The near non-existence of emergency medical services (EMS) to victims of trauma such as road traffic accidents, falls from heights, firearms injuries, burns and air crashes in Nigeria, has made survival rate for patients very low.
Lagos is the only state with a public trauma centre.
Records show that trauma is the fifth leading cause of death in all ages and a leading cause of death in people under 40 years of age. While individuals within this age bracket constitute the economically viable population, their absence remains a significant loss economically for the family, society and the nation in general.
Poor road networks, traffic congestion, etc. have made trauma patients spend more hours unattended, before they are carried by personal cars, buses, or trucks (as against ambulances) to the emergency department of either a general or teaching hospital.
Official reports released by the Federal Road Safety Corps (FRSC) reveal that a total of 3,247 road traffic accidents were recorded nationwide in the third quarter of 2013, with 1,533 deaths and 8,710 injuries. Within the period under review the report from the Corps stated that the month of July had the highest rate of road accidents with 1,126 crashes and 544 persons killed.
The report which was signed by Osita Chidoka, Corps Marshal and Chief Executive, FRSC, indicates that most of the crashes were caused by speed limit violation, which accounts for more than 40 percnet Other causes include loss of control, dangerous driving, tyre burst and wrongful overtaking.
While some secondary and tertiary health institutions lack basic equipments for resuscitation and care of trauma, care for victims of trauma and other medical and surgical emergencies is absent, BusinessDay investigations reveal.
Michael Ugbeye, an orthopaedic surgeon, revealed that the concept of trauma team is non-existent in most Nigerian hospitals, with different aspects of patient care compartmentalised. Ugbeye pointed out that an important barrier to effective emergency trauma patient care is the issue of funding.
“Patients and their relatives are made to bear the cost of treatment in the emergency room. Some hospitals have the policy of free emergency services for the first day of admission for trauma victims, but this is more often not the case. There is also the challenge of inadequate intra-hospital transfer services for specialist care.
“Most trauma care funding is by the federal government, which is usually limited to teaching hospitals and tertiary institutions in urban centres. Annually, more Nigerians die as a result of failure of emergency response system. Though there are flashes of intervention at both federal and state levels, these efforts are often under resourced and not sustained long enough to provide sufficient care for victims,” Ugbeye pointed out.
Biodun Ogungbo, consultant neurosurgeon, Cedarcrest Hospitals, Abuja, revealed there is no designated trauma centre in Nigeria with dedicated extensive staff, physicians and faculty resources, to give seriously injured patients the best possible chance of survival and least residual disability.
As trauma centres were outcomes of the EMS built by the United States (US) military in Vietnam in 1970, Ogungbo stated that there cannot be a trauma centre and excellence in trauma care without the training of staff, as they are first responders to the scene of a disaster.
“The emergency services and the trauma centre staff need training appropriate to their levels. Trauma centres play a critical role in saving the lives of those seriously injured in everyday accidents.
“Every hospital or medical facility treating trauma patients must have a Trauma Incident Plan. It helps with protocols and guidelines in management, so that they are not caught unawares when a sudden disaster occurs and patients start piling up.
“There must be prompt action by government and the private sector to set up regional trauma centres to cover the whole country, especially ‘hot spots’ such as Abuja, Maiduguri, Jos and Bauchi.”
The neurosurgeon added that the Federal Government should create a Presidential Task Force that will design a blue print, break through bureaucratic red tape and make trauma centres available and operational in the country as a matter of urgency.
While occupational therapy for rehabilitation is still in the rudimentary stage of development, and hospital liaison services with personnel management in organisations are still lacking, a lot of patients have not been reintegrated into the society after the harrowing trauma experiences.
It will be recalled that the Federal Government sent 10 medical doctors last year for trauma and emergency training in Tel Aviv, Israel. The measure, the FG said, was to enhance Emergency Medical Service in view of the recent security challenges in the country.
