Pre-hospital Care and the Golden Hour Theory
Pre-hospital care encompasses the scenario out of hospital, on scene. It refers to medical care provided by medical team on board, ground or air with all the required life saving medicine/medical equipments to intervene traumatic and medical emergencies as well during transport to and between medical facilities.
Understanding all the facts of geography, difficult roadways, lack of communications, public unawareness and the scarcity of well-trained medics on ambulances carrying large volume of patients are some issues that needs to be dealt with in order to provide emergency medical care on a timely manner.
Dr. Sanjaya Karki
In order to perform a high quality pre-hospital care, all the six stages of star of life should be followed and the concerned medical team should always be committed to capture the Golden hour theory. These six aspects are: 1) Early detection 2) Early reporting 3) Early response 4) On scene care 5) Case in transit 6) Transfer to definitive care.
A total of 16,000 people die everyday in the world due to injuries only, and 90 percent of these occur in the developing countries. In this context, Nepal is placed in a very vulnerable situation. If we talk only about the road-related accidents apart from other injuries, in the year 2012-2013, a total of 13582 accidents sustained injuries in accidents and the fatalities were 1816, serious injuries were 3986 and slight injuries were 8000. Statistics show that half of the accidents occur in the Kathmandu valley alone. Moreover, vast majority of the victims fall on the productive age group. Apart from other medical emergencies and injuries these RTA can be addressed on scene promptly.
Emergency Medical Services can address a diverse set of diseases that span the spectrum of communicable infections, non-communicable conditions, obstetrics and injuries. Patients with all these conditions may present to the emergency medical system either in the acute stages (such as diabetic hypoglycaemia, septicaemia, premature labour or asthma) or may present with conditions that are acute in their natural presentation (such as myocardial infarction, acute haemorrhage or injuries).
The implementation of the emergency medical system (EMS) will help increase health equity and will prevent the existing health disparities from exacerbating. More importantly, this could function as the foundation stone in terms of establishing proper EMS in Nepal. In this context, medical evacuation using helicopters begun by Grande International Hospital since 2013 is commendable.
(Dr Karki is the Coordinator, Pre Hospital Care Service, Grande International Hospital)
