title: Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study.
abstract: OBJECTIVE
  To assess the availability of trauma care services in a district referral hospital of Southern India.
  
  
  METHODS
  This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-depth interviews of hospital stake holders and key informants.
  
  
  RESULTS
  The hospital had physical infrastructure in terms of emergency room, inpatient wards, operation theatres, intensive care unit and blood bank facilities. The recently constructed designated building for trauma care services was not operational and existing facilities were used beyond capacity. A designated trauma team was lacking and speciality services for managing polytrauma were deficient and thus, existing personnel were performing multiple tasks. Neurosurgeons and rehabilitative nursing staff were unavailable, and a radiographer was not available on a 24/7 basis. Existing nursing personnel had not received any formal training in trauma care and standard operating protocols were not available for trauma care. Resources for acute resuscitation were partially adequate. The hospital lacked adequate resources to manage head, abdomen, chest and spine injuries, and most of the polytrauma cases were referred to nearby city hospitals.
  
  
  CONCLUSIONS
  District hospital, the only referral hospital in public health system for trauma victims of that region, had inadequate resources to manage trauma victims, which was probably responsible for delay in trauma care, improper referrals, high cost of care and poor outcomes.
authors.affiliation: Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Bangalore, Karnataka, India  
authors.forename: Pallavi Sarji
authors.initials: PS
authors.lastname: Uthkarsh
authors.affiliation: Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety promotion, Centre for Public Health, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India  
authors.forename: Gopalkrishna
authors.initials: G
authors.lastname: Gururaj
authors.affiliation: Community Medicine, Sree Siddhartha Medical College, Tumkur, Karnataka, India  
authors.forename: Sai Sabharish
authors.initials: SS
authors.lastname: Reddy
authors.affiliation: Department of Community Medicine, Sree Siddhartha Medical College, Tumkur, Karnataka, India.
authors.forename: Mandya Siddalingaiah
authors.initials: MS
authors.lastname: Rajanna
keywords: Emergency care; Health care facilities; India; Injuries; Manpower; Services