deaths due to trauma have increased by 62.9% in 2014 as compared to 2004 in india as per the national crime records bureau ( ncrb ) .
there is a paucity of literature on prehospital care , emergency care , and epidemiology of traumatic cardiac arrest ( tca ) .
hence , the present study has tried to highlight the profile and characteristics of tca patients presenting to emergency department ( ed ) of a level 1 trauma center of india .
a retrospective single - centered cohort study was conducted between 2008 and 2013 in the ed of a level 1 trauma center of india , which has an annual ed visit of 50,00060,000 patients .
details of tca patients arriving to ed were retrieved from paper - based registers and computerized patient record system .
it represented patients above 1 year of age , of either sex who had an out - of - hospital or in - hospital ( ed ) tca .
the epidemiological variables studied were age , sex , mechanism of injury , prehospital care and transportation , primary arrest rhythms , and outcome in terms of death or discharge from the hospital .
the data were analyzed using stata ( version 11.2 , stata corp , texas , u.s.a ) software .
about 0.3 million trauma victims presented to the ed of the trauma center from 2008 to 2014 [ figure 1 ] . of these ,
1061 ( 0.36% ) presented with tca who provided cardiopulmonary resuscitation ( cpr ) and recruited in the study .
a total of 992 ( 93.5% ) patients had out - of - hospital cardiac arrest ( ohca ) and 40 had cardiac arrest in ed .
a total of 909 patients ( 85.67% ) were males and 152 ( 14.33% ) were females ( male : female ratio being 5.9:1 ) .
the majority were in the age group of 19 - 64 years with median age of 32 years ( interquartile range [ iqr ] 2345 ) .
annual burden of trauma patients in the emergency department age and sex distribution in patients with traumatic cardiac arrest ( n=1061 ) mechanism of injury was available in 872 patients .
rtc was seen in 571 ( 57.16% ) , fall from height in 185 ( 18.52% ) , and assault in 105 ( 10.51% ) patients .
the remaining 200 patients had other modes of injury ( railway track , gunshot , drowning , electrocution , self - harm , etc . ) .
asystole in 253 , pulseless electrical activity ( pea ) in 11 , ventricular fibrillation ( vf ) in 6 and ventricular tachycardia ( vt ) in 5 patients were observed [ table 2 ] .
it was provided by police personnel in 382 ( 36.59% ) , ambulance personnel in 110 ( 10.54% ) , relatives in 474 ( 45.40% ) , and bystanders in 78 ( 7.47% ) patients [ table 2 ] .
initial arrest rhythms , prehospital care , and transportation data regarding return of spontaneous circulation ( rosc ) after the first attempt of cpr were available in 933 patients .
rosc was present in 69 ( 7.4% ) , and 864 ( 92.60% ) patients could not be revived [ table 3 ] . in patients with rosc ,
the burden of trauma in india is increasing as per the ncrb . despite this increase ,
the outcome of resuscitative efforts is still very poor as highlighted in the present study .
prehospital transportation services are run by the government ambulances , private ambulances , and police without any coordination among them .
ambulances are often used as merely transport vehicle with limited or non- trained personals manning the ambulances .
most of the trauma victims do not achieve access to medical care within 1 h. the present study shows that police personnel were major prehospital service providers .
although they played a valuable role in patient transportation , they provided minimal prehospital care .
this is because police personnel in india are usually untrained in providing cpr and basic emergency care ( bec ) .
husain and eisenberg concluded that providing the police officers with basic cpr skills and training in the use of automated external defibrillator can increase survival rates for ohcas ( major link of  early defibrillation  in the  chain of survival  ) .
hence , there is an immediate need for training of police personnel and paramedics in bec in india .
the authors have taken initiatives in this regard , and the all india institute of medical sciences bec course was designed to address the issue .
they have trained medical and nonmedical personnel , including paramedics , police , and paramilitary forces in bec .
allison et al . developed and tested an undergraduate prehospital trauma course in 205 medical students of 4 year of medical school .
the feedback was positive and they all felt better equipped to deal with the emergency situations in the future .
the authors recommend the training in basic prehospital care for laypersons including school children and medical professionals in india .
rosc was achieved in 7.4% cases on the first attempt at cpr in our study .
there has been a debate on cpr in traumatic ohca patients citing its futility , wastage of resources and time .
battistella et al . in their study concluded that trauma victims who are pulseless and have asystole or heart rate < 40 beats / min should be declared dead at the scene of injury .
reported a bystander cpr rate of 10.2% with on - scene rosc rate of 15.4% in traumatic ohca .
leis et al . after analyzing about 167 tca cases found that rosc was obtained in 49.1% , and 6.6% cases achieved a complete neurological recovery .
the high rate of rosc in the above study was attributed to advanced life support ( als ) on - scene , which included intubation , intravenous access , fluid and drug therapy , point - of - care blood analysis , and procedures such as chest drain insertion , pericardiocentesis , and focused assessment with sonography for trauma .
hence , the authors support the view that cpr efforts in trauma - associated ohca patients are not futile and if supplemented by als on scene , may result in increased survival and neurological outcome .
the initial rhythms were asystole in 253 , pea in 11 , vf in six , and vt in five patients .
previous studies have identified shockable ( vt / vf ) or nonshockable ( asystole / pea ) rhythm on presentation as the most important factor for an increased chance of survival from ohca and have concluded that patients with vf or vt had 5 - 10 times increased chances of survival .
about 78.23% patients in our study were in the age group of 19 - 64 years .
found that the median age of traumatic ohca patients was 36 years ( iqr 25 - 55 ) .
the who statistics also supports this trend of young , productive working population being lost each year due to rtc .
male preponderance ( 85.67% ) in our study is comparable with deasy et al . , which reported 77.5% of males in traumatic ohca patients .
this may be explained by the fact that the major working population outdoors are males who are predisposed to traumatic injury risk factors .
this is in accordance with the data from ncrb , india , published in 2014 .
india accounts for as high as 6% of the world 's rtc although it has just 1% of the world 's vehicles .
the rtc rate of 35 per 1000 vehicles in india is one of the highest in the world .
hence , the authors stress the need for mass education of public regarding injury prevention strategies .
cardiac arrest is a terminal event , doctors and paramedics are not enthusiastic and do not stress upon complete documentation of events .
hence , the authors stress the need for electronic recording of data and tca registry .
cardiac arrest is a terminal event , doctors and paramedics are not enthusiastic and do not stress upon complete documentation of events .
hence , the authors stress the need for electronic recording of data and tca registry .
cardiac arrest is a terminal event , doctors and paramedics are not enthusiastic and do not stress upon complete documentation of events .
hence , the authors stress the need for electronic recording of data and tca registry .
 introduction : there is a paucity of literature on prehospital care and epidemiology of traumatic cardiac arrest ( tca ) in india . 
 this study highlights the profile and characteristics of tca.methods:a retrospective cohort study was conducted to study epidemiological profile of tca patients 1 year presenting to a level 1 trauma center of india.results:one thousand sixty - one patients were recruited in the study . 
 the median age ( interquartile range ) was 32 ( 2345 ) years ( male : female ratio of 5.9:1 ) . 
 asystole ( 253 ) , pulseless electrical activity ( 11 ) , ventricular fibrillation ( six ) , and ventricular tachycardia ( five ) were initial arrest rhythm . 
 road traffic crash ( rtc ) ( 57.16% ) , fall from height ( 18.52% ) , and assault ( 10.51% ) were modes of injury . 
 prehospital care was provided by police ( 36.59% ) , ambulance ( 10.54% ) , relatives ( 45.40% ) , and bystanders ( 7.47% cases ) . 
 return of spontaneous circulation was seen in 69 patients , of which only three survived to hospital discharge.conclusion:rtc in young males was a major cause of tca . 
 asystole was the most common arrest rhythm . 
 police personnel were major prehospital service provider . 
 prehospital care needs improvement including the development of robust tca registry . 
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