9 November 2017

National Trauma Research Institute

Dr Joseph Mathew

Designation of Trauma Hospitals

in a Trauma System
Australia
Population
23,881,037 (2015)

Total # of licensed
vehicles
18, 007,767 (2014)

India
Population
1,297,915,977 (2015)

Total # of licensed
vehicles
141,865,607 (2012)
Victoria

227,600 square kilometres

Population 5.8 million
Melbourne 4.0 million
3.4 million licensed drivers
3.7 million registered vehicles
 Victoria Population 6 million
the most densely
populated of the Australia
States (total population of
Australia is 21 million)

Area - 227,600 square

kilometres

State Capital - Melbourne

population of 5.14 million
(70% of state population) -
6,100 square kms

Registered Vehicles - 3.7

950 km (600 miles)
million
 Principles of the
Victorian State Trauma System

Designated levels of trauma care

3 major trauma services
9 metropolitan trauma services
50 urgent care services
61 primary injury services
Preprogrammed response
Can rapidly transfer to a Major Trauma Service
9 November 2017 7
9 November 2017 8
20:4
5

22:1
7
22:30
22:45

Level Australia
1 High end multi trauma care
requiring
Neurosurgery/Cardiothoracic
and Interventional Radiology
9 November 2017 10
Tamil Nadu
provide the highest level of definitive and
comprehensive care for patient with complex
injuries.
Emergency physicians, nurses and surgeons would
be in-house and available to the trauma patient
immediately on their arrival.
services of all major super specialties associated
with trauma care would be available 24*7.
should be situated at essentially at a distance of
less than 750 to 800 kms apart;
need not necessarily be along with the Highways
corridor.
These should be tertiary care centers to which
patients requiring highly specialized medical care
are referred.
should be only in medical college hospitals.

Level Australia
2 Isolated injuries and multi-
trauma not requiring the
above interventions
9 November 2017 11
India
Provides definitive care for severe trauma
patients.
Emergency physicians, surgeons,
Orthopaedicians and Anaesthetists are in-house
and available to the trauma patients immediately
on arrival.
Have on-call facility for neurosurgeons,
pediatricians. If neurosurgeons are not available,
general surgeons trained in neuro surgery for a
period of 6 months in eminent institutions would
be made available 24*7.
should be equipped with emergency department,
intensive care unit, blood bank, rehabilitation
services, broad range of comprehensive
diagnostic capabilities, and supportive services.
The existing medical college hospitals or
hospitals with bed strength of 300 to 500 should
be identified as Level II Trauma Center.
 9 November 2017 12

Level Australia India

3 Isolated injuries and early Provides initial evaluation and stabilization (surgically if
stabilisation centres
appropriate) to the trauma patient.

Comprehensive medical and surgical inpatient services

available to those patients who can be maintained in a stable
or improving condition without specialized care.

Emergency doctors and nurses are available round the

clock. Physicians, surgeons, Orthopaedic surgeon and
Anaesthetist would be available round the clock to assess,
resuscitate, stabilize and initiate transfer as necessary to a
higher-level Trauma Care Service.

Such hospitals will have limited intensive care facility,

diagnostic capability, blood bank and other supportive
services.

The district/ tehsil hospitals with a bed capacity of 100 to 200

beds would be selected for level III care.
 9 November 2017 13

Level Australia Tamil Nadu

4 Ambulance Victoria
Advance life support
ambulances
MICA paramedics
Fixed wing and helicoptor
provided by appropriately equipped and
manned mobile hospital / ambulances.
shall be provided by MoRTH / NHAI / NRHM /
State Govts., etc as the case maybe.
 9 November 2017 14

Memorandum of Understanding with GVK-EMRI

Signed September 2014

To work on shared goals regarding strengthening trauma

care practices in India and collaborate in trauma research
Focus areas
Jointly carry out research in trauma care
Develop and pilot model trauma
systems/networks
Seek funding for Demonstration projects
Jointly disseminate evidence about the impact of
systems/networks
First project Proposal to the Government of Uttar Pradesh to pilot
model trauma systems and networks. Submitted May 2015.
 Area
(243,286 km) Tertiary Districts Population
Hospital covered (2011 census)
850 km Agra 12 33,269,643

Lucknow 10 31,716,376

Gorakhpur 10 28,538,739
Varanasi 11 32,089,084

Allahabad 7 20,715,552

Kanpur 11 21,932,320
Meerut 10 31,319,763
500km Total 71 199,581,477
Agra
122
3398 0.18% Trauma (Vehicular)
7578 4.91%
10.94%
Trauma (non
Vehicular)
46181 Assault
66.68%
Trauma Trauma (non
11983 Fire/Burns District Assault Fire/Burns Industrial Total
(Vehicular) Vehicular)
17.30%
Industrial Agra 3,680 879 504 255 11 5,329

Aligarh 4,060 971 604 354 12 6,001

Mainpuri
Bareilly 3,762 1,046 781 351 18 5,958
7,449
10.75%
Mathura Agra Budaun 5,430 1,650 1,246 452 15 8,793
Kashiram 4,167 5,329 Aligarh
Nagar 6.02% 7.69% 6,001 Bulandshahar 5,240 841 757 360 11 7,209
Kasganj 8.66% Bareilly
2,794 5,958 Etah 2,643 597 419 158 5 3,822
4.03% 8.60%
Farrukhabad 3,009 1,025 541 235 9 4,819

Firozabad 6,562 1,505 745 279 9 9,100

Hathras 2,485 600 495 239 2 3,821

Hathras Kashiram Nagar
3,821 1,767 498 395 130 4 2,794
Kasganj
5.52% Budaun
Etah 8,793 Mainpuri 4,562 1,720 748 404 15 7,449
Farrukhab
Firozabad 3,822 12.70%
ad
9,100 5.52% Bulandsha Mathura 2,981 651 343 181 11 4,167
4,819
13.14% 6.96% har
7,209 Total 46,181 11,983 7,578 3,398 122 69,262
10.41%
Agra
Bulandshahar
Bareilly
7209
5958
Agra
Aligarh
Bareilly Aligarh Kanshiram.N
6001 2794
Budaun Budaun
8793
Bulandshahar
Etah Mathura
Mahamaya
Nagar
Farrukhabad 4167 3821
Etah

3822
Firozabad
Mahamaya Nagar
Kanshiram Nagar Farrukhabad
4819
Mainpuri
Mainpuri Firozabad 7449
9100
Mathura
Agra
5329
Agra
Bulandshahar
Bareilly
7209
5958
Agra
Aligarh 71 Km
76 km

Bareilly Aligarh Kanshiram.N

6001 2794
Budaun 72.5 Km
Budaun
8793
Bulandshahar
Etah Mathura
Mahamaya
Nagar
73 Km
219 Km

Farrukhabad 4167 3821

Etah

3822
Firozabad 52 Km
Mahamaya Nagar 57Km 66 Km

Kanshiram Nagar Farrukhabad

4819
Mainpuri
Mainpuri Firozabad 7449
9100
Mathura
Agra
5329
Lucknow

3777 155
8916 4.90% 0.20% Trauma (Vehicular) Trauma Trauma (non
11.56% District Assault Fire/Burns Industrial Total
(Vehicular) Vehicular)
Trauma (non
Vehicular) Bahraich 2,915 1,359 594 281 16 5,165
48604 Assault
63.01% Barabanki 6,435 1,930 1,002 472 25 9,864
Fire/Burns
15680
Hardoi 6,781 2,315 1,437 523 13 11,069
20.33%
Industrial
Shrawasti
Kannauj 4,767 1,748 1,013 317 13 7,858
2,303 Sitapur Bahraich
2.99% 7,523 5,165
Shahjahan Barabanki
9.75% 6.70% Kheri 4,578 1,146 1,037 423 19 7,203
pur 9,864
6,760 12.79%
8.76% Lucknow 10,049 2,798 948 613 19 14,427
Pilibhit
4,960 Pilibhit 3,062 909 670 307 12 4,960
6.43%

Shahjahanpur 4,190 1,254 957 342 17 6,760

Hardoi
11,069
Lucknow Shrawasti 1,310 567 296 125 5 2,303
14.35%
14,427
18.70% Kheri
7,203 Kannauj Sitapur 4,517 1,654 962 374 16 7,523
9.34% 7,858
10.19%
Total 48,604 15,680 8,916 3,777 155 77,132
Lucknow

3777 155
8916 0.20% Trauma (Vehicular) Trauma Trauma (non
4.90% District Assault Fire/Burns Industrial Total
11.56% (Vehicular) Vehicular)
Trauma (non
Vehicular) Bahraich 2,915 1,359 594 281 16 5,165
48604 Assault
63.01% Barabanki 6,435 1,930 1,002 472 25 9,864
Fire/Burns
15680
20.33% Hardoi 6,781 2,315 1,437 523 13 11,069
Industrial
Shahjahan Shrawasti Kannauj 4,767 1,748 1,013 317 13 7,858
pur 2,303 Sitapur Bahraich
6,760 2.99% 7,523 5,165 Barabanki Kheri 4,578 1,146 1,037 423 19 7,203
8.76% 9.75% 6.70% 9,864
Pilibhit 12.79%
4,960 Lucknow 10,049 2,798 948 613 19 14,427
6.43%

Pilibhit 3,062 909 670 307 12 4,960

Shahjahanpur 4,190 1,254 957 342 17 6,760

Hardoi
11,069
Lucknow Shrawasti 1,310 567 296 125 5 2,303
14.35%
14,427
18.70% Kheri Kannauj
7,203 7,858 Sitapur 4,517 1,654 962 374 16 7,523
9.34% 10.19%
Total 48,604 15,680 8,916 3,777 155 77,132
Lucknow Pilibhit
4960

Bahraich

Kheri
Barabanki 7203

Hardoi Bahraich
Shahjahanpur

5165
Kannauj 6760
Sitapur

7523 Shrawasti
Kheri Hardoi
11069 2303

Lucknow
Pilibhit Kannauj
7858

Shahjahanpur Lucknow
Barabanki
9864
Shrawasti 14427

Sitapur
Lucknow Pilibhit
4960

Bahraich 86 Km

Kheri
Barabanki 7203

Hardoi 264 Km 128 Km Bahraich

Shahjahanpur

5165
Kannauj 6760
Sitapur 50Km

7523 Shrawasti
Kheri Hardoi
11069 2303

Lucknow 113 Km
91 Km 131 Km

Pilibhit Kannauj
7858

Shahjahanpur Lucknow
Barabanki
9864
Shrawasti 14427

Sitapur 126 Km
 Pre-hospital Notification

Aim

To introduce PHN, and evaluate the effect on trauma

patients arriving at a trauma centre by ambulance.
Developed a tech-based pre-hospital notification
system
Suchana is an android application for pre-hospital
notification
 Series of 10 pages with dropdowns or simple
data entry

EMT enters simple patient data and clinical signs

Algorithms generate a trauma flag (Red, Yellow
or Green)

Red trauma cases forwarded to a dedicated

mobile in ED which generates a simple SMS that
is forwarded to appropriate staff

Uses Google Maps to generate an ETA

A hospital screen interface has also been

developed
 Training has occurred in all sites
Pre-hospital notification to has started in
Mumbai, with Ahmedabad and Delhi to
follow in June
Plans to expand app for all emergency
medical conditions
Potential to link decision support systems
 RESULTS TO DATE

The first notification of a red trauma was received

on 22nd May 2017, a 25 year old female injured in a
high speed road traffic accident with a suspected skull
fracture. The notification triggered a trauma call out and
trauma team activation. This is the first time pre-hospital
notification has occurred in an Indian setting in a
formalised system.
Since May 22 a total of 192 notifications have been
made by the EMTS of two of the three ambulance
services, and hospitals. The other service is currently in
the testing phase. Data collection continues.

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Results to date

The Suchana App for pre-hospital notification system in India is working

It is an easy to use, reliable method to notify hospitals of incoming red
trauma patients.
So far, use of the app by EMTs in transporting trauma patients has varied
greatly, largely due to process change.
Trauma team activation and responding to app by doctors receiving
notification is also variable.
Ongoing and a continual audit of use is improving the use of the app by both
EMTs and Doctors.
A prospective observational study will evaluate the effect on trauma patients
arriving at a trauma centre by ambulance.
Tamil Nadu RGGGH and GVK-EMRI to implement pre-hospital
notification by the end of 2017
 THANK-YOU
www.ntri.org.au
www.aitsc.org

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