Trauma care in India: A review of the literature

We reviewed the published literature related to prehospital and hospital trauma care in India to identify how trauma care is defined in the literature and what factors limit the delivery of appropriate trauma care. In summarizing the evidence and recommendations regarding trauma care, this review identifies essential research and development goals to address the burden of injury in India.

A review of the literature was conducted between August 2014 and September 2014. The literature was sorted into 3 categories: prehospital care, hospital clinical care, and hospital administrative care. The characteristics of trauma care were explored using the Essential Trauma Care Project of the World Health Organization.

A total of 38 studies were included. Prehospital care lacked care provided at the scene of the injury, timely transport to a hospital, and transport via ambulance. With regard to hospital care, we found a lack of capabilities of basic clinical care, such as airway management, insertion of chest tubes, and efforts at resuscitation. There was a lack of administrative capabilities, including trauma data systems, trauma-specific training, quality improvement, and development of designated trauma teams.

The high rate of injury-related deaths and disabilities in India could be in part due to the absence of integrated and organized systems of trauma care. In the prehospital setting, a multisector approach must be implemented to address the training of emergency medical service providers and community members. Prehospital transport time can be decreased through improved communication and transport modalities. The Indian trauma care system could also be strengthened through hospital-based training programs and trauma response teams.