Article Type : Research Article
Authors : Koliyath S, Chittoria RK, Reddy CL, Mohan PB, Pathan I, Thomas N and Nishad K
Keywords : COVID-19; Pandemic; Trauma
The emergence of
COVID-19 pandemic has created a major impact in the way healthcare facilities
practise in this challenging times. Most of the health care facilities
worldwide have been designated as COVID care centres and in many centres only
emergency and trauma cases are being seen and treated owing to reorganisation
of the healthcare staff for COVID related duties and responsibilities. In this
study we have shared our experience regarding the trauma cases seen in our
plastic surgery department during the COVID-19 pandemic period.
The first case of COVID-19 pandemic
in India was reported on 30 January 2020, originating from china. As of 19 May
2020 India has currently the fourth largest number of confirmed cases in Asia.1
On March 2020, India observed a 14-hour voluntary public curfew at the instance
of the prime minister Narendra Modi. Further on 24 March, the Prime minister
ordered a nation-wide lockdown for 21 days, which was further extended and is
currently in the 4th stage of lockdown. Social distancing norms were
initiated and personal protective measures such as mask and frequent hand
washing and hygiene measures were practiced. With rising number of positive and
suspected patients, various hospitals have been designated as COVID treatment
centers. The field of healthcare in the time of corona has evolved and is
rapidly adapting itself to the day to day newer challenges owing to the spread
of the disease. Elective services were cancelled and only emergency services
were attended to in various hospitals. Here we share our experience regarding
the impact of COVID-19 in plastic surgery activities.
This study was conducted in the department of
plastic surgery during the period of April- June 2020. Departmental ethics
committee approval was obtained. Data was collected regarding the number of
cases attended by duty plastic surgery team in the emergency department during
the time of COVID. Data regarding the type of trauma cases most attended to,
the mode of injury, age group of patient, sex of the patient, work setting etc
were collected and tabulated.
As required by the reorganisation
of the hospital activity, only patients with life-threatening and limb
threatening conditions and malignancies were operated on during the COVID-19
period. Overall, the non-COVID-19 use of the emergency room was greatly
reduced, both because of the (Table 1).
COVID-19(Corona Virus Disease-2019) pandemic is spreading rapidly worldwide since its advent in December 2019. Human coronaviruses (HCoVs) represent a major group of coronaviruses (CoVs) associated with multiple respiratory diseases of varying severity, including common cold, pneumonia and bronchilitis2. Measures like maintaining social distancing, wearing masks, staying at home, avoiding social gatherings etc. have been implemented worldwide, many countries have declared lock-down for days allowing only emergency medical services and other essential services to function.
Table 1: Overall, the non-COVID-19 use of the emergency room was greatly reduced.
|
Cracker Burst Injury Hand |
8 |
|
Machine Cut Injury |
16 |
|
Trauma (RTA, Knife cut injury, Assault) |
33 |
|
Self-inflicted wrist cut |
4 |
|
Scalp Laceration |
3 |
|
Facial lacerations |
5 |
|
Thumb Reimplantation |
3 |
|
MALE |
60 |
|
FEMALE |
12 |
|
TOTAL |
72 |
|
AGE GROUP |
NUMBER |
|
Jan-20 |
10 |
|
21-40 |
30 |
|
41-60 |
22 |
|
61-80 |
1 |
|
Total |
72 |
|
RURAL |
32 |
|
URBAN |
40 |
Disease in healthcare workers is also on the rise
owing to interaction with affected patients. Unnecessary hospital visits are
being avoided. Patient monitoring and interaction has taken a new form owing to
telemedicine services. Hospitals and healthcare workers are striving day by day
to provide medical services to corona as well as non-corona patients taking
precautions to not spread the disease from patient to healthcare workers and
vice-versa. As expected, a
significant reduction of the total number of surgical procedures was seen in
the “COVID-19” period compared to the usual activity. The reasons for surgery
also changed significantly. As required by the reorganisation of the hospital
activity, only patients with life-threatening and limb threatening conditions
and malignancies were operated on during the COVID-19 period. Overall, the
non-COVID-19 use of the emergency room was greatly reduced, both because of the
limitations in movement imposed to the population (with consequent less
accidents and crime) and by the fear of getting infected inside the hospital’s
premises. In our hospital too elective surgeries were suspended and only
emergency and trauma cases were attended too. Most of the cases were from urban
settings as slowly industrial accidents and road traffic accident cases started
increasing as slowly lockdown measures were relaxed and movement of people from
one place to another place started. Hand trauma cases including machine cut
injuries, cracker burst injury, road traffic accidents and self-inflicted wrist
cut injuries formed the majority of emergency cases catered by our department
during the period of study. Male patients were more than female patients in
view of the work place machine cut injuries. Most of the patients were young
patients in the age group of 20-40 years.
In
this study we found that there is a change in the pattern of cases attended to
in the emergency department during the time of COVID pandemic owing to lockdown
and restrictions imposed for various activities. Also we found that there is
decrease in the number of cases attended to in the time period when compared to
usual times. The limitations of the study include that it is a single institute
study without any statistical analysis; further randomised controlled studies
are required to further substantiate the results.
1.
Home,
Ministry of health and family welfare. 2020.