Health Watch

Special training on accident management

Nadira GUNATILLEKE

The world First Aid Day was celebrated yesterday. First Aid saves lives. The first hour of the accident is called the ‘Golden Hour’ because there is 60 to 70 per cent of chances to save the lives of the accident victims during the first hour.

But at the moment this `Golden Hour’ is being wasted on viewing and enjoying the accident and delays occur due to traffic jams. Somehow accident victims are being taken to hospital without paying attention to preventing further damages to their fractured bones, internal bleeding etc.

At the moment Sri Lanka does not have a well trained special accident management team to deploy on the roads when accidents occur. Many foreign countries have such teams. Sri Lanka trained such teams time to time but they have been assigned for other duties and not for the specific duty that they had been trained.

This is a very pathetic situation. But the saddest part is not this. The saddest part is how the public reacts when an accident occurs anywhere in the country.

The public need to be educated on how to act during an accident.

Health Ministry is now providing a special training on accident management to 35 officers attached to the Special Task Force (STF) to be deployed on the Southern Highway. The training was planned by Health Minister Maithripala Sirisena under the direction of President Mahinda Rajapaksa.

The training is taking place at the Colombo National Hospital. The training is based on accident management. The officers are to be trained on how to reach the location as quickly as possible, how to provide First Aid and instant care, how to prevent further damages to patients while transporting them to hospitals, etc.

The training is to be extended to the other parts of the country soon. This is what Sri Lanka needs at the moment. The public should thank the Government for this effort and come forward to acquire knowledge on handling accident victims.

According to health professionals, some key skills are considered as essential in order to provide First Aid. Particularly the ABC of First Aid, which focuses on critical life saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation. Attention must first be brought to the airway to ensure it is clear. Obstruction in airway is a life-threatening emergency. Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if required.

The most pathetic situation is how the majority of the public act during an accident. The majority try to avoid the location and avoid facing the situation. Hardly does a private vehicle stops to carry an accident victim to hospital. With or without knowing about the `Golden Hour’ they always try not to take the victim to hospital. This is a very common scene during accidents. Assisting accident victims never happen because the crowd wait for someone else to take the lead.

Sometimes the victims lay on the road for more than ten or fifteen minutes without getting any assistance. During such occasions the public never try to touch them or move them thinking that the victim is dead. But such victims may look lifeless because they are unconscious. The unconscious victims are the most unlucky because people think that they are dead and do nothing.

On one occasion a person fell on the road after being hit by a three wheeler and no one came near him for about half and hour thinking that he is dead. But he was unconscious and later the family was informed about the accident by a known person.

Then the family went to the location and transported him to the nearest hospital and he fully recovered. At night the situation is worse.

The few persons who come to support, do not think about the safety of the victim. They only think of rushing the victim to the nearest hospital.Sometimes their ignorant handling cause more serious injuries to the victim and make them permanently disabled.

It is very sad to see how the `Golden Hour’ is being wasted in traffic jams. A lot of accident victims die because the ambulance fails to transport him/her to a hospital on time.

If the accident occurs in the morning or evening the situation is much more serious than the other times of the day. Cars, School vans etc block almost all roads in the morning and it is almost the same and or even worse in the evening. Some roads do not have alternative roads. The ambulances have to take the same congested and blocked roads. Some drivers let ambulances over take but the other drivers never do this. The next victim will be either you or one of your close relatives! So better to be a little more humane!

Effective prevention and treatment protocols for animal envenomation

Nipuni WIMALAPALA

The executive director of the Animal Venom Research International (AVRI)Roy Mallaeppah (Bsc) and chairman, Snakebite Expert Committee SLMA Dr. Kolitha Sellahewa delivered two lectures at the Sri Lanka Association For the Advancement of Science (SLAAS) auditorium recently on effective prevention and treatment protocols for animal envenomation.

Dr. Sellahewa mentioned that there are some species in Sri Lanka which are deadly venomous. Spectacled cobra, Common Krait, Hump-nosed viper, Saw Scaled viper, Green pit viper, Russel’s viper are among them. Mostly the farmers in rural areas are bitten by snakes and other venomous species. To save the life of a victim, he or she should be rushed to the hospital. Never cut or suck the affected place and do not apply tourniquets. People can avoid snake bites by carrying a torchn a stick with them when walking during night time or evenings. Also they have to be very careful and should wear foot wears.

“There is a procedure to identify the venom and to treat the patient. Today it is not needed to bring the animal to show the doctors, because there is a method to find out the animal without seeing it. Do not kill snakes and other venomous animals, because they are also a part of the nature. So we should let them live in their own way. But it is very important to establish more effective medicine to save the lives of poor people who are affected”, said Dr. Sellahewa.

The Executive Director of the AVRI , Roy Mallaeppah (Bsc) mentioned that regions such as South Asia, South East Asia and Africa are the most risky parts of the world and yet perfect anti venom treatment is not formed in these parts. The island nation of Sri Lanka, in Southeast Asia, has one of the highest snakebite morbidity and mortality rates in the world. With a population of 20 million, approximately 40,000 people are bitten by snakes every year.

Animal Venom Research International (AVRI) is a non profit public benefit corporation of the USA. The mission of AVRI is to promote the development of more effective prevention and treatment protocols for animal envenomation ( a bite from a venomous animal resulting in toxins being injected into body) by mediating between involved parties, educating medical staff and the public in order to reduce morbidity and morality around the world.

Taking Sri Lanka as the starting point, AVRI’s goal is to reach into areas of the world suffering the worst morbidity and morality rates due to animal envenomation. Currently, anti venoms are the only proven specific treatment for envenomation.

Medicine in the elderly

Medicing in the Elderly

By Professor Colvin Goonaratna Consultant Physician, District General Hospital, Nuwara Eliya

Available at SLMA 6, CMCC office and the Faculty of Medicine, Colombo 8

“Medicine in the Elderly” consists of Volumes 1 and 2, on an emerging area of medical care of national importance. Commendable improvement achieved by Sri Lanka in health indicators such as birth rates, death rates, fertility rates, maternal and newborn survival rates etc, as well as criteria of health service delivery such as healthcare coverage and immunisation rates, have shifted population demographics into the ever increasing proportion of elderly people. Within this background Sri Lanka has experienced also very negative effects of socio-economic changes such as a widening gap between the economically privileged and those who are deprived, as well as changes in corresponding diets and lifestyles.

Wider public awareness on the issues related to this phase of life, particularly the rights of and opportunities for the elderly, are an essential component of humane healthcare. The work presented in these two volumes addresses these trends and issues, while providing “must have” references to the biological changes associated with ageing, the medical conditions affecting the elderly and their management, the responsibilities of society including those of care providers, and the major policy issues involved in organising care of the elderly.

The elderly period of life is one of dynamic change. During the early period (60-69 years) the elderly person still makes useful contributions to society. During the middle (70 to 79 years) an the advance (>80 years) periods of elderly life, social and health dependence increases. It is therefore entirely appropriate that, the first chapter in Volume 1 Part 1, deals with the demographic trends of the ageing population and their implications. The wealth of information given there would be greatly valued by the social, economic and health policy-makers. The impact on labour management and the need for provision of recreational as well as other non-medical facilities so as to enhance quality of life of elders is appreciated. The provision of domiciliary care, in combination with institutional care where necessary, receives proper emphasis. The role of the care provider and the use of temporary institutional care as a means of providing a reprieve for the care provider is an issue that is addressed in this chapter, from the early stages of the management of an elderly person.

Legal and ethical aspects

Chapters 2 and 3 deal with the legal and ethical aspects of caring for the elderly. These provide a focused insight into the realities of the status of the elderly, and the ethical manner in which they should be cared for. The contents of these chapters are a practical guide to those involved, from policy makers at the highest level to those near and dear in the home environment of the elderly. The mechanism of improving the quality of life during the elderly period is by enhancing public awareness in this regard.

Part 2 comprising Chapters 4 to 14 begin by providing in-depth knowledge on the biological process of aging along with age related pathophysiology. The path towards illness resulting from their origins in earlier periods in life due to genetic influences, natural biological events, stresses of life-style and environmental effects are traced in a user-friendly manner. The information given on each medical condition in these chapters is extensive, valuable and would constitute essential reference material.

Nearly all humans are wishful of remaining static at the present point in life by avoiding the aging process or perhaps even reverting back to a youthful state. Chapter 4 has provided a most revealing description of the irreversible biological changes of ageing. It is within this background that the range of disease and injury in the elderly has to be considered. The integration of nutritional needs, along with the many aspects of food intake and utilisation are described in detail in Chapter 5, along with the emergence of non-communicable diseases in recent times. This chapter is of special significance as it concludes with the application of “nutritional care of the elderly with special reference to Sri Lanka”.

While system based analysis of disorders of the elderly are described in detail in Chapters 7 to 15, the reader is reminded that some illnesses specifically occur during the elderly phase while the others are carried over from a previous stage of life. The content presented in these chapters incorporates the relevant aspects applicable to the elderly to a greater or lesser degree. The guidelines provided on the prevention and management of emergency and routine conditions commonly encountered in the day-to-day life of the elderly in each of these chapters are clear and could be readily adapted for use by the care providers.

Mental health disorders

Chapter 7 deals comprehensively and cogently with mental health disorders in the elderly and covers well the key areas of depression, dementia, delusional disorder, distress (grief, bereavement, anxiety) and delirium (the five Ds) in detail. The chapters on sleep problems (Chapter 8) prescribing for the elderly (Chapter 6) and the care of elderly in General Practice (Chapter 15) round off a good selection of topics in Volume 1.

Medical disorders of the elderly in the kidney, endocrine system, respiratory system an alimentary system are covered in Volume 2, which also introduces other focused areas of importance. Although the post-reproductive care of women (during the climacteric or after the menopause) has been an area of interest to women and gynaecologists in the past, wider consideration by society and the general medical profession has now become essential. Furthermore, ageing of the male in the “andropause” has also received recent attention as it presents more subtle but similar problems.

The chapter on sexuality in the elderly in this volume should interest most, if not all readers. Volume 2 deals with the important subjects of rehabilitation after illness or injury, which is an essential area to guide relatives and care providers. Volume 2 presents also vital information on dealing with the inevitable: DEATH. Expertise in helping the elderly person to go through the last stages of life, and guiding the relatives and friends through this difficult period is essential for the medical profession. The discussion of this important aspect of care of the elderly in Volume 2 is most welcome.

Sri Lanka has been globally recognised as one of the leaders in the provision of community and institutional Maternal and Child Health (MCH) care. Care of the elderly, especially during the more advanced stages of life is an analogous situation, but requires modifications and special considerations. Volume 2 addresses this aspect and deals with the organisation of services for the elderly. In this matter, studying the experiences of other countries with such services in place and the systems that are operational in Sri Lanka at present, would be mandatory.

By the medical profession, other healthcare professionals and the public. I complement their choice of topics and authors and the latter for their excellent presentations. I am reminded here of Pandit Jawaharlal Nehru’s sagacious dictum:

“Build your house on your own soil with your own ideas, but keep the windows of your mind open to the winds that blow from foreign shores”.

- Harshalal R Seneviratne (Senior Professor of Obstetrics and Gynaecology and Dean, Faculty of Medicine, University of Colombo)

Medical Crossword Draw No 48 on a new basis

Edward ARAMBEWALA

Following are the prize winners of Medical Crossword No 48 draw held at WISH auditorium on August 27 with Dr Kelum Pelpola and Dr Chula Seneviratne participating.

This draw was on a different basis of the correct entries being separated into four categories of students, pensioners, housewives and professionals, and the future draws will also be on the same basis as the Daily News and the sponsors found this separation enables all categories of those who send entries to get directly into the draw categorywise and get prizes.

The professionals group of correct entries in this Crossword No 48 was drawn at the Daily News Editor’s office by the Editor-in-Chief on Tuesday, September 6 with the sponsor WISH Institute head audiologist Mihiri Wickremarachchi participating.

Prize winners in the draw No. 48 -

Students – Rs 1,000 each:

1. Entry No 79 S Abeywardena, 2 year, Sri Jayawardenapura University.

2. Entry No 84, Sakina Zoeb, 19 years, engineering student, Colombo 5.

3. Entry No 89, R A R Ranasinghe, 24 years, Peradeniya Faculty.

Housewives - Rs 1,000 each:

1. Entry No 40 A G Fernando, Ananda Balika Mawatha, Kotte.

2. Entry No 52, Agnus Nayagam, Balapokuna Road, Colombo 6.

3. Entry No 102, Indra Jayasinghe, Jambugasmulla Road, Nugegoda.

Pensioners – Rs 1,000 each:

1. Entry No 7, E C Jayasinghe, Mirihana, Nugegoda (retired Chartered Secretary – 85 years).

2. Entry No 45, P M Bartholameuse, Matale (retired Pensions Department, Treasury – 82 years).

3. Entry No 20, V C Jayasuriya, Katuneriya (retired Postal Department, 74 years. Doing crosswords as a hobby).

Professionals – Rs 1,000 each:

1. Entry No 80 – K G A T Ekanayake, 29 years, nurse at Durdens Hospital, Colombo 3.

2. Entry No 103, Dr S P G Senadheera, 65 years, RMO, Sri Lanka Ports Authority, Colombo.

3. Entry No 86, Aresha de Cross, 30 years, Data Entry Officer, Daluwakotuwa, Kochchikade.

Get to know rat fever

Rat-bite fever is an acute, febrile human illness caused by bacteria transmitted by rodents, rats in most cases, which is passed from rodent to human via the rodent’s urine or mucous secretions. Alternative names for rat bite fever include streptobacillary fever, streptobacillosis, spirillary fever, sodoku, and epidemic arthritic erythema. It is a rare disease spread by infected rodents and can be caused by two specific types of bacteria.

Most cases occur in Japan, but specific strains of the disease are present in the United States, Europe, Australia, and Africa. Some cases are diagnosed after patients were exposed to the urine or bodily secretions of an infected animal. These secretions can come from the mouth, nose, or eyes of the rodent. The majority of cases are due to the animal’s bite. It can also be transmitted throughout food or water that is contaminated with rat feces or urine. Rats are not the only type of animal that can be infected with this disease. Others include weasels, gerbils, and squirrels. Household pets such as dogs or cats that are exposed to these animals can also carry the disease and infect humans. If a person is bitten by a rodent, it is important to quickly wash and cleanse the wound area thoroughly with antiseptic solution to reduce the risk of infection.

Symptoms will be different for every person and will be different depending on the type of rat bite fever that a person is infected with. Both spirillary rat bite fever and streptobacillary rat bite fever have a few individual symptoms although most symptoms are crossovers. Streptobacillary is most commonly found in the United States and spirillary rat bite fever is generally diagnosed in patients in Africa and other countries. Rat bite symptoms are visually seen in most cases and include inflammation around the open sore. A rash can also spread around the area and appear red or purple. Other symptoms associated with streptobacillary rat bite fever include chills, fever, vomiting, headaches, and muscle aches. Joints can also become painfully swollen and pain can be experienced in the back. Along with rash and swollen joints, skin irritations like ulcers or inflammation can develop on the hands and feet. Wounds will heal slowly, so it is possible that symptoms will come and go over the course of a few months. It is important to contact a physician and report these symptoms immediately.

Symptoms associated with spirillary rat bite fever include issues with the lymph nodes. The lymph nodes which lie in the lymphatic system will often swell or inflame as a reaction to the disease or infection.

The most common locations of lymph node swelling are in the neck, groin and underarm. Symptoms generally appear within two to ten days of exposure to the affected animal. It will begin with the fever and will progress to the rash that will appear on the hands and feet within two to four days. Rash will appear all over the body with this form of the infection and will rarely cause symptoms of joint pain.

- Wikipedia