Despite living in a modern world, one is faced with the realization that we are not at all prepared for

any kind of medical emergency. This is what we observed on October 8, 2005 at 8.55am. When the earth shook, it shook us into reality. Ep icentre: 10kms deep and 95kms north of Islamabad. Total destruction of many town s: 3.5 million home-less, 86,000 or more dead, 70,000 seriously injured, thousands of amputees, and hundreds of spinal injuries crush syndrome/tetanus. The situat ion highlighted the need for being prepared for a disastrous situation and the f act that we need to overview the trauma training efforts and the need for advoca cy for nationwide public private partnership. Every year, two million people die from trauma-related incidents, including traffic injuries. In industrialised co untries trauma is the most common cause of death in 18-40-year-olds. Keeping this in mind, recently a research symposium was conducted at one of the local hospitals with the collaboration of the Johns Hopkins University, USA. It was entitled, Trauma, injuries and disasters: research and training imperatives. S afety is not achieved by luck. It can be planned. And a lot of suffering due to injuries can be prevented through appropriate planning. But the questions that r ear their heads in this regard are: How to achieve safety? What role can advocac y play in it? In this respect, one is reminded of what a famous person said about another pers on who got killed in a crash on January 1, 1996 in Uganda: I cannot remember the exact fateful day Aidha lost her life on her way to a friends funeral. She had ju st completed her last year at the university. To all those who remember her, the lesson learnt is life is too short to be wasted.

-------------------------------------------------------------------------------Sustaining injuries is almost inescapable for human beings. Its better to be prep ared to handle them when they inevitably come -------------------------------------------------------------------------------During one of the sessions at the symposium, Dr Abdul Ghaffar from the WHO talke d about trauma, injuries and disasters: policy perspectives in Pakistan. He disc ussed the ideal policy formulation, which should be evidence-based. It should in volve relevant stakeholders, be transparent and an inclusive process. Then we ha ve to consider the policy players for trauma, injuries, disasters, the health se ctor, the transport sector, the police/legal/justice system, the cabinet divisio n, civil society organizations, the donor and development community, civil defen ce, and the armed forces. Injuries have made a visible appearance on (national) public health map. There a re interested partners to work with (nationally and internationally). Some devel opment and private sector partners have shown serious interest. A significant in terest by researchers, academics and the media in the last 10 years has also bee n brought into the limelight. Challenges and realities: Injuries are still not seen as a disease. Attention is given to injuries only when there is a catastrophe. No major donor is willing t o commit significant resources. It is also not a priority issue for our governme nt. We are faced with poor regulatory and legal systems, which is nothing except ional as far as the usual tussle between researchers and policy-makers is concer ned. Now the question that should be asked: do researchers and policy-makers desire t he evidence-based policies?

There is limited evidence to support this argument. There are different opinions about the role of science in policy-making. Differences between researchers and policy-makers are genuine, systemic and structural. Some common features Culture of blame and arrogance In some cases, even lack of mutual trust and respect No real incentives for either to work together The likely middle ground Shared vision and responsibility Confidence building measures Enhancing functional outcomes post trauma: At the symposium, Ellen J. MacKenzie, Professor at the Johns Hopkins School of Public Health, talked about: Injury be ing not just a major cause of death but also a leading cause of disability. He said, injuries often result in significant long-term consequences that have a life-long impact on the injured, his or her family and society The top 10 causes of premature mortality and disability in Pakistan, 1990 Premature mortality 1. Diarrhea 2. LTRI-Child 3. Tuberculosis 4. Rheumatic heart 5. Chronic liver disease 6. Cong malformations 7. Birth diseases 8. Ischemic heart disease 9. Child septicemia 10. Other respiratory 11. Injuries Injuries are the second most common cause of disability in Pakistan. National injury survey of Pakistan Nationally representative, household survey for all injuries to all ages: 1997-9 9 Sample of 28,926 people; 300 injury events

 Incidence of serious injury: 41/1000 per year Road traffic injuries account for 36 per cent of all injuries Serious injuries result in an average of 17 lost work-days per person per injury Issues related to injuries in Pakistan What is the magnitude of the problem? Which are the high-risk groups? What are the actual physical injuries/trauma seen in these victims? What is the quality of trauma care they receive? David B. Hoyt, Professor of Surgery at University of California, San Diego talke d about how a community should prepare against world wars, biological weapons, a ssassinations and disasters. What examples do we have from a more prepared socie ty, developed world? Disasters Problems: Hospital based trauma programs Good infrastructure Needs modification Resources different This could perhaps play the role of a template for the developing world. We can, with our resources, see and decide whatever we would be able to implement in ou r setup. Injuries are a major public health problem. They are largely preventable and if adequate steps towards prevention are taken then this problem can be reduced sig nificantly. -------------------------------------------------------------------------------Distribution of injuries among children in Karachi A study undertaken in Islamabad found only 60 per cent of fatalities reported by local newspapers in police records Type of injuries Motor vehicle crashes Falls Burns Downing/near drowning Falling objects Explosion Poisoning Frequency 1059 (81%) 67 (5%) 64 (5%) 44 (3%) 32 (2%) 21 (1.6%) 15 (1%)

Electrocution Bites/envenomation

11 (0.8%) 7 (0.5%)

Source: http://archives.dawn.com/dawnftp/72.249.57.55/dawnftp/weekly/dmag/archiv e/060423/dmag11.htm