and 864 in 2015, 2016 and 2017 respectively. The number of surgeries performed was 953, 1336 and 2612 in 2015, 2016 and 2017 respectively. The number of surgeries performed in trauma unit during 2017 accounted for 1885. We at JPMC receive over fifteen hundred patients every month; a vast majority of the patients come with head injuries. He then discussed the control of elevated intracranial pressure and surgical management of penetrating injuries.

Dr. Inayat Ali Khan spoke on CT head in hemodynamically unstable patients. He pointed out that Emergency is the show case of any hospital which reflected the overall hospital image. He laid emphasis on supportive measures for traumatic brain injuries which is going to be an epidemic and it will form major burden of work at hospitals. It is important to identify the risk benefit while managing these patients. Alarm should be visible and audible with all the patients. Dr. Naveed Khan discussed spinal trauma and its management. Dr.Syed Nadir Naeem’s presentation was on Chest Trauma. He was of the view that one must know the chest X-ray very well as it will give you lot of information. Only about 10% of blunt injuries need surgery while 15-30% of penetrating injuries will require surgical management. He also referred to life threatening injuries. If you see tension Pneumothorax, it means someone has missed it. He also talked about cardiac tamponade, open Pneumothorax, flail chest and pulmonary contusion. Prof. Shafiqur Rehman talked about abdominal and urogenital trauma. He opined that accurate diagnosis helps in saving lives. At times it is difficult to evaluate the patient for which high degree of suspicion is important. Motor vehicle collision results in greater mortality. He also referred to critical findings, detailed assessment of the trauma victims. Some patients may be in shock, some may be having solid organ injury or splenic injuries. He then discussed the management of hepatic injuries in detail. Pancreatic injuries, he said, are often missed. Management of sepsis, wound infection, bladder urethral injuries was also discussed in detail.

In the afternoon session, the topic which came under discussion by various speakers included disaster management, musculoskeletal trauma, trauma leadership and management, Massive transfusion protocol/coagulopathy in trauma patients, recent updates in trauma management besides career guidance for Emergency Physicians in Pakistan.

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