Road traffic accidents do not choose to injure a single body part. Most often they involve multiple organs. Called ‘Polytrauma’ it is a multifaceted problem that requires a multilateral approach. The essence of polytrauma care is that the specialty he or she requires must come to the patient. This is possible only in a multispecialty tertiary care institution. If a patient sustains polytrauma in the form of head injury, chest injury, abdominal injury and multiple long bone injuries, he or she requires all the concerned specialties’ care at once. In such situations a patient requires management by Neurosurgeon, Cardiothoracic surgeon, surgical Gastroenterologist and Orthopaedic surgeon. When all these specialists are available, the patient undergoes surgery by these specialists in one sitting with due preference given to the injury requiring most immediate attention. In other words, the patient need not make frequent visits to the operating theatre for different procedures. This does not apply to surgical specialties alone. A patient who undergoes multiple surgical procedures can develop medical complications. In a hypothetical situation, a patient who underwent multiple surgical procedures develops delayed complications of the kidneys, this must be addressed by the Nephrologists as early as possible. When the institution is equipped with a portable dialyzing unit, the patient is saved from the trouble of transfer. A patient can develop multiple medical complications which is to be addressed by concerned medical specialties. This is possible only when the institutionprovides multispecialty care. The patient may require multiple investigations in the form of X-rays, CT scan, MRI scan, and ultra sound as early as possible. The equipment for these investigations need to be located adjacent to each other so that the patient need not be moved unduly. Management of Polytrauma which causes disability and death is the most challenging sector in trauma care management. Patients with severe traumatic brain injury (TBI) have a high death rate (30-50 per cent) and many survivors will have persistent severe neurological disability making them invalid. The management starts at the accident site and ends at the discharge of the patient from hospital and follow-up of the patient as an outpatient. The management is to be done at various levels.*At the injury site*In the nearest hospital*In the ambulance*At the tertiary referral hospital*At the injury siteThe management in the first one hour is crucial which can be done by anybody at the accident site. The three factors that require attention are 1)Maintenance of airway which is achieved by just lifting the chin of the patient to prevent the tongue from falling back and blocking the air passage.Prevention of blood loss which is achieved by tight bandaging of the bleeding site.Prevention of aspiration which is managed by putting the patient on the side, headdown and lifting the chin. These steps can help prevent what is called ‘second head injury’ which kills the patient. Management in the nearest hospital It’s always preferable to rush to a nearby hospital, where patient has to be screened from head to toe and first aid given. The patient needs to be stabilised with oxygen, IV fluids, etc. If severe injuries are noted, and facilities are not available in that hospital, the patient must be referred to a multispecialty/tertiary health centre by appropriate transport vehicle (ambulance with ventilator facility) accompanied by trained paramedical staff.Dr R R RaviSenior Consultant and Head of Neurosurgery, Medical Trust Hospital
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