Sociodemographic Details

Forty-five (n = 45) family members were included in the study. The majority of the family members were female (30, 66.7%) and males were 15 (33.3%). It was also found that primary family members were either mother or father 12 (26.7%), son or daughter 11 (24.4%), spouse 9 (20%), sister or brother 8 (17.8%), and sister-in-law or brother-in-law 5 (11.1%). More than half belonged to below poverty line (BPL) 23 (51%) and 22 (49%) were from the above poverty line (APL). Thirty-three (73%) hailed from a rural background and 12 (27%) were from urban backgrounds. The majority of the family members believed in the Hindu religion (84.4%) and 7 (15.6%) were from nonHindu backgrounds such as Islam and Christianity. Table 2 depicts the family members’ demographic details.

TBI survivors' mean age was found to be 33 years (33.09 ± 13.20), of which males were 23 (51.1%) and females were 22 (48.9%), respectively. The educational level of the patients was found to be 21 (46.3%) who had completed primary or secondary level of education, graduation 14 (32%) and illiterate 10 (22.2%). The majority of the patients were diagnosed with subdural hematoma 43 (93.3%), epidural hematoma 2 (4.4%), and contusion 1 (2.2%). Tables 3 and 4 depicts the TBI survivor’s demographic details and illness characteristics.

Prehospital Care

Majority of the patients had met with an accident in the morning (6 a.m. to 9 a.m., 16 [35.6%]), early morning (3 a.m. to 5 a.m., 13 [28.9%]), and night (around 6 p.m. to 10 p.m. 4 [8.9%]). The accident took place at circles or cross roads 25 (55.6%), service roads at village 10 (22.2), and nearby school or workplace 4 (8.8%).

Besides, good Samaritans or general public 25 (55.7%), police 9 (20%), friends 6 (13.3%), and auto drivers 5 (11%) helped in terms of moving the patient to the safer side of the accident spot, calling 108 ambulance services, and shifting the TBI survivors to a nearby hospital. The study results described that the majority of 30 (67%) of the TBI survivors were shifted by 108 ambulances, private ambulance 10 (22%), and used bus /car /auto 5 (11%). First aid was provided to TBI survivors by good Samaritans or general public 20 (44.5%), staff nurses 19 (42.2%), and medical physicians 6 (13.3%).

Pathways of Prehospital Care

The results showed that hospital shopping was done to gain timely access to prehospital care. The majority of family members travelled along with TBI survivors from accident spot (AS) to general hospital (GH) and from there to government tertiary trauma care centre (GTTCC) 30 (66.7%). Further, AS to private hospital (PH) to another PH to GTTCC 7 (15.6%), AS to primary health care centre (PHC) to GTTCC 4 (8.9%), and AS to directly GTTCC were only 4 (8.9%). Overall, on an average 41 minutes (41 ± 30) later, first aid was provided by trained medical or paramedical. Fig. 1 depicts the pathway of care.

Close

Fig. 1 Pathway of care after traumatic brain injury (TBI) 4 (8.9%) (direct).

Export to PPT

Fig. 1 Pathway of care after traumatic brain injury (TBI) 4 (8.9%) (direct).

RTA Impact on Family Members in Prehospital Care

After hearing the accident of their loved one, family members took 131.56 minutes (131.56 ± 130.9) to reach the accident spot. Family members experienced negative feelings, negative thoughts, and stress-induced behavioral and physical problems during prehospital care.

The majority of family members experienced shock (82.2%), sadness (68.9%), depression (66.7%), bargaining or acceptance (64.4%), loneliness (35.6%), anger (28.9%), and denial (24.4%); the least percentage of family members experienced guilt (22.2%).

Family members exhibited behavioral problems such as agitation (100%), crying spells (73.3%), over-involvement (71.1%), and social withdrawal (22.2%). Further, family members had negative reactions such as the being preoccupied (100%), while more than half caregivers had a feeling of hopelessness (55.6%) and helplessness (48.9%).

All family members manifested physiological changes such as heart palpitations (100%), fatigue (75.6%), headache (75.6%), not feeling like having food (71.1%), and insomnia (62.2%) while preaccompanying the TBI survivor during prehospital care.

The results showed that the majority of family members were at home (82.2%) at the time of the accident, traveling along with TBI survivor 4 (8.9%), and engaged in occupational activities (8.9%) in the field. Further, family members also struggled with a lack of support from family (48.9%) and lack of financial support (48.9%) during prehospital care. The study results also identified a few other needs like lack of information and timely transport to reach the accident spot (24.4%) which were identified as major barriers. Table 5 shows the family members' psychosocial problems experienced during prehospital care.

Status of Prehospital Care

The current study findings revealed that the majority of the accidents took place in the morning or early morning and night, particularly at crossroads, service road junctions, nearby schools, and workplaces. A recent study reported that more accidents occurred between 9 PM to 7 AM16 Our study findings emphasize the establishment of traffic signals and visible signboards at service roads and schools.

Good Samaritans, police, auto drivers, and known friends helped in terms of calling the ambulance and shifting the TBI survivors to the nearby hospital. The results further showed that most of the time 108 ambulance services along with other vehicles like bus or car or auto were available for the needy during the golden hour or after. Ambulances (common emergency number 108) and auto-rickshaws are the most frequently used transport from the AS to the hospital as well as the interhospital referral.10 Prehospital transport is restricted in poor resource settings, and families use the available transport to reach the hospital.8 17 The present finding is consistent with the fact that transport facilities during prehospital care were available but far away from complete satisfaction of family members.

The present results depicted that first aid was provided to TBI survivors by good Samaritans, patrolling police, bystanders, and family members before shifting the survivor. Reviews show that stopping the bleeding and immobilization were the most common types of first aid provided by untrained people such as good Samaritans, police, and family members. Adding to that, lack of education, poor training standards for paramedics, and lack of manpower bring in unskilled persons to provide first aid at the AS.17 18 The present study findings emphasizes that there is an urgent need to provide basic first aid training to the general public, traffic, patrolling police, and auto drivers. There is also a need for prompt and proper training for the paramedical and medical professionals to save the life of the injured person until the survivor reaches the trauma care center or nearby hospital.

Pathway of Care and Psychosocial Impact on Family Members

Only a less proportionate TBI survivors had got the right referrals and directions to reach AS to GTTCC for treatment directly. Most of the TBI survivors along with family members had approached multiple hospitals such as GH, PH, PHC, and then finally GTTCC for trauma treatment and care. Further findings showed that most of the family members were not aware of the accident and unable to reach the AS in time or immediately even after receiving information due to barriers such as long distance, not able to leave the half-done work in the workplace, and lack of timely transport facilities. As a result, family members took 131.56 minutes (131.56 ± 130.9) to reach the AS after hearing about the accident in the present study.

Family members were dissatisfied to access the golden hour care. This finding goes in line with previous studies which also report that prehospital care is nonexistent in most rural and semiurban areas, implementation of “golden hour care” is poor, and accessing trauma care services in the outskirts of the cities difficult.9 Thus, there is an urgent need to establish a trauma care center in the highways as well as in the rural areas to get timely treatment to provide basic life support care, in order to save the TBI survivors. This will help to save the reproductive age group and strengthen the Indian economy in the country. An earlier study reports that the economic loss due to TBI is phenomenal, although it is not explored in the developing countries.19 In addition to this, family members had experienced a range of psychosocial problems such as shock, agitation, anxiety, fear, anger, distress, helplessness, hopelessness, loss of appetite, headache, fatigue, insomnia, lack of support from family, and financial struggles. Informational and educational needs were unmet. Literature also reports that the unmet needs of prehospital care create misery among family members besides TBI survivors.20 Financial constraints and advice, and emotional and social support are lacking in general among TBI family members during in emergency time.21 22 Educational levels, religious background, pre-existing family interaction, trauma details, and financial challenges triggered by injury will disturb the family functioning under stress.23 Family members' psychosocial problems in prehospital care on a larger sample and family functioning after TBI is a potential area for further research.