DIRECTORATE GENERAL OF HEALTH SERVICES

National Programme for Prevention and Management of Trauma and Burn Injuries

Brief- National Programme for Prevention & Management of Trauma & Burn Injuries 0

 Component –I Trauma Care

1. Magnitude of the problem

Global Scenario:

As per the Global status report on road safety 2018, the number of annual road traffic deaths has reached 1.35 million in 2016. Road traffic injuries are now the leading killer of people aged 5-29 years. The burden is disproportionately borne by pedestrians, cyclists and motorcyclists, in particular those living in developing countries.  It is the 8^th leading cause of death for all age groups surpassing HIV/AIDS, tuberculosis and diarrhoeal diseases. As per the Report, 3 times higher death rate occurs in low-income countries than in high-income countries. The SDG 3.6 target to halve road deaths and injuries by 2020 will not be met without drastic action.

India Scenario

In India, accidental injury is one of the leading causes of mortality and morbidity. Road traffic crashes are one of the major causes of disability, morbidity and mortality in India. As per Ministry of Road Transport and Highways, road injuries are one of the top four leading causes of death and health loss among persons of age group 15-49 years. During 2017 (report of MoRTH), the total number of road accidents are reported to be 4,64,910 causing injuries to 4,70,975 persons and claiming 1,47,913 lives in the country. This would translate, on an average, into 53 accidents and 16 deaths every hour.

1.2 Background:

This programme was started on pilot mode under the 9^th& 10^th FYP as “Pilot Project for strengthening emergency facilities along the highways”. During the 11^th Plan, the programme was named as “Assistance for capacity building for developing trauma care facilities in Govt. hospitals on National Highways”. The 11^th FYP was approved for developing a network of 140 trauma care facilities in the  Govt. Hospitals along the Golden Quadrilateral highway corridor covering 5,846 Kms connecting Delhi-Kolkata-Chennai-Mumbai-Delhi as well as North-South & East-West Corridors covering 7,716 Kms connecting Kashmir to Kanyakumari and Silchar to Porbandar respectively. Under this programme during 11^th FYP, 118 trauma care facilities in the Govt. Hospitals were identified and funds were released to 116 trauma care facilities, 20 hospitals were under PMSSY and 2 were self- funded (Dr. RML Hospital and AIIMS New Delhi).

The scheme was extended to the 12^th plan period and the proposal for extension of scheme during 12^th plan as “Capacity building for developing Trauma Care Facilities in Govt. Hospitals on National Highways”, was approved for development of 85 new trauma care facilities.

Now, the scheme has been extended beyond the 12^th FYP, till March, 2020 as “National Programme for Prevention & Management of Trauma and Burn Injuries”.

1.3 Objectives:

• To establish a network of trauma care facilities to reduce the incidence of preventable deaths due to traffic accidents by observing golden hour principle.
• To develop proper referral and communication network between ambulances and trauma centres and within the trauma centres.
• To develop National Injury Surveillance, Trauma Registry and Capacity Building Centre for collection, compilation, analysis and dissemination of information for policy formulation and preventive interventions.
• To develop trauma registry centres for ensuring delivery of quality services.
• To develop a National Trauma System Plan.
• To improve awareness through IEC activities.

1.4 Major achievements:

• Infrastructure strengthening:
  • During the 11^th FYP, a total 116 TCF were identified and funded in 17 states for establishing Trauma Care Facilities. Out of these, 105 TCFs are functional as reported by State Govt.
  • During 12^th FYP, a total of 80 Medical Colleges/District Hospitals (LI-5, LII-19, and LIII-56) have been approved for financial assistance in 22 states/UTs.
• National Injury Surveillance, Trauma Registry and Capacity Building Centre have been established at Dr. RML Hospital. The website is already launched by the name of www.nisc.gov.in. The Minimum Data set, injury surveillance format, SOPs for data entry and other documents in respect of National Injury Surveillance Centre have been developed. Software for Injury Surveillance and Burn Registry developed. NISC, Dr. RML Hospital has been connected with 46 Hospitals in 14 States for collection of injury related data.
• Capacity Building:
  • ATLS/ NELS& BLS training is being conducted at Dr. RML Hospital for Doctors and Nurses posted in trauma care facilities.
  • The pre-hospital trauma technician course initiated during 2007 has been revised by an Expert Group through an Agreement for performance of work (APW) with WHO. So far, more than 500 PTT students have been trained since 2007 in the three Central Govt. Hospitals of Delhi. Draft PTT module has been finalized and is in process for printing.
  • 6-months course curriculum on Neuro-trauma has been developed for General Surgeons.
  • First Aid course developed in consultation with AIIMS and WHO and released by MoS (AKC), MoHFW during the Road Safety Week 2019.
  • Medical First Aid training imparted to 300 Airport Rescue & Firefighting (ARFF) Personnel, Terminal staff and Airport Health Organization staff at Delhi International Airport.
  • First Aid trainings provided to 200 staff and students of Safdarjung Hospital, Dr. RML Hospital, LHMC and Nirman Bhawan at Safdarjung Hospital during the Road Safety Week 2019.
  • First Aid training provided to 800 Medical Officers/ Paramedics in preparation of Ardh-Kumbh Mela, Jan-March, 2019. A TOT provided to 40 Medical Officers.
  • 120 ANM students & staff at RHTC Najafgarh provided with First Aid training.
• IEC activities:
• Audio-video spots and documentary films on Good Samaritan & First Aid have been developed and distributed to all states through Mass Mailing Unit (MMU). They have also been translated into major Regional Languages.
• Print material (2 charts, 2 posters and 5 stickers) have been developed and distributed to all states.
• Publicity campaigns of telecast, broadcast and bulk SMS campaigns have been undertaken.
• Miscellaneous:
  • List of manpower and equipment to be recommended for Trauma care facilities has been revised by the Technical Resource Group (TRG).
  • The schematic design diagram of trauma care facility has been designed for L-III, L-II, and L-I in collaboration with Central Design Bureau.
  • Operational Guidelines for the programme have been finalized and circulated to the States and UTs. 
  • Nine Screening Committee Meetings have been held under the chairmanship of AS (H) to approve Trauma and Burn Unit.
  • On the directions of Hon’ble Supreme Court of India, a committee has been constituted in the Dte. GHS, MoHFW to work on the “Report of the Working group on Emergency Care in India, 2011” which is in the process of framing National Trauma System Plan. For this, 7 Regional workshops have been organized for the states for developing State-wise Action Plan. A total of 32 States/UTs have submitted first draft of their State Action Plan. The Committee has also finalized the technical specifications of the medical equipment component of the ambulances.
  • In respect of the Gazette notification issued by the Ministry of Road Transport & Highways on Good Samaritan, the Ministry of Health & Family Welfare has issued guidelines to all States/ UTs on the same specific to the Health care facilities.
  • As per the Hon’ble Supreme Court’s Directive, an advisory has been issued to all the States to implement the PTT course curriculum in their respective State for capacity building and training of para-medical personnel for ambulances, as there is an acute shortage of the same in States.
  • World Trauma Day, Remembrance day for road accident victims, Road Safety Week 2018 & 2019 were observed wherein various awareness generation activities were undertaken. Felicitation of Good Samaritans was undertaken by MoS (AKC), MoHFW during the Road Safety Week 2019.
  • Technical Resource Group has been re-constituted which has finalized the following:
    • Minimum Standards for trauma care facilities for uploading on the Clinical Establishment Act
    • Standard Treatment Guidelines for trauma injuries & maxilla-facial trauma injuries
    • Key performance indicators for pre-hospital, hospital and rehabilitation care for trauma victims.
  • A ‘Hand Book on Prevention of Accidents and Awareness of First Aid’ has been developed (in Hindi and English) by the Programme Division and released by MoS (AKC), MoHFW during the Road Safety Week.
  • Coordination with NHSRC in providing technical inputs for Operational Guidelines of Primary Emergency Healthcare.
  • Visits undertaken to identified TCFs with officials from NITI Aayog in compliance to the Consultative meeting of NITI Aayog held in August, 2018 on Developing World Class Trauma and Emergency Care Services.
• Pre-Hospital Trauma Technician Course Curriculum.pdf 0
•  Norms for TCFs- 12th FYP.pdf 0
• Monitoring reporting format for TCFs- Trauma Prog.pdf 0
• List of the TCFs approved for financial assistance- 12th FYP.pdf 0
• List of approved TCFs of 11th FYP.pdf 0
• Injury Surveillance format.PDF

Component –II Burn Injuries

1. Pilot Programme for Prevention of Burn Injuries (PPPBI) - 11^th Five Year Plan:

A pilot programme was initiated in the year 2010 by Ministry of Health & Family Welfare in the name of “Pilot Programme for Prevention of Burn Injuries” (PPPBI) with a total budget of Rs. 29 crore.  The programme was initiated in the following three Medical Colleges and six Districts Hospitals:

• Haryana: Post Graduate Institute of Medicals Sciences Rohtak; General Hospital, Gurgaon; Civil Hospital, Panipat. 
• Himachal Pradesh: Dr. Rajendra Prasad Medical College, Tanda at Kangra, District Hospital, Hamirpur; Zonal Hospital, Mandi.
• Assam: Guwahati Medical College; District Hospital, Nagaon; District Hospital, Dhubri.

The Goal of PPPBI was to ensure prevention of Burn Injuries, provide timely and adequate treatment in case burn injuries do occur, so as to reduce mortality,  complications and ensuing disabilities and to provide effective rehabilitative interventions if disability has set in.

2. National Programme for Prevention & Management of Burn Injuries (NPPMBI) - 12^th Five Year Plan:

The proposal for continuation of pilot project as full-fledged programme was approved by Empowered Finance Committee (EFC) on 17.05.2013 and subsequently by Cabinet Committee for Economic Affairs (CCEA) on 6^th February, 2014, for covering 67 State Government Medical Colleges and 19 District Hospitals during the 12^th Five Year Plan. The District Hospital component was undertaken under National Health Mission (NHM).

Now, the scheme has been extended beyond the 12^th FYP, till March, 2020 as “National Programme for Prevention & Management of Trauma and Burn Injuries”.

2.1    Objectives

• To establish a network of burn units with adequate infrastructural facility for burn management and rehabilitation in all identified Govt. Medical Colleges and District Hospitals.
•  To improve the awareness among the general masses and vulnerable groups especially the women, children, industrial and hazardous occupational workers.
•  To establish Burn data registry under NPPMBI with integration with National Injury Surveillance Centre for collection, compilation and analysis of burn injury data to bring down the incidence of burn injury cases.
•  To carry out Research for assessing behavioral, social and other determinants of Burn Injuries in the country to facilitate effective need based program planning, monitoring and evaluation.
•  To organize burn Injury training Programmes for doctors, nurses and paramedical staff associated in management of burn injuries from the identified District Hospitals and Govt. Medical Colleges.

2.2   Components

• Prevention Programme (IEC)
• Treatment
• Rehabilitation
• Training
• Monitoring and Evaluation
• Research

2.3  Achievements during 12^th FYP

• The list of equipment, manpower and the architectural design of the proposed burn unit/ ward has been revised in expert group meeting, with technical design specifications supplied by Central Design Bureau.
• The Practical Handbook/ Manual for Burn Injury Management developed during the 11^th FYP has been revised. A chapter on the Standard Treatment Guidelines for Acid attack victims has been incorporated in the practical handbook.
• Operational Guidelines for the Programme have been finalized and circulated to all States and UTs. Operational Guidelines for the District Hospital component have also been finalized and uploaded on the website of NHM Division.
• The Quarterly report format has been finalized and circulated to states.
• 47 Medical Colleges have been approved for financial assistance under the Programme. 17 District Hospitals have been identified to be financially supported under NHM. 
• Burn Data Registry and software have been developed and will soon be implemented at National level to collect, compile and analyze data related to Burn Injuries in the country. 
• Under Information Education and Communication (IEC) activities, following activities have been undertaken:
• Print IEC material (8 posters/pamphlet) has been developed and distributed in states through Mass Mailing Unit (MMU).
• Audio-visuals developed on first aid on acid burns and translated into major Regional languages.
• Publicity campaigns undertaken through telecast, broadcast, digital cinema and campaign of external train wrapping.
• The 6-day practical training of Medical Officers in Burn Injury management for doctors organized at Safdarjung Hospital and Dr. RML Hospital. Around 80 doctors have been provided the training so far.
• A manual on dressing techniques for paramedics has been developed and a pilot training for 25 dressers was undertaken during the WOUNDCON2017. 
• Technical Resource Group has been re-constituted which has finalized the Standard Treatment Guidelines for burn injuries.
• The activity of Situational Analysis of burn injuries is being undertaken through AIIMS, New Delhi. A 2-day Workshop was held to orient the participating Hospitals (around 20) for this project.

              Practical handbook for burns injury management (draft).pdf 0

             Norms of Burn Unit of District Hospital- Burns Prog.pdf 0

             Norms of Burn Unit of District Hospital- Burns Prog.pdf 0

             Norms of Burn Unit of District Hospital- Burns Prog.pdf 0

             List of the Medical College approved for financial assitance- Burns.pdf 0

             Burn Registry format.pdf 0