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REPORT ON TRAUMA CENTER SIRSA BY- DR.JAIDEEP KUMAR MPH ON
8/8/2009
What is Trauma?
The word ‘trauma’ is derived from the Greek meaning ‘bodily injury’.
What is Trauma Centre?
Trauma centre is defined as a specialised hospital facility distinguished by the immediate
availability of specialised surgeons, physician specialists, anesthesiologists, nurses, and
resuscitation and life support equipment on a 24-hour basis to care for severely injured
patients or those at risk for severe injury.
Magnitude of Trauma and Injuries:-
Incidence of trauma is on the rise globally due to industrialization, urbanisation,
increase in mechanised transport, urban violence, social conflicts, and man-made as well
as natural disasters. Trauma is a number one killer below 40 years leading to high
morbidity, mortality, disability and economic loss to the country.If current trend
continues, road traffic injuries intentional injuries i.e. self inflicted injuries, interpersonal
violence and war related injuries will rank among the 15 leading causes of death and
burden of disease. Road traffic injuries are a leading cause of death by injury accounting
for 20.3 per cent of all deaths from injury.
It is 10th leading cause of all deaths, ninth leading contributor to the burden of disease
worldwide. Deaths from injuries are projected to rise from 5.1 million at present to 8.4
million by 2020. In India, 80, 000 persons got killed and 38 million persons got injured
due to road traffic accidents. In Armed Forces, approximately 20 persons per 1000
population get admitted in the hospitals due to non-enemy action injuries per year. India
has 1% of the motor vehicles in the world, but bears the burden of 6% of the global
vehicular accidents. Road-traffic accidents are increasing at an alarming annual rate of

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3%. In 1997, 10.1% of all deaths in India were due to accidents and injuries. A vehicular
accident is reported every 3 minutes and a death every 10 minutes on Indian roads.
During 1998, nearly 80,000 lives were lost and 330,000 people were injured. Of these,
78% were men in age group of 20-44 years, causing significant impact on productivity.
A trauma-related death occurs in India every 1.9 minutes. The majority of fatal road-
traffic accident victims are pedestrians, two wheeler riders and bicyclists.
India is a disaster-prone country with frequent floods, cyclones, landslides and
earthquakes. Train accidents and industrial mishaps are not uncommon. Government
plans are in place, in general, to deal with disasters. However, regular drills to test
preparedness are not carried out. Only 26% of the systems in the survey reported a well-
documented disaster management plan. The rest of the systems have plans under
development, or no plans. This deficiency has resulted in excessive numbers of deaths in
natural disasters. In 1999, there was an increase of 20.8% in fatalities due to such
disasters compared to the previous year. This figure for 2001 is likely to rise even further
as a result of a killer earthquake in Gujarat, causing over 12,000 deaths.
Why Trauma centre was developed?
It is established that the mortality in serious injuries is six times worse in a developing
country such as India compared to a developed country. The future appears both daunting
and challenging. It is estimated that from its present position of the ninth leading cause of
deaths in India, trauma will move up to third position by 2020. It is also estimated that in
the developing countries over 6 million will die and 60 million will be injured, or
disabled, in the next 10 years. India will have a large share in this, with an estimated
economic loss of around 2% of GDP. To meet this challenge several efforts are required:
resource creation, education, legislation, upgrading prehospital and hospital based care,
public awareness and a change in the attitude of the policy-makers. The public health
institutions will also benefit from adopting WHO Essential Trauma Care guidelines for
trauma care, which is aimed at low cost improvements to the trauma care. There are
already some ongoing efforts in that direction.. Rapid urbanisation and industrialisation

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have created an environment in which humans are continuously exposed to myriad
hazards. An accident is rarely caused by a single factor rather a series of events coincide
in time and space for the unfortunate event to occur. Last decade has witnessed a
considerable increase in morbidity and mortality from the road accidents. Trauma is the
third major cause of death amongst all possible reasons after heart ailments and chest
infections. Most of the serious injuries resulting from traffic accidents are related to head,
spine at internal vital organs. In accidents 50% of the victims have serious injuries to
cardiovascular or central nervous system and die in the first 15 minutes.Of the rest ,basic
life support,first –aid and replacement of fluid,if arranged within the first hours of injury
(golden hour) can save many lives. 35% die within next 1-2 hours due to head and chest
injuries and over 15% die over a next 30 days due to sepsis and vital organs failures. The
time between injury and initial stabilization is the most critical period for the patient
servival.Among trauma patient treated through conventional emergency services the
preventable death ranges up to 17%.The pre hospital trauma care plays great role in this,
so we must emphasis on this area.
Thus the time between injury and initial stabilisation which ranges between 30 to 60
minutes is most critical period for patient's survival. Stabilisation of general condition of
accident victims coupled with early treatment can shorten the period of recovery. Delay
on this account may result in death and permanent disability. The lessons learned in
successive military conflicts have advanced our knowledge of care of the injured patient.
Wars established the importance of minimising time from injury to definitive care. The
extension of this concept to the management of civilian trauma led to the evolution of
today's trauma systems.
A trauma centre equipped with necessary modern gadgets, appliances and trained
manpower can increase the patients' survival and full recovery.
Planning parameters for trauma centre :-
1. Location: It should be located on ground floor and should have direct access from main
road. A separate approach, other than the OPD with a spacious parking area for cars and
two-wheelers is required. It should be located adjacent to the OPD to share the resources
such as diagnostics and also pool resources in case of a disaster.

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It should be well lighted and boldly signposted both for day and night, direction signs
should be put on the main traffic routes passing through the station (If happens to be the
only trauma service in the station). Drive through and covered ambulance post should be
capable of accommodating at least two ambulances.
Helipad is required for major trauma centres and in rural, hilly, or unapproachable areas.
Good and well maintained lawn with fixed benches and seasonal flowers serves as an
additional waiting area for relatives.
2. Inter-relationship: A trauma centre should have close inter-relationship with operation
theatre, radiology, blood bank, laboratory, ICU, obstetrics, records, OPD and mortuary.
Some authorities recommend close relationship with CCU as well. Many sub departments
are required in trauma centre itself i.e. OT, diagnostics etc.
3. Work & traffic flow: Efficiency of any busy and high intensity department like trauma
centre can be greatly increased by smooth and orderly flow of traffic for
(a) Patient
(b) Staff
(c) Supplies
Internal traffic flow should aim at maximising efficiency at all times. All modalities of
communication be employed to save time such as telephone, intercom etc.
4. Entrance: Entrance should be separate from main hospital's entrance and separate for
ambulant and stretcher bound patients which includes a ramp. Doors of entrance should
be 2.4 metre wide, 2-way with glass panel at eye height and spring to keep them in open
position and they should open into the reception area. Automatic sliding doors also can
be used to prevent accidents in case of swinging doors. The entrance to registration
should be at a close distance.

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5. Reception area: Entrance should open into a large open space with reception desk in
front. Trolley, stretcher, and wheelchair parking area as well as a facility for cleaning
stained trolleys are a must. Waiting room for patients and relatives, police desk room,
room for drivers, space for medico-social worker, cafeteria, toilets, registration and
records, security, cash counter, and telephone booth should open into reception.
Other areas recommended are puja room, grief room, flower, chemist, and bookshop.
Size of reception area depends on patient load, (0.75 sqm per patient for 1/3rd of
attending population in waiting area). BIS recommends 1.75 sqm per hospital bed for
reception area.
6. Waiting area: Waiting area is required for ambulant patients and accompanying family
members. It is also for preventing people from entering clinical areas and can be used as
triage area in case of disaster. It should be visible from reception desk. Provisions for
reading material and wall posters regarding health as well as for public relation activity
and facilities such as drinking water, ladies and gents toilets, television and channel
music are a must in these areas.
7. Examination and treatment area: Main area of trauma department. Going as per patient
flow, the various rooms/ areas in this area are:
(a) Triage area.
Separate area or lobby may be used.
(b) Nurses and surgeon's station.
It should be near entrance and registration area, with multiple communication modes,
may be glass enclosed above counter level, with a private toilet. It should have work area
with lockers, refrigerators, counter sink, a small flash steriliser, IV fluids and medicine
storage.
Other features are dispensing/storage cabinets, ample counter and drawer space, CC
monitoring, TV for surveillance of holding and treatment areas, bulletin boards, racks for

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references and manuals, and storage area for supplies. It should have easy approach to
clean and dirty utility area.
(c) Examination and main treatment area.
The importance of this area is 'Urgency in diagnosis and treatment' and not any social
consideration. It should be large, unobstructed, well-illuminated space for moving heavy
equipment, stretchers, and team of health care providers. 11.5 X 11.5 metre for an open
trauma treatment room is recommended for access to patient from all sides.
Treatment spaces/cubicles can be partitioned by curtains or semi-permanent booths.
Where cubicles are planned they should be 3.3 X 4.5 metre in size. Doors should be at
least 1.6 metre wide.
8. Resuscitation room: Thirty sq metre room required for stabilisation of injured or
acutely ill patients who need care of Airway, Breathing and Bleeding, and Circulation
(ABC). It is an equipment intensive area, requiring both diagnostic and therapeutic
equipment such as patient's trolley, piped oxygen and suction, adjustable lamps,
cupboards, washbasin, worktops, as well as equipment for minor surgeries.
All shelves and drawers must be clearly labelled. It should be connected to emergency
electrical supply and from here patient will be moved either to intensive care area,
operation theatre, recovery room, treatment room, or transported to a nursing unit.
9. Operation room: It is required for ease in urgent surgery. There is no requirement of
transferring contaminated cases to main OT complex, and schedule of normal OT is not
disturbed by emergency cases.
It is preferable to have one room for clean operations and one for septic/contaminated
cases. The latter can also be used for plaster room, both of these must provide enough
space for staff, instrument trolley, mobile X-ray apparatus, and storage.
10. Other areas required in trauma centre

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(a) Plaster room: It should have provision for orthopaedic and cast work. It should
include storage for splints and orthopaedics supplies, traction hooks, X-ray film
illuminators and examination lights, plaster trap is a must in the sink.
(b) Surgical ICU minimum of eight beds for a centre handling 1200 cases per annum with
attendant facilities, well staffed and equipped trauma ward as a step down facility.
(c) Radiology: Seventy five per cent of trauma patients will require radiographic
investigations. This dept may become a bottleneck in smooth flow if not managed
properly. Size and facility will depend on relation and distance from main radiology
department unless latter is just adjacent, otherwise a satellite X-ray unit is definitely
required.
A large X-ray room may be divided by partition into two or three bays, each large enough
to carry out an examination of patient on stretcher, besides mandatory mobile unit. It is
recommended to have a static 300/500 mA unit dedicated to a large trauma department.
CT scan unit for a large trauma centre and dedicated USG facility.
(d) Laboratory: Type and size of laboratory will depend on relation with main hospital
laboratory. An emergency facility capable of performing routine blood and urine
analysis, bacterial smears and stains definitely is required. Advanced tests such as BGA,
and biochemistry may be done in main laboratory.
(e) ECG, blood bank: Closely related to or easy access to a blood bank recommended.
(f) Duty room for doctors and nurses: A nine sqm room each with bed, chair, desk,
bookshelf, TV, telephone, lockers, toilet and shower required.
(e) Storage area: Area/alcove for mobile equipment such as mobile X-ray, crash cart,
ventilators, and area for storing mobile furniture, clean instruments and linen, drugs, IV
fluids, and dirty utility.
(g) Janitor's closet: With a designated space for waste disposal containers.

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(h) Administrative areas: Offices for director and matron are required. Conference hall is
required in a teaching institute, preferably with a reference library. Pantry of seven sqm
for providing hot and cold fluid/beverages round the clock for staff is necessary. Disaster
area 90 sqm with lighted open space, close to the entrance, with little fixed furniture and
adequate storage spaces.
(j) Communication room: Two way radio communication with ambulances,
intercommunication between hospitals, intramural communication in the form of check-
in board, PA system, telephone (including hotline), intercom, computer network and
dumb waiters for supplies are now a days required in such a modern centre.
11. Hospital organisation: Level I centre must have the following staff: -
(a) A dedicated trauma medical director who could preferably be a surgeon
(b) Trauma team:
(i) General surgeon
(ii) Emergency physician
(iii) Surgical and emergency residents
(iv) Nurses
(v) Laboratory technician
(vi) Radiology technician
(vii) Anesthesiologist
(viii) Security officers
(ix) Social workers

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12. Training of staff: Training of staff is of utmost importance to run an efficient trauma
centre. Training is a continuous process as staff keeps on changing in a large hospital.
They should not only be highly proficient in own trade but should also be trained in good
human relationship as well.
The acute distress, anxiety and urgency on part of patient and relatives should be matched
by calm, alert and reassuring attitude of staff. Human relations and human attitudes are
consistently put to a very severe test and success depends largely on reputation of
hospital and confidence of community in its service.
13. Ambulance services: An efficient ambulance service is a must for the success of
trauma system. The ambulance has been defined by the committee on ambulance design
criteria, US, as a vehicle for emergency care which provides a driver compartment and a
patient compartment which can accommodate two emergency medical technicians and
two lying patients so positioned that at least one patient can be given intensive life
support during transit.
Two way radio communication for safeguarding personnel and patient's under hazardous
condition and light rescue procedures. It is designed and constructed to afford maximum
safety and comfort. It avoids aggravation of the patient's condition, exposure to
complication and threat to survival.
14. Essential requirements for a well organised trauma centre:
(a) Trauma centre should be readily accessible to afford quick transfer of patient from
ambulance to bed or operating table.
(b) Efficient , promptly responding, well equipped ambulance service with competent
personnel in charge.
(c) Well equipped, trauma operating room with supplies always ready for use.
(d) Recovery room where patient can be sent after emergency treatment.

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(e) Efficient hospital personnel always on duty or on call which should include at least a
competent surgeon, nurse, and an attendant or orderly.
(f) Supervision of treatment of fractures by a well qualified orthopaedic surgeon, and
supervision of the care of other injuries by those who are competent in their respective
fields.
(g) Adequate diagnostic and therapeutic facilities under competent medical supervision.
(h) Complete medical record of all patients treated which includes particularly immediate
record of injury and a detailed description of physical findings, treatment and results.

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Sirsa district has an area of 4,276 sq km and its population is 9,03,000. The district
headquarter is situated in Sirsa town. It is 255 km from Delhi and 280 km from
Chandigarh. Other smaller towns are Dabwali, Ellenabad, Rori and Rania. The district
lies between 29 14 and 30 0 north latitude and 74 29 and 75 18 east longitudes, forming
the extreme west corner of Haryana. It is bounded by the districts of Faridkot and
Bhatinda of Punjab in the north and north east, district Ganganagar and hanumangarh of
Rajasthan in the west and south and Hissar and Fatehbad district in the east.Sirsa district
is divided into 3 sub-divisions and 4 tehsils. There are a total of 323 villages in the
district out of which 313 are connected with paved roads. About 79% of the population
lives in the rural areas. Sirsa gets an annual rainfall of about 26 cm. The area under

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cultivation is 3,88,000 hectares out of which 3,06,000 is irrigated. The district excels in
the production of cotton and citrus fruit.
Purpose with which Trauma centre Sirsa was opened?
Haryana State is situated in the North West part of India adjoining Delhi, Rajasthan,
Himachal Pradesh, U.P. & Punjab. Four National Highways i.e. National Highway No. 1
(Ambala-Delhi G.T. Road), No. 2 (Delhi-Jaipur Road), No. 10 (Defence Road passing
through Sirsa) and Delhi-Mathura Road pass through the State. Also the State Highway
between Chandigarh and Delhi crosses different districts of the State. National Highway
No.10(Defence Road) is passed through Sirsa.This road joins the main border army
stations like Hissar,Hanumangarh and Shri ganganagar with each other.Air-force station
of Sirsa is also situated on it.Inspite of importence in defence line,this district is
contributed in providing the health services to many adjoining areas of Panjab,Rajasthan
and Haryana.All these areas depends on Sirsa for critical care,but due to lack of
superspeciality care the patient from sirsa hospital are referred to PGI Rohtak for further
treatment. The time which is taken by the distance (App.5hours) cause many morbidity
and mortality of injured person. About 50% of the victims die in the first 15 minutes due
to brain injuries. A further 35% die within next 1-2 hours due to head and chest injuries
and over 15% die over a next 30 days due to sepsis and vital organs failures. Thus the
time between injury and initial stabilisation which ranges between 30 to 60 minutes is
most critical period for patient's survival. Stabilisation of general condition of accident
victims coupled with early treatment can shorten the period of recovery. Delay on this
account may result in death and permanent disability.BY taking the account of this
situation the State Govt. has sent a proposal amounting to Rs.5.50 crores to the Govt.
of India for setting up a Trauma centre at Sirsa vide letter No. 25/9-3PM-2000/3326
dated 14.6.2000.
Facilities proposed to be provided at Trauma Centres:-
- Fully equipped Emergency wards to provide appropriate medical and
surgical care to the accident victims.

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- Fully equipped operation theatres.
- Intensive care Units for the seriously ill.
- Neurology units for dealing with head and spine injuries
- CT Scan, Ultra-sound and round the clock X-ray facilities
- Laboratory services
- Fully equipped orthopaedic units.
- Waiting Halls for attendants of the patients
- Canteens for the patients and their attendants
MACHINERY AND EQUIPMENT
Sr. No. Item Quantity Approx. cost
1. Spiral CT 1 Rs. 2 crores
2. 800 MA X-ray Machine 1 Rs. 12 lacs
3. Portable X-ray Machine 1 Rs. 8 lacs
4. Image Intensifier (one each for OT & 2 Rs. 30 lacs
Casuality)
5. Electronic Tourniquet Kit 3 Rs. 1 lac
6. Battery operated Drill Machine with all 2 Rs. 7 lacs
attachments for Jacob's Chunk reamers
7. DHS (Dynamic with Hip Screw) 1 Rs. 4 lacs
8. DCS ( Dynamic Condylor Screw) 1 Rs. 4 lacs
9. Inter locking nail for flunners, libia, humans 1 Rs. 9 lacs
10. Basic sets for Plating (3.5m, 4.5m) 2 Rs. 6 lacs
11. Instrument set for Kuntsilmer Nailing 1 Rs. 20000
12. Instrument set for partial hip Replacement 1 Rs. 20000
13. Bone Nibblers, Amputation saw Curttes, 1 each Rs. 20000
Plaster Saw (Electric), Bone Cutter
14. Cautery Machine 3 Rs.40000
15. Orthopaedic table for OT/Casuality 2 Rs. 60000
16. OT table with radiolucent top in each OT room 1 Rs. 80000
17. Bulken frames for beds (one for each bed) Rs. 60000
18. OT lights- ceiling/ Satellite portable OT light 2 Rs. 40000
in each OT
19. Horizontal Autoclave 2 Rs.2.60 lacs
20. Small Horizontal Autoclave (for casuality) 2 Rs. 60000
21. Centrifugal Machine 1 Rs.40000
22. Microscope Binocular 2 Rs.25000

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23. Semi Autoanalyzer 1 Rs. 2.00 lacs
24. Misc. item for one year Rs.75000
25. Central Pipeline for Oxygen Rs.20 lacs
26. Boyle's Apparatus fully equipped with all Rs. 2 lacs
accessories atleast one per OT
27. Suction Machines in OT Rs. 1 lac
28. Cardiac Monitor/Pulse Oximeter in each OT Rs. 2 lacs
29. Extension board & sufficient power points for Rs. 2 lacs
electricity in each wall of OT
30. Ventilators for OT/ICU for prolonged IPPV Rs. 7 lacs
(Intermittent Positive Procure Ventilation)
31. Neurological Equipment Rs.1 crore
32. Hospital Furniture Rs. 40 lacs
33. General Equipment Rs. 10 lacs
Total 4.75 crores per Trauma Centre
OVERVIEW OF TRAUMA CENTRE, SIRSA

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Trauma Centre Starts on : 12.04.08
Previously chosen area: 1200 sqm
Current area: 1264.20 sqm
Cost: 154.47lakh
1.Machinery Equipment & Instruments for Trauma Centre, District Sirsa already
supplied
Sr. No. General articles Quantity
1 OT Table 4

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2 Ceiling Lights 2
3 Portable OT Lights 1
4 Suction Machine 1
5 ICU Beds with Mattress 5
6 Revolving Stool 10
7 Microscope 1
8 Calorimeter 1
9 X- ray machine(without accessories) 500mA 1
2. STAFF POSITION OF TRAUMA CENTER, SIRSA
Sr. Name of the post Sanctioned Filled up Vacant Salary Remarks
No.
1 Medical officer (neuro surgeon) 1 - 1 -
2 Medical Officer (neurology) 1 - 1 -
3 Medical officer (ortho) 2 1 1 -
4 Medical officer (gen. surgery) 2 - 2 -
5 Medical officer (anesthesia) 2 1 1 -
6 Medical officer (radiology) 2 - 2 -
7 Medical officer 4 - 4 -
(gen. duty)
8 Pharmacist 4 4 - 16299 -
+12662
+12662
+12662
=54285
9 Radiographer 4 4 - 12570 1 absent
+11160 from duty
+11703
=35433
10 Nursing sisters 1 1 - 19071 -
11 Staff nurse 7 7 - 12665*7 -
=88655
12 OT Assistant 3 3 - -
13 Lab technician 4 - 4
14 Store keeper 1 - 1 -
15 Office clerk/ accountant 3 - 3 -
16 Sweeper and ward boy On
contract

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3. Services provided in the trauma center (12.04.08-23.02.09)
Total Treated by Treated by Treated Referred Cause of Deaths
number of Dr. Gaurav Dr. Chauhan (cured) referral
patients  (ortho (orthosurgeon)
surgeon)
249 233 16 242 7 Critical 0
care
 Dr.Gourve Bishnoi is on call ortho surgeon from General Hospital Sirsa
4.Annual report of trauma centre : No
5.Self assessment report of trauma centre authority: No
6.Fire safety measures :No