EFFECTIVE AND LIFE SAVING INTERVENTION NEEDS ATTENTION

Emotions of relatives, parents and care givers who bring the critically ill patient in the hospital are at peak in the emergency setting.Person at that point of time behave differently even though he/she is well educated and aware of situation. Emotional outburst may be slightly low in persons coming from lower socio-economic strata or different region of the area means not from the local population. Even though qualified person may not be good in many basic skills specially in stressful situations and what to talk about rural or common person who does not have medical knowledge or background. Family or parents coming to emergency department of the hospital are not well prepared for the situation except the emergency is planned like delivery of a pregnant woman. In our context in the hospital, our target is to save the patient in any condition so that mortality is less. We often forget about morbidity as a result of our intervention which is a big concern of today. Specially in children there are no method to check the morbidity as a result of intervention or treatment and no guidelines have been framed to assess the disease specific morbidity and their outcome. Certain morbid conditions are as a result of hospital induced injury. This may be due to understaffing, inadequate skills, poor resources or facility. In Indian setting many actions which needs scientific knowledge of particular skills are carried out by family members or parents.  One of the skill performed by family member or parents is doing positive pressure ventilation in the intubated child with the help of self-inflating bag; commonly known as ambu bag. This is a specialized action required to provide ventilation and oxygenation in critically ill patients in emergency or intensive care setting. Action performed by untrained person can result damage to lungs, pleura, heart, brain and long term complications. Specially there are not much methods/technique available to assess lung functions or other organ assessment in paediatric population as result of damage to done by performing positive pressure ventilation in intubated patient by unskilled person or even skilled person. This service is frequently required in government hospitals/dispensary receiving more sick patients and where we have less trained staffed and also frequently understaffed.  The basic skills of providing basic life support and positive pressure ventilation using self-inflating bag in resource limited settings is essential for all health care providers in including non-medical personals working in hospitals at all level and also during transport of sick patients in our setting. In an observational study conducted by us in various settings it was observed that most of the time persons were not able to perform the skill properly (selection of size, holding of tubes and bag, selection of rate/minute, effective rise in chest, adequate ventilation and oxygenation, assessment of effectiveness, patient fighting with the procedure, how long to continue, tiring of one person and need for another person, tube dislodgement, tight seal, stressful event for family, death). All these factors contribute to increase morbidity, mortality, stress, tension and poor outcome. No data is available in most of the hospital regarding this activity in government sector. Time has come to act fast to prevent morbidity in adult and paediatric population.  Action must be taken to trained all health care providers and other persons working in the hospital. Also steps to be taken to train the family in crisis by showing them video in the emergency rooms. These basic skills including basic life support procedure in resource limited country like India are essential to understand to save human life in emergency situations. Efforts should be made to create force for future. May start this initiative from schools in rural areas first.

Kundan Mittal
Professor
Department of Paediatrics
PGIMS, Rohtak
kundanmittal@hotmail.com
9416514111
H K Aggarwal
Senior Professo
Department of Medicine
PGIMS, Rohtak
Anupama Mittal
Deputy Civil Surgeon
Rohtak

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