Letters to Editor
for assessment instead of hypothetical situations.
When asked about the differences between conventional
teaching and IMNCI training, students expressed
that this is an excellent form of integrated teaching. A
different modality of presentations is not seen during the
usual teaching of pediatrics and preventive medicine.
Active interest was created during this training, which
reinforced their existing knowledge.
Most of the opinions from students suggest that it
was useful to them but will be more important and
meaningful for health workers.
The methodology was impressive and the whole
program can increase the conÞdence of undergraduates
in managing common pediatric morbidity and promoting
positive behavioral changes.
It will be premature to generalize the observations as it
Challenges in Organizing Trauma Care Systems in
India
Sir,
Injury and trauma, often used interchangeably, represent
a major health problem worldwide. Everyday around the
world almost 16,000 people die from various injuries.
Injuries represent 12% of the global burden of disease.(1)
Road trafÞc injuries are a major cause of mortality: 22.8%
in the overall burden of death related to injuries.(2) It is
startling to note that the lower and middle income group
countries (which include India) contribute about 90% of
the global burden of injury mortality, thus highlighting
the disparities in outcome of trauma between the high,
middle, and lower income nations. Injuries affect the
productive youth of the country. In addition to excess
mortality, there is a tremendous burden of disability
from extremity, head, and spinal injuries in developing
nations. The more tragic fact is that injury is the third
most important cause of mortality and the main cause of
death among 1 to 40-year-olds. Therefore, trauma effects
the productive youth of the country, which is otherwise
healthy and free from chronic disease. Road traffic
injuries represent only a fraction of the trauma spectrum.
In India, most of the available literature regarding trauma
epidemiology is pertaining to road trafÞc injuries(3) and
there are hardly any studies done on the other causes of
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has just been started in Gujarat but students’ perceptions
and opinions can be of great help in organizing future
IMNCI trainings.
References
1. Simoes EA, Desta T, Tessema T, Gerbresellassie T, Dagnew M,
Gove S. Performance of health workers after training in inte-
grated management of childhood illness in Gondar, Ethiopia.
Bull World Health Organ 1997;75:43–53.
2. WHO Division of Child Health and Development and WHO
Regional Office for Africa. Integrated management of child-
hood illness: Field test of the WHO/UNICEF training course in
Arusha, United Republic of Tanzania. Bull World Health Organ
1997;75:55–64.
Mamta Rani, Abhay Kavishvar1,
Ratan K Srivastava2
Tutor and 1Assistant Professor, Department of Community Medicine,
Government Medical College, Surat, 2Professor, Department of
Community Medicine, Banaras Hindu University, Varanasi, India.
E-mail: psmmamta@yahool.co.in
trauma. Trauma is caused by a wide variety of risks e.g.,
fall (common in pediatric patients), agricultural-related
injuries, Þrearm injuries, poisoning, burns, drowning,
intentional self harm (suicides), assault, falling objects,
natural- and man-made disasters.
The improved survival and functional outcome among
injured patients in developed countries can be partly
attributed to high-cost equipment and technology.
Much of this high-end technology is unaffordable
and unavailable to victims from developing nations.
However, much improvement in the outcome of trauma
patients has come from improvements in the organization
of trauma care services in the form of developing trauma
systems in given geographical areas. The improvement
and organization of trauma services or trauma systems is
a cost effective way of improving patient outcome and is
achievable in almost all settings.(4,5) Proper organization
of these systems reduces the time between injury and
the deÞnitive treatment thereby reducing morbidity and
mortality. In India, such a trauma system is almost non-
existent and even if present in some urban areas, lacks
the cohesive effort required.(6)
Indian Journal of Community Medicine / Vol 34 / Issue 1 / January 2009
 Letters to Editor
The organization of a trauma system has four impact
pillars: organization of pre-hospital care facilities, hospital
networking, communication systems, and organization
of in-hospital care (acute care and deÞnitive care). An
integrated approach is required at all levels: human
resources (stafÞng and training), physical resources
(infrastructure, equipment, and supplies) and the process
(organization and administration). Compared to the
western world, the trauma care services in India lack
each of the elements listed above. Most of the physical
resources for in-hospital care in terms of infrastructure
and equipment are already available at secondary and
tertiary care hospitals and need moderate upgrades.
Therefore, the thrust areas in the Þeld of trauma services
are as follows:
1. Provide physical resources for pre-hospital care and
communication systems.
2. Provide well-trained staff at all levels of care from
pre-hospital to deÞnitive trauma care. Providers
should be well trained and should understand the
critical needs of a trauma victim. Skill-based training
programs for doctors as well as paramedical staff in
Acute Life Support (ALS) procedures are needed.
3. Organize and integrate pre-hospital services with
deÞnitive care facilities (hospital) so that a patient
is shifted to an appropriate facility in the shortest
possible time.
The Government of India has planned this organization
in an apex to the base format. The establishment of the
Jai Prakash Narain Apex Trauma Center (JPNATC)
at the All India Institute of Medical Sciences in New
Delhi is a step forward in providing an apex institution
for quality trauma patient care facilities, which will
act as a role model for other institutions and centers
providing trauma care in the country. More than
providing the best patient care facilities, the role of
this apex trauma center has been envisaged as an apex
research and training institution that will help the
Review of Epidata Entry and Analysis Freewares
Sir,
Database management and data analysis are important
skills of public health professionals. Available
epidemiological and statistical softwares can be divided
broadly into two categories; commercial and open source
products like other computer softwares. SPSS, SAS and
STATA represent the former category while Epidata
Indian Journal of Community Medicine / Vol 34 / Issue 1 / January 2009
nation’s administrators formulate policies regarding
the organization of trauma care facilities throughout
the country.
It should be once again emphasized that the establishment
of innumerable trauma centers with heavy Þnancial
burden should not be the goal of policy makers.
Instead, upgrading existing hospital infrastructure to
treat severely injured patients should be undertaken.
Training of manpower in acute care and pre-hospital
services should be a priority. Proper organization and
administration of trauma services along with legislative
backup will go a long way in strengthening India’s
essential trauma care services.
References
1. WHO global burden of disease project 2002. [accessed on 2008
Feb 1]. Available from: http://www.who.int/whr/2002/en/index.
html.
2. Peden M, Scurfield R, Sleet D, Mohan D, Jyder A, Jarawan E,
et al. editors. World report on road traffic injury prevention.
Geneva: World Health Organization 2004.
3. Dandona R. Making road safety a public health concern
for policy makers in India. Natl Med J India 2006;19:
126–33.
4. Sasser SM, Varghese M, Joshipura M, Kellermann A. Preventing
death and disability through the timely provision of prehospital
trauma care. Bull World Health Organ 2006;84:507.
5. Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM.
Trauma care systems in India. Injury 2003;34:686–92.
6. Joshipura M. Guidelines for essential trauma care: progress in
India. World J Surg 2006;30:930–3.
Amit Gupta, Ekta Gupta1
Department of Surgery, JPN Apex Trauma Center, All India Institute
of Medical Sciences, New Delhi, 1Department of Microbiology,
Maulana Azad Medical College, New Delhi, India.
E-mail: amitg70@hotmail.com
entry, Epidata analysis, Openepi and Epiinfo DOS (EPI6)
and Windows, belong to the latter category.
EPI6(1) users remember its functionality and range of
commands and capabilities. The underlying concept
is solid. Type your questionnaire and use the speciÞc
variable types. Convert into a record Þle and begin the
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