title: Trauma care in India and Germany.
abstract: BACKGROUND
  Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status.
  
  
  OBJECTIVE
  We compared India and Germany in terms of (1) vehicular infrastructure and causes of road traffic accident-related trauma, (2) burden of trauma, and (3) current trauma care and prevention, and (4) based on these observations, we suggested how India and other countries can enhance trauma care and prevention.
  
  
  METHODS
  Data for Germany were obtained from federal statistical databases, German Automobile Club, and German Trauma Registry. Data from India were available from the Ministry of Road Transport and Highways. We also performed a standardized literature search of PubMed for India and Germany using the following key words: "road traffic accidents", "prevention", "prehospital trauma care", "trauma system", "trauma registry", "trauma centers", and "development of vehicles."
  
  
  RESULTS
  The total number of registered motor vehicles increased 473-fold in India and 100-fold in Germany from 1951 to 2011. The number of road traffic deaths increased in both countries until 1970, but thereafter decreased in Germany (3606 in 2012) while continuing to increase in India (142,485 in 2011). The differences between Germany and India relate to the relative sizes and populations of the countries (1:9 and 1:15, respectively), and differences in prevention and prehospital care (nationwide versus big cities) and hospital trauma systems (nationwide versus exceptional).
  
  
  CONCLUSIONS
  Improvement requires attention to three major issues: (1) prevention through infrastructure, traffic laws, mandatory licensing; (2) establishment of a prehospital care system; and (3) establishment of regional trauma centers and a trauma registry.
authors: Department of Traumatology, Orthopaedics, and Neurotraumatology, AO Foundation, Schubertstraße 12, D-29223, Celle, Germany. hans-joerg.oestern@t-online.de
authors: Hans-Joerg
authors: HJ
authors: Oestern
authors: Bhavuk
authors: B
authors: Garg
authors: Prakash
authors: P
authors: Kotwal
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D004632:Emergency Medical Services; D005858:Germany; D006801:Humans; D007194:India; D018986:Motor Vehicles; D012042:Registries; D014193:Trauma Centers
references: J Trauma. 1997 Mar;42(3):514-9
references: 9095120
references: Acta Cardiol. 2005 Dec;60(6):611-7
references: 16385922
references: Arch Surg. 1991 Nov;126(11):1427-30
references: 1747058
references: Unfallchirurg. 2002 Nov;105(11):1027-32
references: 12528671
references: Ann Emerg Med. 1987 Apr;16(4):464
references: 3826821
references: Eur J Trauma Emerg Surg. 2012 Feb;38(1):11-7
references: 26815667
references: J Trauma. 1999 Sep;47(3 Suppl):S59-66
references: 10496613
references: J Trauma. 1986 Sep;26(9):812-20
references: 3746956
references: J Trauma Acute Care Surg. 2013 Jan;74(1):143-7; discussion 147-8
references: 23271089
references: J Trauma Acute Care Surg. 2012 May;72(5):1298-302; discussion 12303
references: 22673258
references: J Trauma Acute Care Surg. 2012 Apr;72(4):962-7
references: 22491612
references: Unfallchirurg. 2004 Oct;107(10):844-50
references: 15452655
references: J Trauma. 1987 Aug;27(8):866-75
references: 3612863
references: World J Surg. 2008 Aug;32(8):1613-7
references: 18553048
references: Stud Health Technol Inform. 2012;180:512-6
references: 22874243
references: Arch Surg. 1987 May;122(5):523-7
references: 3579561
references: Eur J Trauma Emerg Surg. 2012 Jun;38(3):253-60
references: 26815956
references: J Inj Violence Res. 2010 Jan;2(1):49-54
references: 21483198
references: Ann Surg. 1993 Oct;218(4):512-21; discussion 521-4
references: 8215642
references: Indian J Surg. 2012 Dec;74(6):440-4
references: 24293896
references: Indian J Community Med. 2009 Jan;34(1):75-6
references: 19876465
references: J Trauma. 1992 May;32(5):576-83
references: 1588645
references: Natl Med J India. 2008 Jan-Feb;21(1):14-20
references: 18472698
references: Int J Epidemiol. 2006 Dec;35(6):1522-9
references: 16997852
references: Unfallchirurg. 2009 Oct;112(10):878-84
references: 19756455
references: Injury. 2003 Sep;34(9):686-92
references: 12951294