- Magnitude of the problem
1.1 Global Scenario:
According to WHO’s Global Burden of Disease Project, road traffic accidents (RTA) cause over 1.27 million deaths an year. Traffic injuries affect all age groups, but their impact is most striking among the young. Road Traffic injuries are consistently one of the top three causes of death for the people aged 5 to 44 years.
While road traffic death rates in many high income countries have stabilized or declined in the recent decades, data suggest that in most regions of the world the global epidemic of RTAs still increasing. It is estimated that unless immediate actions are taken road deaths will be the fifth leading cause of death by 2030, leading to estimated 2.4 million deaths per year. In addition to mortality, Road traffic crashes injure or disable 20 million and 50 million people a year. Over 90% of the world’s fatalities on the roads occur in low-income and middle-income countries, which have only 48% of the world’s vehicles.
1.2 India Scenario:
In India, accidental injury is one of the leading causes of mortality and morbidity. Road traffic crashes are one of the major causes of disability, morbidity and mortality. India has just one per cent of total vehicles in the world but accounts for six per cent of total road accidents. During 2014 - 4,50,898 road accidents caused 1, 41,526 deaths. As per, World road statistics 2010, by 2020 road accidents will be a major killer in India accounting for 546,000 deaths and 15,314,000 disability-adjusted life years lost.
This programme was started on pilot mode under the 9th & 10th FYP as “Pilot Project for strengthening emergency facilities along the highways”. During the 11th Plan, the programme was named as “Assistance for capacity building for trauma care for up gradation and strengthening of emergency facilities in Govt. hospitals located on National Highways”. The 11th FYP was approved for developing a network of trauma care facilities in the Govt. Hospitals along the Golden Quadrilateral highway corridor covering 5,846 Kms connecting Delhi-Kolkata-Chennai-Mumbai-Delhi as well as North-South & East-West Corridors covering 7,716 Kms connecting Kashmir to Kanyakumari and Silchar to Porbandar respectively. Under the 11th FYP 116 trauma care facilities in the Govt. Hospitals were identified and funded.
The scheme was extended to the 12th plan period as “Capacity building for developing Trauma Care Facilities in Govt. Hospitals on National Highways”, for development of 85 new trauma care facilities
- To establish a network of trauma centres in order to reduce the incidence of preventable death due to road traffic accidents by observing golden hour principle.
- To develop proper referral and communication network between ambulances and trauma centres and within the trauma centres for optimal utilization of the services available.
- To develop National Trauma Injury Surveillance and Capacity Building Centre for collection, compilation, analysis of information from the trauma centres for the use of policy formation, preventive interventions.
- Salient Features:
As per the norms of the Scheme, designated hospitals are upgraded for providing trauma care facilities. It is envisaged that the network of trauma care facilities along the corridors will bring down the morbidity and mortality on account of accidental trauma on the roads in India by providing trauma care within the ambit of golden hour.
The trauma care network has been so designed that no trauma victim has to be transported for more than 50 kms to a designated hospital having trauma care facilities. For this purpose an equipped basic life support ambulance is to be deployed by NHAI (Ministry of Road Transport and Highways) at a distance of 50 KMs on the designated National Highways
Financial assistance to the existing State Govt. Medical colleges/ District Hospitals is being provided for upgradation of infrastructure, procurement of equipments, engagement of contractual manpower, establishment of communication network, training etc.
- The criteria for identification of State Govt. hospitals on the National Highways during the 12th FYP:
- Connecting two capital cities.
- Connecting major cities other than capital city
- Connecting ports to capital city
- Connecting industrial townships with capital city
- During the 12th FYP, preference was given to states which were not covered during 11th FYP, and to the Hilly and North Eastern states.
- Funding pattern:
Table I: Financial Assistance during 11th FYP:
Level wise Unit Cost: (Rs. in Crores)
||Unit cost L-I
||Unit cost L-II
||Unit cost L-III
||Legal Assistance & Data Entry
Table II (a) and (b): Financial Assistance during 12th FYP:
(a) Non-recurring cost
(Rs. in crore)
||Items wise non-recurring cost
||Legal Service & Data Entry
|Total non-recurring cost
(b) Recurring cost per year
(Rs. in crore)
||Items wise recurring cost
||Manpower cost per year **
*Building cost not to exceed Rs. 30,000 per square meter.
**Manpower cost to be provided only for three years.
a) a) Unlike 11th plan, during the 12th FYP, the scheme was not 100% centrally sponsored. The proposed amount of assistance was shared between Central and State Governments in a ratio of 70:30. The ratio of sharing for North Eastern states and hilly states of Himachal Pradesh, Uttarakhand and Jammu & Kashmir is 90:10. Further, as per the decision of the NITI Aayog, from April, 2015 onwards; the financial assistance will be shared between Central and State Governments in a ratio of 60:40, the ratio of sharing for North Eastern states and hilly states of Himachal Pradesh, Uttarakhand and Jammu & Kashmir will be 90:10; for UTs there will be 100% Central funding.
- Organization structure
- Progress- physical and financial- 12th FYP:
- MoU for implementation of the programme has been concurred by IFD and circulated to the States/UTs.
- List of manpower and equipment to be recommended for Trauma care facilities to be established in States finalized by the Technical Resource Group (TRG).
- The schematic design diagram of trauma care facility has been designed for L-III, L-II, and L-I in collaboration with Central Design Bureau.
- Operational Guidelines for the programme have been finalized and circulated to the States/ UTs.
- Screening Committee for Trauma & Burn Programmes has been formed to screen proposals of the scheme, prioritize the sites across States / UTs and monitor the physical and financial progress made in the development of Trauma Care Facilities and Burn Units.
- 81 Medical Colleges/District Hospitals (LI-5, LII-18, and LIII-58) have been approved by the Screening Committee till date.
- A Core committee between Ministry of Health & Family Welfare and Ministry of Road Transport and Highways has been constituted for better coordination in order to provide effective pre-hospital trauma care. Meetings are being held regularly for the same.
- National Injury Surveillance, Trauma Registry and Capacity Building Centre has been established at Dr. RML Hospital. NIC has developed software for Injury Surveillance and Burn Registry.
- ATLS & BLS training is being conducted at Dr. RML Hospital for Doctors and Nurses posted in trauma care facilities.
- Pre-hospital trauma technician course initiated during 2007 has been revised by an Expert Group through an Agreement for performance of work (APW) with WHO, and training is provided in the three Central Govt. Hospitals in Delhi.
- As per the Hon’ble Supreme Court’s Directive, an advisory has been issued to all the States to implement the PTT course curriculum in their respective State for training of para-medical personnel for ambulances, as there is an acute shortage of the same in States.
- Under the IEC activities, print material, audio-video spots and documentary film on Good Samaritan/ First Aid have been developed. A Bulk SMS activity has also been undertaken.
- In respect of the Gazette Notification issued by the Ministry of Road Transport & Highways on Good Samaritan, Ministry of Health & Family Welfare has also issued guidelines to all States/ UTs.
- A committee has been constituted in the Dte. GHS, MoHFW to work on the “Report of the Working group on Emergency Care in India, 2011” as directed by the Hon’ble Supreme Court of India. Several meetings of this committee have been held so far to develop various documents as per the recommendations of the report. The Committee is in the process of framing of National Trauma System Plan, for which all the States/UTs have been requested to submit State Tauma Care Action Plan. The Committee has also finalized the technical specifications of the medical equipment component of the ambulances.
- A 6-months course curriculum on Neuro-trauma is being developed for General Surgeons.
- Operational Guidelines Trauma 2 Mb