Reating of Alcohol-Related Trauma, High Speed as One of the Major Causes of Accidents in Major Highways - Assignment Example

ASSESSMENT 1: SHORT CRITICAL THINKING QUESTIONS Name: Course: Date QUESTION 1 Alcohol related trauma is major cause mortality and morbidity among the youths. In Australia, alcohol related trauma is responsible for around 3,000 deaths and over 65000 hospitalized cases annually (Chikritzhs et al., 2003). This fact explains why the Australian government has invested heavily alcohol-related cases; for instance, the 2004-05 a budget of $15.3 billion was channeled towards controlling alcohol related cases (Collins and Lapsley, 2008). In this regard, it beats logic that there is need to manage alcohol consumption among the youths. One of the vital means of managing alcohol related trauma is a successful adoption of ambulance program. The main reason being that ambulance services will offer the much needed prehospital care that hence reducing the number of trauma related deaths occurring between the scene of accident and hospital. As people gain knowledge of the connection between trauma prevention and alcohol consumption, the value between the two concepts become apparently critical (Collins and Lapsley, 2008). In both cases, Preventing Alcohol Related Trauma in Youth (P.A.R.T.Y) program identifies that a comprehensive approach is important in limiting the number of accidents and severity of injuries related to alcohol. Just like other critical health and social issues, there are limited resources in managing drug and alcohol related cases (Collins and Lapsley, 2008). Therefore, ambulance services presents that opportunity to manage alcohol related case effectively. Alcohol is responsible for a large portion of violent events. A study undertaken in a Santa Clara County (Carlifonia) revealed that the highest numbers of crimes were related to high concentration of alcohol (Calhoun and Coleman, 1989). For instance, the study showed that in 217 rape cases in the county, 72.4% were alcohol related (Calhoun and Coleman, 1989). This emphasizes the need for establishing a program to manage alcohol related trauma. Investing in alcohol prevention program will not have physical benefits but also social and economic benefit. Most of the youths that abuse alcohol are characterized by anti-social nature. However, with this program, these youths will be taught and managed in such a way that they will regain their lost social touch. The community does not need just a program; or rather it requires a program that will contribute a long with a range of existing education, policy and regulatory initiatives to the reduction of harm linked with alcohol among youths. This is the kind solution that will be offered Preventing Alcohol Related Trauma in Youth in this community. Economically, investing in Preventing Alcohol Related Trauma in Youth program will increase the economic viability of the community. In every society, youths are the majority and give the manpower for economic development. However, a community that is characterized by alcohol addicted youths will have the drive to perform economically. Successful implementation of this program will reduce the number of youths engaging in alcohol abuse hence economic production in the community. Overall, Preventing Alcohol Related Trauma in Youth program is worth investing in because it will not improve health status of the affected youths, but also improves the social and economic status of the community. QUESTION 2 High speed is one of the major causes of accidents in major highways. Speed increases the risk of vehicle collisions. It is also a significant factor in several fatalities and the number and severity of the injuries that originates from accidents. Some may argue that driving is a personal responsibility and that reduction of road accidents is a consequence of personal responsibility of the driver. However, I tend to argue that reducing road accidents is a collective responsibility from both the driver, regulators and any other stakeholder. Much care should be taken from the side of the driver while driving; while on their part, the regulators should implements the law that are meant to reduce the accidents and fatalities in the highways. Removing the speed limit on the 200-kilometer stretch between Alice Springs and the Barrow Creek area is a good move so to say. I agree with the fact that the move is aimed at giving the drivers the chance to demonstrate their own responsibility by doing the right thing while driving. In fact, as you have indicated, most people have doing the right thing and some are very pleased with the move. The questions are; is everybody doing the right thing? How many people will do the right thing and for how long? These types of questions are what make me takes side with Ian Faulks and other experts with similar opinions. I believe that a negligence of one driver poses a risk to other good drivers. Implementing the no speed limit policy will encourage some irresponsible behaviors in the highway. As Ian Faulks states; “It's not the kind of road that's like an autobahn where you would want to go really fast” I could not agree more. Lifting the high speed regulation is a show of lack of responsibility on the part highway authorities. Drivers are human beings that need to be controlled otherwise they might overstep their authority. High speed is not about the driver taking the responsibility neither it is about the highway; it is about the dangers that the driver is exposed to while driving at a speed of 250 kilometers per hour. Facts that high speed is one of the major causes of accidents in major highways should not be ignored while implementing this policy. These are facts and figures that have been proven everywhere across the globe hence Stuart Highway is no exception. Last but not least, I want to categorically state that the decision to introduce no speed limit policy on Stuart Highway is based on anecdotal information. For it to be beneficial and effective, it must be based on really good data and good evidence. Therefore, I refute the decision to implement the no speed limit policy without clear guidelines and data oriented support. QUESTION 3 Trauma is regarded as one of the leading cause of deaths and disability among the youth. Prehospital trauma care services are regarded to be a dynamic field of medicine for care of trauma patients (Bernard et al., 2010). Prehospital emergency care system should be aimed at matching the needs of the patients to the resources at disposal to the maximum thereby prompting a cost-effective care. There is always a gap between expected and actual level of care (Morrison, Verbeek and McDonald, 2000). To bridge this gap, there is need for the community, administrators and medical practitioners to take positive steps to appreciate the current changes that are taking place within the medicine sector. The increasing innovation and ever rising technological advancements have contributed vehemently to improvements in Prehospital trauma care services (Bernard et al., 2010). Prehospital care providers respond to several calls. These calls range from relatively small to life threatening situations. In this regard, it is appropriate for prehospital care providers to upgrade their knowledge of anatomy and physiology, in addition to the assessment of all patients despite the prevailing situation (Bernard et al., 2010). In circumstances of trauma, medical providers are required to consider immediate needs while at the same time anticipating what treatment they require in the future. As much as there is development in prehospital care, developing countries are still characterized low standards in management of trauma (Morrison, Verbeek and McDonald, 2000). The World Health Organization (WHO) estimates that 5.8 million deaths annually are attributable to injuries. As a result, several governments in developing countries have made attempts in strengthening prehospital emergency medical systems to reduce the number of deaths are a result of injuries. One of the basic concepts of prehospital is the Golden hour. This concept states that the critical trauma patient has 60 minutes from the time of injury to reach definitive care (Bernard et al., 2010). A significant number of emergency medical services providers have knowledge of their 1st experience with the “golden hour” concept. As stated by 3R rule of Dr. Donald Trunkey, the concept of golden hour can be summarized as “Getting the right patient to the right place at the right time” (Bernard et al., 2010). Having stated that, it is worth noting that prehospital trauma care process comprises of six basic steps: detection, reporting, response, on-scene care, care in transit and transfer to definitive care. Prehospital interventions I. Spine immobilization in penetrating trauma This intervention has the ability to delay the transport of trauma patients. It is mostly considered as one of the prehospital treatments for patients with head, neck or torso injures (Bernard et al., 2010. However, spine immobilization is advised for spine immobilization in situations of spinal cord injury. A retrospective analysis of penetrating trauma patients in the National Trauma Data Bank supports the former statement (Bernard et al., 2010). II. Thrombosis Considering the fact that early thrombolytic therapy is highly desirable and trained paramedics can interpret 12 lead of electrocardiography readings effectively; it is therefore a question to ponder if skilled paramedics can effectively monitor thrombolytic therapy in pre-hospital setting. A study undertaken in Scotland showed that general practitioners that are responsible for prehospital therapy affected mortality rates positively (Morrison, Verbeek and McDonald, 2000). In addition, a meta-analysis study by American Heart Association showed that thrombolytic treatment decreased time to treatment from the onset of symbols by an average of 58 minutes; thereby reducing the relative risk in hospital mortality and absolute risk by 17% and 2% respectively (Rawles, 1996). QUESTION 4 Traumatic injury is a common problem, with annual deaths of at least 5 years occurring across the world. It is estimated that around 10-20% of these deaths can be prevented with a better management of bleeding (Storey and Storey, 2006). Damage control resuscitation comprise of early delivery of platelets and plasma as the basic resuscitation approach aimed at minimizing trauma-induced coagulopathy. It is worth noting that the best substitution for the whole blood is best undertaken by a ratio of 1:1:1 of plasma, red blood cell and platelet. In this regard, damage control resuscitation is the basic focus upon arrival in hospital (Ning et al., 2002). Hypothermia is one the factors that are vital in damage control resuscitation. A long with acidosis and coagulopathy, hypothermia is a lethal triad in injured patients. The 21st century is characterized by numerous studies that show the benefit of mild-to-moderate hypothermia humans or even animals following cardiac arrest or TBI or during and after HS respectively (Storey and Storey, 2006). That is, there has been several research and clinical studies in therapeutic hypothermia for resuscitation; but while some fears for the side effects, others tend to focus on the benefits. It is worth noting that hypothermia in trauma patients can either be controlled or uncontrolled. However, the clinical implications of both controlled verses uncontrolled hypothermia in cooling poikilothermia is yet to be proven (Storey and Storey, 2006). Hypothermia, taken in a controlled manner, can be vital in protecting tissues form ischemic injury. According to Alzaga, Cerdan and Varon (2006), hypothermia requires necessary sedation and neuromuscular blockade to reduce the effects of deleterious of intense shivering. The intense shivering occurs between 34-36o C. taking that into consideration, other studies have shown that controlled decrease in main body temperatures are linked with decreased metabolic and oxygen demand in tissues, blunted inflammatory and immune response, and reduced activation of cell death pathways (Ning et al., 2002). It is argued that mild hypothermia if induced in hypovolemic patients will decrease the mortality rate in addition to protecting cells and reducing the likelihood of secondary inflammatory response syndrome, and ultimately late deaths. A study carried out by Ehrlich et al., (2002); effects of hypothermia on cerebral blood flow and metabolism in the pig showed that cooling to temperatures below 180 C in the pig can achieve greater metabolic suppression. However, this is linked with the loss of cerebral auto regulation. On their part, Storey and Storey (2006) undertook a study on molecular regulation of hypometabolism and asserted that; induced hypothermia generates a state of metabolic depression. This state preserves cellular energy when oxygen and substrates are limited in supply. According to Storey and Storey (2006), hypothermia decreases the activity of Na+/K+ ATPase pump that is responsible for up to 40% of ATP utilization in different tissues. Hypothetically, several medical practitioners believe that selective brain hypothermia reduces lactate and inorganic phosphate formation, decreases the basal metabolic rate in the brain, and slows the breakdown of glucose and phsophocreatine hence limiting cellular damage during ischemia and reperfusion. In addition, induced hypothermia alters cell survival and stress pathways that are responsible for tissue viability. A rabbit mode of ischemia-reperfusion by Ning et al., (2002), showed that hypothermic animals displayed decreased expression of pro-apoptotic proteins that increased their expression of anti-apoptotic Bcl-2 homologue Bcl-x (Ning et al., 2002). Reference Alzaga A.G, Cerdan M, Varon J (2006). Therapeutic hypothermia: Resuscitation. MA: Jones & Bartlett Learning. Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ et al (2010).Prehospital rapid sequence intubation improves functional outcomes for patients with severe traumatic brain injury: A randomized controlled trail. Ann Surg: London. Calhoun S and Coleman V, (1989). Alcohol availability and alcohol-related problems in Santa Clara. Santa Clara County Health Department: Santa Clara, CA. Chikritzhs, T, et al. (2003). Australian Alcohol Indicators: Patterns of Alcohol Use and Related Harms for Australian States and Territories 1990-2001. National Drug Research Institute and Turning Point Alcohol & Drug Centre: Melbourne. Collins, D., Lapsley H. (2008). The cost of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Commonwealth of Australia. Ehrlich M.P, McCullough J.N, Zhang N, Weisz D.J, Juvonen T, Codian CA, Greipp R.B (2002). Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg. New York International Conference of Chinese Transportation Professionals, Wang, Y., North America Chinese Overseas Transportation Association., Haerbin gong ye da xue., Transportation & Development Institute (American Society of Civil Engineers), & American Society of Civil Engineers. (2009). ICCTP 2009: Critical issues in transportation system planning, development, and management : proceedings of the Ninth International Conference of Chinese Transportation Professionals : August 5-9, Harbin, China. Reston, VA: American Society of Civil Engineers. International Conference on Urban Transport and the Environment, & In Brebbia, C. A. (2014). Urban transport XX. Morrison L., Verbeek P., McDonald A., (2000). Mortality and prehospital thrombolysis for acute MI. A meta‐analysis. JAMA: (PubMed Ning X., Chen S., Xu C., Li L., Yao L., Qian K., Krueger J., Hyyti O., Portman M., (2002). Selected contribution: Hypothermic protection of ischemic heart via alterations in apoptotic pathways as assessed by gene array analysis. J Appl Physiol Rawles J. (1996).Magnitude of benefits from the earlier thrombolytic treatment in acute MI: new evidence from the GREAT trial. BMJ Storey K., Storey J., (2007). Tribute to P.L Lutz: Putting life on 'pause' - molecular regulation of hypometabolism. J Exp Biol: SAGE Publ. Read More