Case Series Analysis of Wild Elephant Attack-Related Trauma Victims at a Peripheral Base Hospital in Sri Lanka

Abstract

Although traumatic injury has been the foremost reason for hospitalization and a common cause of in-hospital mortality, Sri Lanka lacks a defined prehospital trauma management protocol, an accredited trauma care hospital network, or an integrated trauma system. Further, there has been a shortage of clinical outcome data following major trauma care, precluding the identification of overall lapses. Wild elephant attack-related human injury has been a subdomain of traumatic injury, which has never been evaluated from the surgical point of view. In such a background, the demographics of the cases, socio-environmental details of the incidents, prehospital care specifics, injury severity classification, treatment details, and clinical outcome data with disability status of the victims of elephant attacks were studied at a rural base hospital in Sri Lanka for 18 months from July 2022. Among 54 eligible cases (males, 37 (68.5%); mean age, 45.4 (range 23–75) years), there had been 13 (24%) fatalities. Polytrauma with intracranial, thoracic, or abdominopelvic injuries has been the main cause of death. For 47 cases brought alive to the hospital, the median transportation duration was 65 min (range 20–125). Among them, six out of 15 patients with class III/IV hemorrhagic shock had crystalloid resuscitation, 10/23 with tachypnoea or pulse oximetry < 94% had received prehospital oxygen treatment, and none of 9 patients with Glasgow Coma Scale ≤ 8 had protected airway as prehospital care. Among 41 survivors, 13 (25%) had suffered major injuries with a revised trauma score ≤ 5. The average hospital stay had been 25.2 days (range 6–79) for major injury survivors and 7.2 days (range 2–26) for survivors with a revised trauma score > 5. Eleven patients (27% of survivors) had a long-term disability, and 20 (49%) had a short-term disability. Seventy-five percent of the attacks have happened during vulnerable time periods (4 am–8 am or 4 pm–8 pm), and 93% have happened in the vicinity of human habitats. Human injuries caused by wild elephant attacks have led to high injury severities, disabilities, and fatalities. Therefore, to reduce the overall negative outcomes of these injuries and to decrease the health economic burden, all possible steps have to be taken for the primary prevention of human injuries caused by wild elephant attacks. The majority of the victims in the cohort have not received prehospital care after the elephant attacks and have been transferred to the surgical facility, with an average transport time of over an hour. With such inferences, this study has highlighted several deficiencies in initial trauma care management in rural areas of Sri Lanka, signifying the need to have an improved prehospital trauma care structure for better outcomes. The development of a streamlined trauma system and a dedicated trauma care hospital network equipped with adequate infrastructure and human resources would be the sustainable answer to this ongoing concern of uncoordinated overall major trauma care in Sri Lanka. All major trauma victims including the ones that resulted from wild elephant attacks would surely benefit from such a development.