‘Everybody has to contribute in golden hour management’

I have recently been elected to two big positions. The first is as president of the Indian Orthopedic Association. Since the Association was formed, only a few doctors from North India have reached this position. This will allow me to formulate policies in orthopedics. We always try to improve academics and through the Association we send young doctors abroad for training. We can also call doctors from abroad. It is an academic body, and our aim is to bring the doctor from the village at par with the doctor posted in urban areas. I want to work in such a direction that the doctor at the village uses the latest technology while treating patients.

Another post to which I have been elected is the chairman of research for AO Trauma, Asia Pacific. I will take over this position in July. No Indian has reached that level before. I am one of the five members of the world board. The five members take research-related decisions for the future of trauma management all over the world. We are going to look towards the larger policies.

What is the current status of trauma management in the country?

If we look at India today, our biggest problem is road accidents. The problem is that everyone blames the government. I think this is misleading, because it is people driving vehicles, which causes the accidents. No matter how much the government spends funds on making roads better, the problem is coming from us (the people). The better-educated areas like Europe see fewer accidents related to speed or drunk driving. In Chandigarh, one of the Chowks is called ‘Killer Chowk’. That Chowk is not killing anyone. The accidents are happening because there are problems in people’s driving. I am trying to initiate research into how can we go down in improving road safety, which is the biggest problem.

What about North India? What problems are we facing?

In North India, the problem is that trauma is not managed properly. The biggest weakness is in transporting patients from the site of the accident to the trauma center. In trauma, there is an important thing called the golden hour. Currently, instead of within one hour, it takes six hours before the patient gets to reach the trauma center. People raise questions such as ‘we bring the patients alive’, and then accuse doctors for deaths. But it becomes difficult for the doctor to save an accident case. The biggest deficiency is at the level one responder level, and for that we need funds and training. The government can play a role here. Abroad, there are primary care responders. Everybody has to contribute in golden hour management. I am also a member of the Punjab road safety council and we are working on how to improve road safety. We can save lot of funds and resources with proper management.

At PGI, we have a separate advance trauma center. What is the daily load and are we able to manage the load?

The condition is such that we cannot stop the Operations Theater and it runs uninterruptedly, because the load is huge. We are seeing trauma cases mostly from Punjab. We are running a 200-300 patient capacity at our trauma centre, and have a waiting list of people who need surgeons.

Is PGI better than AIIMS?

AIIMS doesn’t take extra patients if they reach their set limit. On the other hand, we don’t refuse patients here. If we are allowed to work as per the sanctioned beds and with sanctioned staff, we will be the world’s number 1 trauma center.

Why are there more cases from Punjab, which claims to have the best infrastructure now?

Firstly, only serious cases should be referred to PGI. They should stop sending people to PGI, if they can be managed at their level. Here, we have a triage system and first serious patients are looked into. The problem is when the non-serious patients are brought here; they are not properly looked at, because we focus on saving the serious cases. Earlier, we used to get a lot of cases from Himachal Pradesh, which has somehow stopped now because cases are getting managed there. But cases from Punjab continue to come to PGI, because they don’t have sufficient infrastructure. To improve the system, we need to have a strong peripheral system so that people are treated at the local level if they can be managed there.

Experts keep saying that awareness about road safety is important from the school level. How do you see it?

Awareness about road safety should start from childhood. If we start providing awareness from the school level, it will help the next generation. Indirectly, it will help the present generation. We need to understand that changes can’t happen overnight. In the country, we don’t have trauma specialists so far. An accident patient is still managed by a group of doctors from various specialties. In Germany, there are trauma specialists. In India, they are yet to come. You need specialist infrastructure and then people will become trauma specialists.

You also have expertise in sports injuries. Can an orthopedic treat sport injuries?

Yes, I’ve been interested in this field for a long time now. In India, the is a problem where anyone with a sport injury goes to an orthopedic surgeon, which is wrong. 90 percent of orthopedic surgeons are not specialised in treating sports injuries. A sportsman who has injuries needs a very different treatment. Sports injuries have come from the sport itself. It is the one branch of the medicine where the doctor is sending you back to where the problem has come from. The key factor, however, in this that you have to go 150 percent stronger. It is a different ball game and they need to understand how much rest is good and bad. Only sports specialists will understand, not an average doctor, will understand these things.