PURBANCHAL UNIVERSITY

ACME ENGINEERING COLLEGE

SITAPAILA, KATHMANDU

DEPARTMENT OF ARCHITECTURE

THESIS PROPOSAL ON
ADVANCE TRAUMA CENTER

SUBMITTED BY: SUBMITTED TO:

SANJEET KR. SINGH DEPARTMENT OF ARCHITECTURE
074/ B. ARCH/026

DATE: 2078-11-03
ABSTRACT

A trauma center is a specialized medical facility equipped to provide comprehensive care to critically
injured patients. Trauma centers are designed to rapidly assess and stabilize patients, provide emergency
treatment, and facilitate recovery. The staff of a trauma center is trained to handle a wide range of
injuries, including those resulting from accidents, violence, and natural disasters. Trauma centers also
play a crucial role in research, education, and community outreach related to trauma care. The
establishment of trauma centers has been shown to improve survival rates and reduce the long-term
impact of traumatic injuries.
Table of Contents
1. INTRODUCTION AND BACKGROUND .................................................................................................. 4
1.1 INTRODUCTION ............................................................................................................................. 4
1.2 BACKGROUND ............................................................................................................................... 4
1.3 TRAUMA CENTER SCENARIO IN NEPAL ......................................................................................... 4
1.4 TRAUMA CENTER DEVELOPMENT EXAMPLE ................................................................................ 5
2. LEVELS OF TRAUMA CENTERS ............................................................................................................. 6
3. OBJECTIVES OF TRAUMA CENTER ....................................................................................................... 8
4. IMPORTANCE OF TRAUMA CENTER .................................................................................................... 8
5. PROJECT DESCRIPTION ........................................................................................................................ 9
6. PROJECT JUSTIFICATION ..................................................................................................................... 9
7. METHODOLOGY ................................................................................................................................ 11
7.1 CASE STUDY................................................................................................................................. 11
7.2 LITERATURE REVIEW ................................................................................................................... 11
7.3 DATA COLLECTION ...................................................................................................................... 12
8. SITE .................................................................................................................................................... 12
9. CONCLUSION ..................................................................................................................................... 12
10. REFRENCES ...................................................................................................................................... 13
1. INTRODUCTION AND BACKGROUND

1.1 INTRODUCTION

Traumatic injuries resulting from accidents, violence, or natural disasters are a leading cause of death
and disability worldwide. In response, trauma centers have emerged as specialized medical facilities
equipped to provide comprehensive care to critically injured patients. The aim of trauma centers is to
rapidly assess and stabilize patients, provide emergency treatment, and facilitate recovery. The concept
of trauma centers has evolved over time, with increasing recognition of the need for multidisciplinary
teams and specialized resources to manage the complex and varied injuries that can result from trauma.
This has led to the establishment of different levels of trauma centers, each with varying capabilities
and resources to manage injuries of different severity. The establishment of trauma centers has been
shown to improve survival rates and reduce the long-term impact of traumatic injuries. In this article,
we will explore the history, evolution, and current state of trauma centers, their roles in research,
education, and community outreach related to trauma care, and the challenges and opportunities for the
future.

1.2 BACKGROUND

The concept of trauma centers emerged in the mid-20th century as a response to the high number of
deaths and disabilities resulting from traumatic injuries. Prior to this, most hospitals were not equipped
or staffed to handle severe trauma cases, and patients often had to be transported long distances to
receive specialized care. This delay in treatment contributed to many preventable deaths.

In the 1960s and 1970s, there were several landmark studies that demonstrated the benefits of
specialized trauma care. These studies found that trauma centers, with specialized teams and resources,
could significantly improve survival rates and reduce the long-term impact of traumatic injuries. This
led to the development of the first Level I trauma centers in the United States, which were designed to
provide the most advanced and comprehensive care for trauma patients.

Over the years, the concept of trauma centers has evolved, with the establishment of different levels of
trauma centers to manage injuries of varying severity. In addition to providing emergency care, trauma
centers have also become important centers for research, education, and community outreach related to
trauma care.

Today, trauma centers play a crucial role in the healthcare system, providing specialized care to
critically injured patients and working to improve outcomes for trauma patients across the globe.

1.3 TRAUMA CENTER SCENARIO IN NEPAL

Nepal is a country prone to natural disasters such as earthquakes, landslides, and floods, as well as high
rates of road traffic accidents and violence, all of which contribute to a significant burden of traumatic
injuries. However, Nepal has limited resources for trauma care, with few specialized trauma centers
and a shortage of trained trauma care providers.

The government of Nepal has recognized the importance of trauma care and has taken steps to improve
the capacity and quality of trauma care in the country. In 2016, the Ministry of Health and Population
developed a National Trauma Policy to guide the development of trauma care services across the
country. The policy aims to establish trauma centers at all major hospitals, strengthen the capacity of
existing trauma centers, and develop a comprehensive trauma care system that includes prehospital
care, emergency medical services, and rehabilitation services.

There are currently a few trauma centers in Nepal, such as the National Trauma Center in Kathmandu,
which was established in 1983 and is the only center in the country with a dedicated trauma team and
resources. However, these centers are limited in their capacity and face challenges such as shortages of
essential supplies and equipment, inadequate training of staff, and insufficient funding.

Despite the challenges, there have been some positive developments in trauma care in Nepal. For
example, there are ongoing efforts to strengthen prehospital care and establish a national ambulance
service to improve access to trauma care. Additionally, there are several non-governmental
organizations and international partners working to support the development of trauma care services in
Nepal.

Overall, while trauma care in Nepal is facing significant challenges, there are opportunities for
improvement, and efforts are underway to strengthen the capacity and quality of trauma care services
in the country.

1.4 TRAUMA CENTER DEVELOPMENT EXAMPLE

One example of trauma center development can be seen in the United States, where trauma centers have
evolved significantly since their inception in the 1960s. For example, in the 1980s, the American
College of Surgeons developed the verification process for trauma centers, which established specific
standards and guidelines for trauma care and enabled trauma centers to be formally recognized for their
expertise and quality of care.

Since then, there have been ongoing efforts to improve trauma care in the United States, with the
establishment of regionalized trauma systems, which coordinate the care of trauma patients across
multiple hospitals and healthcare providers. In addition, trauma centers have become important centers
for research and education, with many trauma centers engaged in research to improve the care and
outcomes of trauma patients, as well as providing training and education for healthcare providers.

Another example of trauma center development can be seen in Australia, where trauma systems have
been developed to improve the care of trauma patients in both urban and rural areas. In Australia, trauma
care is organized around a network of trauma centers, with specialized centers providing care for the
most severe cases, and regional hospitals providing care for less severe cases.

Australia has also developed a trauma registry, which tracks data on traumatic injuries and outcomes to
inform the development of trauma care policies and guidelines. This has enabled the development of
evidence-based trauma care protocols and has helped to improve the quality of trauma care across the
country.

Overall, the development of trauma centers and trauma systems has been crucial in improving the care
and outcomes of trauma patients, and has helped to reduce the burden of traumatic injuries worldwide.
While the specific models and approaches to trauma center development may vary by country or region,
the overarching goal remains the same: to provide the best possible care to critically injured patients
and improve their chances of survival and recovery.
2. LEVELS OF TRAUMA CENTERS

There are typically five levels of trauma centers, which are distinguished based on the resources and
capabilities they have available to manage trauma cases. These levels are:

Level I Trauma Centers: These are the highest level of trauma centers, with the most
comprehensive resources available to manage the most complex and severe trauma cases. They
are typically located in large urban areas and academic medical centers, and have specialized
teams available 24/7 to provide immediate care for patients. It should be able to provide
comprehensive care for all aspects of injury, starting with prevention and ending with rehabilitation.

Requirements for level I trauma centers often include:

• A minimum annual volume of severely injured patients

• Research and training efforts to pursue trauma care innovations
• A comprehensive quality assessment program
• Continuing education for members of the trauma team
• Provision of public education and prevention leadership to nearby communities
• Referrals for nearby communities
• Round-the-clock in-house coverage by general surgeons
• Specialty care available promptly, including critical care, pediatric care, oral and maxillofacial,
plastic surgery, internal medicine, radiology, emergency medicine, anesthesiology,
neurosurgery, and orthopedic surgery.

Level II Trauma Centers: These centers are also well-equipped to handle traumatic injuries,
but may not have the same level of research and educational resources as Level I centers. Level
II trauma centers should be capable of initiating definitive care for all injured patients.

Requirements for level II trauma centers often include:

• A comprehensive quality assessment program

• Continuing education and trauma prevention programs for trauma care team members
• Ability to refer tertiary care needs (such as microvascular surgery, hemodialysis, and cardiac
surgery) to a level I trauma center
• Immediate round-the-clock coverage by general surgeons
• Specialty care available for critical care, radiology, emergency medicine, anesthesiology,
neurosurgery, and orthopedic surgery
Level III Trauma Centers: These centers are typically located in smaller cities or rural areas,
and have fewer resources and capabilities than Level I and II centers. Trauma centers that have
demonstrated a capability to provide emergency care, intensive care, stabilization of injured patients,
surgery, resuscitation, and prompt assessment generally qualify for level III categorization.

Requirements for level III trauma centers often include:

• An active outreach program and prevention efforts for referring communities

• Continuing education for trauma team members or for allied health and nursing personnel
• Transfer agreements in place with level I and II trauma centers for patients who require more
comprehensive care
• A comprehensive quality assessment program
• Immediate round-the-clock coverage by emergency medicine physicians
• Prompt availability of anesthesiologists and general surgeons

Level IV Trauma Centers: These centers have limited resources and are typically located in
remote or underserved areas. They are able to stabilize and transfer patients to higher-level
trauma centers. Level IV trauma centers provide diagnostic, stabilization, and evaluation capabilities
for injured patients. Trauma centers must demonstrate the ability to provide patients with advanced
trauma life support (ATLS) before transferring them to a higher-level facility in order to qualify for
level IV categorization.

Requirements for level IV trauma centers often include:

• An active outreach program and prevention efforts for referring communities

• A comprehensive quality assessment program
• Transfer agreements in place with higher-level trauma centers for patients who require more
comprehensive care
• Ability to provide critical care services and surgery if available
• 24-hour laboratory coverage
• Ability to implement ATLS protocols with basic emergency department facilities
• Physicians and trauma nurses available upon patient arrival

Level V Trauma Centers: These centers provide initial evaluation, stabilization, and diagnostic
capabilities, but do not have surgical capabilities. They may be located in rural or remote areas with
limited access to higher-level trauma centers.

Requirements for level V trauma centers often include:

 • Transfer agreements in place with level I, II, and III trauma centers for patients who require
more comprehensive care
• Ability to provide critical care services and surgery if available
• Protocols for after-hours activation is the facility is not open 24/7
• Physicians and trauma nurse(s) available upon patient arrival
• Ability to implement ATLS protocols with basic emergency department facilities

3. OBJECTIVES OF TRAUMA CENTER

The primary objective of a trauma center is to provide specialized care to critically injured patients,
with the ultimate goal of improving outcomes and reducing the long-term impact of traumatic injuries.
To achieve this goal, trauma centers typically have a range of objectives, which may include:

1. Providing timely and effective care: One of the primary objectives of a trauma center is to
provide timely and effective care to critically injured patients, with the goal of stabilizing the
patient and preventing further damage.
2. Providing comprehensive care: Trauma centers are designed to provide comprehensive care
to trauma patients, including emergency care, surgical interventions, and rehabilitation services.
3. Improving survival rates: Trauma centers aim to improve survival rates for trauma patients
through the use of specialized teams and resources, such as trauma surgeons, anesthesiologists,
and critical care specialists.
4. Reducing the long-term impact of injuries: In addition to improving survival rates, trauma
centers aim to reduce the long-term impact of injuries by providing specialized rehabilitation
services and working to prevent complications such as infections or disabilities.
5. Conducting research and education: Trauma centers often conduct research to improve the
care and outcomes of trauma patients and provide education and training for healthcare
providers to improve the quality of care across the healthcare system.

4. IMPORTANCE OF TRAUMA CENTER

Trauma centers are critically important for several reasons:

1. Improving outcomes for critically injured patients: Trauma centers are designed to provide
specialized care to critically injured patients, which can significantly improve their chances of
survival and recovery. Research has shown that trauma centers with specialized teams and
resources have higher survival rates and better outcomes for patients compared to non-trauma
centers.
2. Coordinated care across the healthcare system: Trauma centers are typically part of a larger
trauma system, which is designed to coordinate care across the healthcare system and ensure
that trauma patients receive timely and appropriate care. This coordination can help to reduce
 the time it takes to get a patient to a trauma center, and can improve the continuity of care as
patients move through the healthcare system.
3. Providing a range of specialized services: Trauma centers typically have a range of
specialized services, such as emergency care, surgical interventions, and rehabilitation services,
which can help to ensure that trauma patients receive comprehensive care tailored to their
specific needs.
4. Conducting research and education: Trauma centers often conduct research to improve the
care and outcomes of trauma patients, and provide education and training for healthcare
providers to improve the quality of care across the healthcare system.
5. Reducing the burden of traumatic injuries: Trauma centers play an important role in
reducing the burden of traumatic injuries on individuals and society as a whole. By providing
specialized care and working to improve outcomes, trauma centers can help to prevent the long-
term physical and emotional impact of traumatic injuries.

5. PROJECT DESCRIPTION

The main Aim of this project is to connect all the district of Madhesh province and highways to the
trauma medical facility in order to provide timely and effective care to increase survival rate in the case
of major accident and emergencies. East west highway, hulaki highway and district headquarter
highway are the major spot for the accident. To provide trauma care for such accident cases, Advance
level trauma care center is the need of hour for the Madhesh province alongside the east-west Mahendra
highway. Since dhanusa, parsa and saptari consists hospital with better facility. Sarlahi lacks the good
hospital and falls in the center of the Madhesh province. That is why iam purposing ADVANCE
TRAUMA CENTER at Hariwon, Sarlahi,Nepal.

6. PROJECT JUSTIFICATION

The establishment of a trauma center in Nepal is a crucial step towards improving the care of critically
injured patients in the country. Nepal has one of the highest rates of traffic accidents in the world, and
the majority of the country's hospitals are ill-equipped to handle the complex and urgent needs of trauma
patients. As a result, many patients suffer from unnecessary long-term disabilities or even die due to
lack of access to specialized trauma care.

The establishment of a trauma center in Nepal can significantly improve patient outcomes and reduce
the long-term impact of traumatic injuries. By providing specialized care to critically injured patients,
a trauma center can improve the chances of survival, reduce the incidence of complications and
disabilities, and lower overall healthcare costs. A trauma center can also reduce the burden on other
healthcare facilities and providers, ensuring that patients receive the appropriate level of care in a timely
and efficient manner.
In addition to improving patient outcomes, the establishment of a trauma center in Nepal can have
significant positive impacts on the community. It can provide jobs and economic benefits to the
surrounding area, as well as offer community outreach and education programs designed to promote
injury prevention and improve access to care. The research and innovation programs associated with a
trauma center can also contribute to the overall body of knowledge on trauma care, benefiting patients
in Nepal and around the world.

Therefore, the establishment of a trauma center in Nepal is a critical and necessary step towards
improving the care of critically injured patients in the country. The benefits of a trauma center are wide-
ranging and have the potential to significantly improve patient outcomes, reduce healthcare costs, and
positively impact the community.

Nepal has one of the highest rates of traffic accidents in the world, with an estimated 2,000 fatalities
and 8,000 serious injuries occurring each year. In addition to traffic accidents, falls, burns, and other
types of accidents also contribute to the high incidence of traumatic injuries in Nepal. The lack of access
to specialized trauma care is a significant challenge, as the majority of hospitals in the country are not
equipped to handle the complex and urgent needs of trauma patients.

According to the Ministry of Health and Population in Nepal, the most common causes of trauma in the
country are:

1. Road traffic accidents

2. Falls
3. Burns and scalds
4. Poisoning
5. Drowning

The incidence of traumatic injuries is particularly high among young people, with individuals aged 15
to 44 accounting for the majority of cases. The lack of access to specialized trauma care in Nepal is a
significant challenge, with many patients suffering from unnecessary long-term disabilities or even
dying due to the lack of appropriate care.

According to the data published by the Ministry of Home Affairs of Nepal, in 2020, there were 4,696
road accidents, resulting in 1,342 fatalities and 4,108 injuries. The data also shows that the majority of
accidents were caused by reckless driving and speeding, followed by driving under the influence of
alcohol and overtaking in dangerous areas.

In addition to road accidents, the data also shows that falls, burns, and other types of accidents
contributed to a significant number of traumatic injuries and fatalities in Nepal. The lack of access to
specialized trauma care continues to be a major challenge, with many patients suffering from long-term
disabilities or even dying due to the lack of appropriate care.

Madhesh province lack the facility of the proper trauma center. If any case of major accident and
emergencies, patient are evacuated or transported to the Kathmandu, which increases the time between
accident and hospital facility due to which mortality rate is higher in the madhesh province in accident
case. Madhesh province consists east west highway, hulaki highway etc which passes through the
human settlement and causes the major road accident, to give the quick trauma response, various trauma
centre are the need of the Madhesh province. Also Madhesh province is prone to various natural
calamities, so trauma centers are the need of hour of the Madhesh provine.
7. METHODOLOGY

The knowledge on any topic is gained by the deep study and research on the topic. To know about
trauma center, I will be doing detail case study and literature review.

7.1 CASE STUDY

For the national case study, I will be studying

1. National trauma center
From this case study I will be studying about

• About the Nepal trauma sector infrastructure.

• About the requirements of the trauma center.
• About the bed per area capacity.
• Doctors to patient and nurse to patient ratio.
• About the various departments.
• Flow of the patient and doctors in the hospital.
• About the connection and relationship of various spaces.
• About the waste management, power backup, mortuary and canteen.

For international case study, I will be studying

1. kingwood emergency hospital. U.S.A
2. Rashid hospital trauma center. Dubai.
From these international case studies, I will be studying

• About the international trauma care practices.

• About the various design techniques applied.
• About doctor and nurse to patient ratio.
• About various department required to run trauma center.
• Area required per bed.
• Relationship and connection between various spaces.
• Area of spaces to perform various activities in the trauma center.
• About the function of space.
• Various zoning in the hospital and it uses.

7.2 LITERATURE REVIEW

Literature review from the books, reports and through internet over the topic will be done. The study
book includes previous thesis report on TRAUMA CENTER. Also the guidelines of the various
country for the trauma center will be studied. Which Ares,
1. Swastha bhawan nirdeshika. Ministry of health, Nepal.
 2. NBC Architectural code.
3. Capacity Building for Developing Trauma Care Facilities on National Highways, Operational
Guidelines, Government of India, Ministry of Health & Family Welfare.
4. Trauma Center Standard, State of Florida, Department of Health, January 2010.
5. Guidelines for Essential Trauma Care, World Health Organization, 2004.
6. Model Resource Criteria for Level I, II, III & IV Trauma Services in Australasia, Royal
Australasian College of Surgeons, August 2009.
7. Emergency Medicine and Trauma Services Policy, Medical Development Division, Ministry
of Health, Malaysia, 2012.

7.3 DATA COLLECTION

In this study I will be collecting data about the accident cases and natural calamities in the madhesh
province to support this project.

8. SITE

I have choosen site anywhere around the Hariwon, Sarlahi. I have choosen site in this area because
this area doesn’t have any good medical facility, always suffers the accident cases along the highway
almost accident a day, consists the industries and also experience flood and other natural calamities.
This area also acts as the middle point for the district such as rautahat and mahotari.
LOCATION: Anywhere near Hariwon, Sarlahi, Nepal.
AREA: About one Bigha (6800 sq.m approx.)

Probable site

9. CONCLUSION

Trauma center in the terai alongside the highways is the need of an hour. Trauma center in this area
can save the thousands of live. Trauma center also can act as disaster relief center when the disaster
occurs in this area. This trauma center can play vital role in coordinating with district and municipal
hospital and raising awareness about the various accident and emergency case. This trauma center
also will create the jobs and business in this area and will give the feelings of governance.
10. REFRENCES
1. https://www.scribd.com/document/330865505/Trauma-Center-Research-paper-docx
2. World Health Organization. (2019). Global status report on road safety 2018. World Health
Organization.
3. Nepal Police. (2021). Annual Road Accident Statistical Report 2020. Retrieved from
http://nepalpolice.gov.np/en/annual-road-accident-statistical-report-2020/
4. Ministry of Health and Population. (2019). National Policy for Trauma Care. Retrieved from
https://mohp.gov.np/downloads/National%20policy%20for%20trauma%20care.pdf
5. Joshipura, M. K., Shah, S. P., & Mehta, C. (2015). Trauma care in Nepal: Present and future.
Journal of Nepal Medical Association, 53(199), 84-88.
6. Acharya, S. P., & Maharjan, S. (2016). Trauma care in Nepal: Where do we stand? Journal of
Nepal Medical Association, 54(201), 85-90.
7. Poudel, R., Shrestha, S., & Dhakal, R. (2018). Establishment of a National Trauma Center in
Nepal. International Journal of Trauma Nursing, 22, 7-11.
8. World Bank. (2019). World Bank Data: Nepal. Retrieved from
https://data.worldbank.org/country/nepal