Growing volume of traffic, utter indiscipline of road users, over speeding and flagrant violation of road rules, not to forget potholes and poor lighting… All this makes travel on our roads stressful and extremely accident prone. When an accident occurs, the roads are the last place the victim should be left in. Every minute is precious, more so in the Golden Hour.
What is this Golden Hour? Dr. P.V.A. Mohandas, Founder and Managing Director, MIOT Hospitals, Chennai has the answer: “An injured victim of a road accident should be rushed to hospital within a certain time frame for the highest chance of survival. This is reffered to as The Golden Hour. Doctors have estimated 60 minutes as the time that gives the best survival rate after a severe injury. The chance of survival of a victim with multiple injuries is highest when the patient is brought to the right hospital at the right time within the golden hour.”
Dr. Rakesh Mattoo, Senior Consultant Orthopaedics, Fortis Hospital, Noida, adds, “A majority of critically injured patients can be saved with prompt treatment, as urgent initial resuscitative measures make a big difference and secondary irreversible changes can be avoided.”
Why is treatment during the Golden Hour crucial? Dr. Mohandas says, “After a severe injury the accident victim may suffer severe shock due to injuries and multiple fractures resulting in loss of blood with permanent kidney and brain damage. This may become irreversible unless attended to within the shortest possible time.”
There are several variables to reckon with in predicting the outcome and recovery for a victim. Dr. Dina Shah, Senior Consultant and Head of Emergency, Fortis Hospital, Noida, says “Much depends on the intensity of trauma, treatment modalities and experts giving treatment.”
The hard reality is that, even in an ideal situation, there is a lapse of a few minutes till help arrives. Ignorant bystanders attempting to help can cause more damage than they think. Dr. Shah refers to a case where a 28-year-old biker was hit by a bus and brought to the hospital by the bystanders. But due to careless handling while being shifted he suffered a complete spinal cord injury and remained paralysed for the rest of his life.
Dr. Mohandas highlights how the Golden Hour principle works. A 28-year-old man was brought to the emergency 15 minutes after a road accident. He was shifted to the ICU and resuscitated within 15 minutes. An emergency surgery was performed and the man went was back on his feet in 10 weeks.
What are the dos and don’ts s to be kept in mind while rendering immediate first aid?
As Dr. Mohandas points out, “We have all seen people rushing to the accident site, crowding around the victim, trying to assess the extent of injury, attempting to wake him by slapping his cheeks or pouring soda or coffee down his throat. All this can increase damage to the injured organs. “
According to Dr. Shah, the public needs to know basic life support measures in terms of assessing and supporting breathing and circulation till help arrives. Since a trauma victim requires a dedicated medical team, he should be taken to a hospital with an intensive care unit with a team of intensivists available 24x7. A blood bank to provide blood and blood products/components like plasma and platelets is mandatory besides round-the-clock availability of operation theatres, theatre staff and diagnostic equipment to detect the injury and track the progress.
Talking of damage control, Dr Mohandas says, “An already traumatised body cannot tolerate surgical trauma. In damage control, patients with polytrauma (injury to more than one body system) are clinically and metabolically assessed and taken to the operating room only to stabilise the major life threatening injuries and then resuscitated again.” Once the patients are stable they can be taken for the definitive treatment of their injuries. The logic behind this approach is that the traumatised body initiates an inflammatory response which reaches its peak in about 24 hours and may start settling down after 4-5 days.
The right hospital at the right time and proper first aid in the Golden Hour are, indeed, words to be etched in gold
What to do
Bring the victim to an open and safe place near the accident site after putting him on a rigid board so that lifting does not injure the damaged organs.
Remove all tight clothing so that he can breathe freely and remove any foreign body in his mouth or nose so that there is no obstruction to the airway. Immediately summon an ambulance and inform the police.
If there is any active bleeding, stop it by applying pressure or by packing the area with a clean cloth. If there is a fracture, immobilise the area with a wooden stick or cardboard.
The bottomline is to get the victim to a hospital, which has the requisite infrastructure and experts and uncompromising standards of hygiene to prevent infections.
