Impact and Modifications of In-Hospital Trauma Care Workflow Due to COVID 19 Pandemic: Lessons Learnt for the Future

To describe the restructuring in-hospital systems of care at a Level -1 trauma center in India and to analyze injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19. Methods: Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day’s number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, place of injury, injury severity, and injury outcome to compare the statistical analysis between two periods. Results: Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. Injuries resulting due to blunt forces, increased significantly during lockdown. The number of road traffic injury (RTI) victims decreased significantly during lockdown but the proportion of Red Triaged RTI patients was more. There was also a significant increase in number of ‘falls’ reported during lockdown. There was a significant decrease in the percentage of patients having major trauma (Injury Severity Score, ISS>12), during lockdown. Significantly less number of patients presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown. As expected, significantly less number of patients were transferred by three wheelers. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown. Conclusion: This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.