J.A. Razzak, S.P. Luby

Department of Community Health Sciences

According to Pakistan Demographic Survey, injuries, accidents and poisoning are the most common cause of death in the age group 15-45 years and the third leading cause of death in urban Pakistan. Developing sound intervention strategies to reduce the number of injury deaths requires a clear understanding of the problem. Unfortunately, epidemiological data on Injuries and accidents in Pakistan is scarce. We used the Edhi Ambulance Service (EAS) database to characterize serious injuries in Karachi. EAS is the largest ambulance service in Karachi, with more than 120 ambulances providing emergency services 24 hours per day.

We reviewed the records of all the victims of accident and injuries who were transported from the site of accident to the hospital by EAS between January 1 and June 31, 1994. The information which was in Urdu, was first coded and then entered into a computer.

From January to June 1994, Edhi ambulances transferred 1743 injured to a hospital. Road traffic Accident (RTAs) accounted for 1146 (66%) of the injuries, homicidal/homicidal attempts for 346 (20%) and others causes including burns, falls, electrocution and drowning for 251 (14%). These injuries led to a total of 454 deaths before reaching the hospital. One hundred seventy-six of the deaths (39%) were due to RTAs; 157 (35%) were due to homicide and 53 (12%) to other causes. The prehospital fatality rate was 15% for RTAs and 45% for homicides. Males were more likely than females to be injured both in RTAs (84% versus 16%) as well as in homicide (93% versu 7%). The mean age of the RTA victims and homicide victims was 33 and 26 years respectively. Most RTA victims were pedestrians 424(37%), motorcyclists 241(21%), and car passenger of (8%). Among the attempted homicide cases, 215 (62%) were due to gun shots, 55 (16%)were fist fights and 37 (11%) were due to blunt objects. Victims having gunshot injuries were more likely to die before reaching the hospital than homicide attempt victims assaulted by other means. (109 (51%) vs. 48 (37%) (odds ratio 1.8; p=0.01).

Edhi Ambulance Service data suggests that homicide and motor vehicle injuries are the two leading causes of injury death in Karachi. Young males are at particular risk. Interventions to reduce road traffic deaths should focus on pedestrian and motorcycle safety. For the large number of homicidal deaths occurring before reaching the hospital, improving curative care would not prevent their deaths. Thus emphasis should rather be placed on preventing the occurrence of violence.

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