Evaluation of Tamil Nadu Accident

and Emergency Care Initiative (TAEI)

Programme in selected districts of
Tamil Nadu, 2021
Dr. B. M. Pabithadevi M.S.,
Professor of Surgery
Tirunelveli Medical College
 Objectives
• To evaluate the inputs to the program, including the activities
conducted and the human and financial resources invested
• To evaluate the processes of the program, including the
mechanisms used to transform these activities into outcomes.
• To evaluate the outcome of the program, including the benefit in
terms of better health.
 Methodology
• Study Setting: The study was done in the hospitals, randomly
selected from 3 southern districts of Tamil Nadu.
• Virudhunagar District: Virudhunagar Medical College Hospital
• Thoothukudi District: Thoothukudi Medical College Hospital
• Tirunelveli District: Tenkasi Govt Hospital
 Sample size
• 110 patients in each centre who got admitted due to
Injury ( RTA, Assault and accidental injury) were
selected randomly.
• 320 people in the community (160 rural and 160 urban)
from each centre were selected for the interview.
• Study Design: Cross-sectional descriptive study
• Study Period: 6 months
Data collection:
• Secondary data from review of records and the TAEI
portal
• Records reviewed includes MLC register, NMLC register,
Nominal register, EOT register and Death register
• The data was collected from Jan 2019 to Dec 2021
• Interviews – from patients, ambulance drivers (both 108
& private) and the people in the community
Sl. objective Indicators Tools for data collection Remarks
no.

1. To evaluate the inputs 1. The proportion of Medical officers trained in From the TAEI center record The project technical
to the program, TAEI protocol officer appointed for
including the activities 2. The proportion of staff nurses trained in TAEI From the hospital record this purpose will collect
conducted and the protocol data.
human and financial 3. The proportion of paramedical staff trained in From the hospital record Piloting will be done in
resources invested TAEI protocol other TAEI centers and
4. No of vehicles including 108 From 108 service center the data collection
ambulances dedicated to TAEI program format will be modified
5. The proportion of emergency technicians of From 108 service center accordingly.
108 ambulances trained in TAEI protocol
6. List of new types of equipment purchased for
TAEI care center From the TAEI center record
7. Number of training sessions conducted for From the TAEI center record
medical officers for TAEI program.
8. Number of training sessions conducted for From the TAEI center record
staff nurses for TAEI program
9. Number of training sessions conducted for From the TAEI center record
paramedical workers for TAEI program
Sl. no. objective Indicators Tools for data collection Remarks

2. To evaluate the 1. The proportion of patient (referred by 108 ambulance) entries From the record, available from 108 The project technical
processes of the made by the triage nurse in TAEI registry/ day services and hospital officer appointed for this
program, including 2. The proportion of patient (referred by 108 ambulance) entries From TAEI registry purpose will collect data.
the mechanisms made by the triage nurse in TAEI registry/day Piloting will be done in
used to transform 3. The proportion of patient (non 108 cases) entries made by the From TAEI registry other TAEI centers and
these activities into triage nurse in TAEI registry/day. the data collection format
outcomes. 4. The proportion of patient (non 108 cases) entries made by the From TAEI registry will be modified
triage nurse in TAEI registry in the last 15days. accordingly
5. The proportion of trauma cases transported to the TAEI center in From 108 services record
108 ambulance
6. Are the private ambulance drivers aware of TAEI care centers? Semistructured questionnaire
7. No of trauma victims admitted under TAEI/ day From hospital records
8. The average duration of time taken for trauma victims to reach the From 108 services records, time is
TAEI center? taken from receiving the call to
reaching the hospital
9. No. of trauma patients referred to higher centers for expert medical From the hospital referral register
care? From the hospital referral register and
10. The average duration of time taken for the referral? the admission register of referred
hospital
11. The common injuries for which referrals are made? From the hospital referral register
12. The average time taken to complete secondary survey in ER From TAEI case sheet and TAEI
dashboard
13. The average time spent by each patient in the emergency room From TAEI center admission and
nominal registers
14. The average time taken from triage to specialist intervention From TAEI case sheets
Sl. objective Indicators Tools for data collection Remarks
no.

3. To evaluate the 1. No. of emergency surgeries performed From the emergency OT The project technical
outcome of the within 6 hrs of admission registers officer appointed for
program, 2. No. of trauma patients die within one hour From the admission register
this purpose will
including the of admission and death register of the TAEI
collect data.
benefit in terms 3. The mortality rate of trauma patients within center Piloting will be done
of better health 6 hrs, compared to the previous years. From the medical record dept.
in other TAEI centers
4. The incidence of quadriplegia compared to Of the hospital and the data
previous years collection format will
From the admission register of be modified
5. The proportion of cases triaged to RED the TAEI center accordingly
zone/ day From TAEI center dashboard
6. Are all activities being implemented as Semi-structured
intended? If not why? questionnaire
7. How well the program achieved its Semi structured
objectives? questionnaire
 Results

VIRUDHUNAGAR
MEDICAL THOOTHUKUDI MEDICAL TENKASI GOVT
INDICATORS COLLEGE COLLEGE HOSPITAL

The average duration of time taken 30 min 30 min 30 – 40 min

for trauma victims to reach the TAEI
center?

The average time spent by each 1-2 hours 1-4 hrs depending on the 1 – 2 hrs
patient in the emergency room condition of the patient

The average duration of time taken 1- 2 hrs 30 – 60 min 1- 2 hrs

for the referral?

The common injuries for which Head injury, vascular injury & Pelvic Head injury, Polytrauma,
referrals are made? Polytrauma and fracture vascular injury & Pelvic
vascular injury fracture
 Results

Virudhunagar Medical Tenkasi govt

Thoothukudi medical College
College hospital
Indicators
2019 2020 2021 2019 2020 2021 2020 2021

No. of trauma patients die within one hour of 0.4% 0.1% 0.1% 0.1% 0.13% 0.12% 1% 0.5%
admission

No of trauma victims admitted under TAEI/ year 3301 4339 11189 11113
2674 11025 175 665

Proportion of patients admitted in Red zone 62% 50.5% 55.5% 21.9% 15.1% 12.6% 2.9% 6.3%

Proportion of patients admitted in Yellow zone 37.9% 43.7% 40.6% 62.4% 66% 74.8% 61.4% 90.7%

% of red zone cases referred 16.5% 20.7% 17.2% 0.29% 0.64% 0.56% 50% 73.5%
to higher centers for expert medical care?
 Results

Virudhunagar Medical College Thoothukudi medical College Tenkasi Govt hospital

Outcome indicators
2019 2020 2021 2019 2020 2021 2020 2021

Surgeries done within 6 hrs 12 9 30 68 60 130 4 15

Common surgeries done Intercostal drainage Intercostal drainage Intercostal drainage

K wire fixation
Wound exploration
K wire fixation Wound exploration
Wound exploration
Blunt injury abdomen- Exploratory
laparotomy
Penetrating injury abdomen –
Laparotomy
SDH & EDH – Emergency
craniotomy
 Results

Virudhunagar Medical Thoothukudi medical Tenkasi Govt

Indicators
College College hospital

No of trained staff employed for TAEI care 99% 99 % 95%

center

No of vehicles including 108 ambulances 2 2 1

dedicated for TAEi program

The proportion of trauma cases transported to the 30.2% in 2019 76.3% in 2019 76% in 2020
TAEI center in 108 ambulance 26.7% in 2020 80.9% in 2020 88.5% in 2021
27.4% in 2021 83% in 2021

Are the private ambulance drivers aware of TAEI They know as emergency care They know as emergency care is They know as
care centers? is available but not the concept available but not the concept of emergency care is
of TAEI TAEI available but not the
concept of TAEI
 Thoothukudi Medical college Virudhunagar medical College Tenkasi govt. hospital

TAEI Equipment RED YELLOW RED YELLOW RED YELLOW

AED/ Defibrillator 1 1 1 1 1 1

Central Oxygen Supply 1 1 4 5 3 5

Suction Apparatus 2 1 2 2 1

Ventilator 4 0 5 6 3 3

Pulse oxymeter 4 3 2 2 2 2

POTC - Machine (incl Cartridges) 0 0 0 0 0 0

Volume Infusion Pump 5 0 10 5 2 3

Syringe Infusion Pump 5 0 10 7 3 3

Mobile X Ray 1 0 1 NIL 0 0

 Thoothukudi Medical college Virudhunagar medical College Tenkasi govt. hospital

TAEI Equipment RED YELLOW RED YELLOW RED YELLOW

Oxygen Flow Meter And Humidifier 5 8 8 3 5

ECG 1 1 1 NIL 1 1

Dressing Trolley 1 1 3 2 2

Stretchers/Multi-Functional Stretcher 1 2 2 2 1 1

Wheel Chair 2 2 3 3 1 1

Spine Board and Head rest with Belt(7) 1 0 1 2 1 1

Scoop Board 1 0 2 1 1 2

IV Stand 5 10 7 6 5 2

Traction Splints (Hare, Sager, Thomas Ring) 2 1 1 NIL 1 1

Crash Cart – Adult + Paediatric 1+1 1+0 2+0 1+0 1+0 0

 Results Cont….

Input indicators
• All the medical officers posted in TAEI ward were trained in TAEI protocol.
• All the staff nurses posted in TAEI ward were trained in TAEI protocol
• 90% of paramedical staff posted in TAEI ward were trained in TAEI protocol
• 90% of emergency technicians of 108 ambulances were trained in TAEI
protocol
• Two trainings once in three months are conducted for the training of medical
officers, staff nurses and paramedical staffs
 Results Cont….

• 99% of patients admitted in TAEI ward, who used 108 ambulance entries were
made by the triage nurse in TAEI register
• The proportion of patient (non 108 cases) entries made by the triage nurse in
TAEI registry/day was about 80%.
• 87.5% of the participants from Tenkasi and Virudhunagar districts aware of the
program, but in Thoothukudi district all the study participants were aware of
the program. But they knew TAEI program as an emergency room or as
casualty, but not the exact name of TAEI.
 Results Cont….

• Only 0.1% of total trauma admission died within an hour

• An average of 3.1% of trauma cases died per month within 6 hrs of
admission
 Discussion

1. It took about 30 – 40 minutes for the patient to reach

the hospital by 108 ambulances
Being a cashless service, the ambulance
deployment and responses are likely to be configured in
favour of urban areas with a higher potential volume of
cases and easy access to hospitals with emergency
departments and health care resources compared to their
rural counterparts
 Discussion

2. 30.2% of RTA patients in Virudhunagar medical

college, 83% of RTA patients in Thoothukudi medical
college and 88.5% of RTA patients in Tenkasi govt.
hospital only used 108 ambulance and this causes
utilisation of two wheelers and private ambulances
for hospital transfer.
non utilisation of 108 ambulance for
hospital transfer prevents the prehospital care which plays
a major role in reducing the mortality and morbidity
3. Many new equipment had been purchased including
ventilator and Defibrillators which helped to reduce
the mortality of the patients admitted in TAEI ward.
The mortality of patients who had admitted in
TAEI ward was about 4% in last three years.
The average time spent by the patient in the triage
areas was about 5 – 15 minutes. Most of the patients
received specialist attention within 30 – 40 minutes of
admission
4. 48% of patients to the maximum of 70% of patients
who got admitted due to road traffic accidents had
head injury. The common causes of referral were for
head injury, pelvic fracture, vascular injury and
polytrauma.
The availability of neurosurgeon and orthopedic
surgeon with improving the infra structure will reduce the
references
5. 3 – 12% of trauma cases admitted are being operated.
The common surgeries were laparotomy, wound
exploration and intercostal tube drainage.
The numbers were too low. The reasons may be
due to inadequate entries in the register. They have not
included minor surgeries done like wound suturing in the
trauma register
6. The equipment and drugs were found adequate in red
zone for the effective resuscitation of patients.
7. The primary, secondary and tertiary care were well
provided in TAEI centers except quaternary care i.e.
Rehabilitation services is poor. Physiotherapy
services were provided in medical college TAEI
centers during the admission period. After discharge,
no rehabilitation services were provided by the TAEI
centers
 Recommendations

1. Dedicated utilization of the services of trained medical officers, staff

nurses and paramedical staff without shifting them for other services
should be done, for the effective function of TAEI program.
2. The utilization of 108 services can be improved by increasing the
awareness among the public which will improve the pre-hospital care
thereby decreasing the morbidity and mortality rate.
3. Neurosurgeon and vascular/ plastic surgeon availability in all TAEI
centers with improving the infrastructure for intervention will reduce
the mortality from head injury.
4. The entries made in the TAEI registers to be improved by including
the treatment particulars even the minor surgical procedures. This will
help to improve the success rate of TAEI program.
5. The rehabilitation program should be improved in TAEI centers in
collaboration with Physical Medicine dept. to improve the
productivity of the injured patients