Emergency management of trauma in India: expectations and reality

Emergency management of trauma in the developing world is at a nascent stage of development. Industrialized cities, rural towns, and villages coexist, with an almost complete lack of organized trauma care. There is no leading national agency to coordinate the various components of a trauma system, and no mechanism for accreditation of trauma centers and professionals exists. Accelerated urbanization and industrialization over the last three to four decades has led to an alarming increase in the rate of accidental injuries, crime, and violence, and ever-increasing terrorist activities over the last two decades have ushered in man-made mass-casualty disasters. However, communicable diseases, maternal and child health, and population control continue to be government priorities, far ahead of trauma care, in countries like India. New initiatives under the National Health Policy 2002 were expected to result in improvements in the systems, but grossly inadequate funding allocation made any significant impact on the outcome impossible. Strengthening in several areas is severely needed to achieve a reasonable level of efficiency, despite significant efforts on the part of the private sector to develop trauma care systems.

Supraglottic devices: a possible role in prehospital toxic mass casualty event?

Rapidly progressive respiratory failure is the leading cause of death from inhalation of toxic chemical warfare agents. In an expected chaotic scenario, direct laryngoscopic tracheal intubation is unlikely to be easily and quickly performed due to shortage of medical personnel experienced with laryngoscopy and/or reduced dexterity imposed by the protective gear worn by the caregivers. Supraglottic devices have increasingly been used for emergent airway control in prehospital settings, thus avoiding the need for laryngoscopy. This review summarizes Medline English literature search on supraglottic devices and their use in the prehospital setting or in mass casualty event focusing on their potential role for emergent airway control in the setup of toxic inhalation.