Study proposes establishment of high quality trauma care centres in Valley
Srinagar: With pellet and bullet injuries being on the rise in Kashmir, a study conducted at SKIMS has impressed upon the need of establishing high-quality trauma care centres across the state to reduce the firearm-related morbidity and mortality, in addition to the establishment of an Advanced Trauma Centre in the Srinagar city.
The study titled ‘Characteristics, Outcomes, and Implications for Care of Firearm Injuries During Unrest in a Conflict Zone of India: A Clinical Retrospective Study,’ is a joint of work of Tabish Syed Amin (former Medical Superintendent, SKIMS), Ennas Chowdary, Neelam Kotwal and Shahnawaz Hamid, Department of Hospital Administration, SKIMS.
The researchers have studied medical records of all such patients admitted and the important details: patient profile, injury diagnoses, severity scores, hospital resource utilization parameters, length of stay, epidemiologic analysis of injury distribution, specific anatomic characteristics of injury, survival, and disposition were recorded.
A clinical retrospective study of patients—all due to firearm-related injuries—was conducted at SKIMS Srinagar between July 1st 2016-December 31st 2016. After the data was compiled, the paper was received on September 28, 2018, and it was accepted for publication on October 27, 2018.
The study concludes that proper health care facilities are essential to treat the injured. “High-quality trauma care centres should be established across the state to reduce the firearm-related morbidity and mortality.”
Although, the study, while saying that such initiatives are capital-intensive, “the resultant reduction in mortality, morbidity and burden of firearm-related trauma will justify such an allocation of resources,” it says, adding that a sound and dependable referral system “will go a long way to avoid inconvenience to the patients, save the lives and limbs and reduce disability.”
The study has proved with reference to the sample that firearm injury is more frequent in very young adults.
“The most common cause of firearm injury was bullets followed by pellets, tear gas shells and blast injury,” the study reads.
There were a total of 391 cases of all types of injuries out of which 240 cases were due to firearm, reported to the Emergency at SKIMS during July 2016 to December 2016 (the period of civil unrest)—these cases were studied by the researchers.
Majority of injuries, as per the study, were due to Pellets 149 cases (62.08%), followed by Shells 45 (18.75%), Bullets 39 (16.25%) and Blasts 7 (2.91%). Upper limb involvement was 25% followed by the head & neck (23%), lower limb (20%), chest and spine (17%), and abdomen (15%).
Characteristically, the study, while studying the nature of injuries reveals that the majority had injuries like a fracture, haemothorax, brain contusions, vascular injury, lung contusions, pneumothorax etc. “Majority of the patients were managed conservatively. Surgical interventions were performed in rest of the cases,” the study said.
Further, the study states that the firearm injuries were detected mainly on the head and neck region followed by the chest region. Eye injury was observed in 8.33 per cent patients. “Mortality was slightly more than 5 per cent in these patients, primarily due to bullet injuries followed by pellet injuries,” it reads.
The study aimed at the characteristics, outcomes, and implications for care of firearm injuries during unrest in a conflict zone of India, reveals that majority of cases received by SKIMS were in the age group of 21-30 years (50%) followed by 11-20 year age group (39.58%), 31-40 years (7.5%) and above 41 years (2.9%).
“The results indicate that a maximum number of cases were reported in the younger age groups of 21-30 years followed by 11-20 years and minimum incidence above 40 years,” the study reads.
Further, in the case of the gender distribution of such cases, it is revealed that the majority of cases were males (95.41%) while females were only 11 (4.58%).
“This indicates that incidence of firearm injuries was far more in males compared to females.” The Rural / Urban distribution of cases, as per the study, indicates more cases received from rural areas (n=184, 76.66%) than Urban areas (n= 56, 23.33%). “The inference drawn was that Rural-urban ratio of cases was 3.2: 1 meaning rural population was involved 3.2 times more than the urban population.”
A study that has been conducted by Tabish et al earlier in the year 2004, titled ‘Clinical profile and mortality pattern in patients of ballistic trauma’, has also stated that the delay in transporting the patients to hospital, lack of Emergency Medical Services System, non-availability of First Aid, loss of a Golden Hour, loss of blood, improper transportation, “were the factors that were beyond the control of doctors at SKIMS thus resulting in death of some patients.”