Delhi stands second to four cities in noise pollution levels

Health Care, Heart Care Foundation of India, Medicine Comments Off

Long-term exposure to noise can lead to induced hearing loss and other issues

New Delhi, 24th April 2018: The National Capital of India, Delhi, is the second worst city in terms of high noise pollution levels, according to a report by the WHO. Noise pollution is a growing issue in the city, which is followed by Cairo, Mumbai, Istanbul, and Beijing in the line-up of cities where the levels have reached triple digits.

Noise pollution is generally defined as regular exposure to elevated sound levels that may lead to adverse effects in humans or other living organisms. One can tolerate exposure to 80 dB for up to 8 hours in a day; 85 dB for 4 hours; 90 dB for 2 hours; 95 dB for one hour; 100 dB for 30 minutes; 105 dB for 15 min and 110 dB for less than a minute without adequate sound protection.

Speaking about this, Padma Shri Dr K K Aggarwal, President, Heart Care Foundation of India (HCFI), said, “Exposure to noise beyond permissible levels is a health hazard. Long exposure to loud traffic can lead to noise induced hearing loss in some cases. Noise shifts the body to sympathetic mode and takes us away from conscious-based decisions. One of the worst affected categories of people are the traffic police. Elevated noise levels can lead to development of tinnitus (buzzing sound in the ear). Tinnitus can further cause various psychological problems and the person may suffer from disturbed sleep, irregular blood pressure and sugar levels. On International Noise Pollution Awareness Day, it is imperative to create awareness on these aspects and take steps to curb noise, starting at a personal level.”

As per guidelines, the permissible noise levels in residential areas is 45 dB in night time and 55 dB in day time. Permissible noise limits in Silence zones are 50 dB in daytime (6am to 10 pm) and 40 dB in night time (10 pm to 6am).

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “On road, one should use the horn only when absolutely necessary. Incessant honking can not only disturb traffic equilibrium but also others’ peace of mind. The IMA-NISS is observing 25th April as ‘No Horn Day’ all over the country, as traffic noise especially honking, is a major component of noise pollution in the country.“

Some tips to reduce noise pollution from HCFI.

  • Signboards displaying ‘Silence zone’, ‘No honking’ must be placed near schools and hospitals.
  • Efforts should be made to ban the use of horns with jarring sounds, motorbikes with damaged exhaust pipes, and noisy trucks.
  • The use of loudspeakers in parties and discos, as well as public announcements systems should be checked and discouraged.
  • Noise rules must be stringent and strictly enforced near such silence zones.
  • Planting trees along roads and in residential areas is a good way to reduce noise pollution as they absorb sound.

Surgery performed on the wrong patient is a never event

Health Care, Uncategorized Comments Off

A patient who was hospitalized in a dedicated Trauma Centre run by the Delhi government with head and face injuries that he sustained in an accident, instead underwent surgery under GA for a fractured leg, as reported in TOI. The surgeon mistook him for another patient admitted in the same ward who had a leg fracture. A small hole was drilled into the patient’s right leg to put a pin on Thursday morning. As the procedure had been done under general anesthesia, the patient could not realize or object to it. However, the pin was removed within hours following a corrective surgery after it was brought to the attention of the authoritis. A committee examined the case found merit in the allegations and a disciplinary action was initiated against the doctor, a senior resident, who has been barred from conducting surgeries without supervision with immediate effect.

Res ipsa loquitur is a Latin term, which literally translates as “the thing speaks for itself”. The doctrine of res ipsa loquitur is a rule of evidence in cases of medical negligence. It infers negligence from the very nature of an accident or injury in the absence of direct evidence on how any defendant behaved. Res ipsa loquitur is not applicable when determining the liability for criminal negligence; it applies only in cases of civil negligence.

To prove medical negligence, usually three components have to be established:

  1. There was an element of duty to be performed
  2. There was breach of duty
  3. Resultant damage

If the patient is not harmed by the physician’s error, then the patient cannot recover damages arising out of the error.

This case answers ‘yes’ to all the three components of medical negligence: there was a duty of care, there was a breach in the duty of care and the patient did suffer damage as a direct result of the breach.

In res ipsa loquitur, these three components of medical negligence elements are inferred from an injury that does not ordinarily occur without negligence i.e. negligence is evident and the complainant does not have to prove anything as the “thing proves itself” as also in this case.

This is a medical error and can be classified as a ‘never event’ i.e. event that should never occur under any circumstance. Never events are defined as adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability. They are usually a direct result of a negligent action and no trial of expert’s evidence is necessary

The US National Quality Forum has defined 29 never events segregated into seven categories: surgical, product or device, patient protection, care management, environmental, radiologic, and criminal.

“Surgery or other invasive procedure performed on the wrong patient” is included in list of surgical never events along with “surgery or other invasive procedure performed on the wrong body part, wrong surgical or other invasive procedure performed on a patient, unintended retention of a foreign object in a patient after surgery or other procedure”.

The World Health Organization (WHO) has developed a Surgical Safety Checklist, to be read out loud, to decrease errors and adverse events for use in any operating theatre environment. The checklist has three phases as below:

“Sign In”Before induction of anesthesia

  1. Has the patient confirmed his/her identity, site, procedure and consent?
  2. Is the surgical site marked?
  3. Is the anaesthesia machine and medication check complete?
  4. Does the patient have a: Known allergy, Difficult airway/aspiration risk or Risk of >500ml blood loss (7ml/kg in children)?