Orthopaedic emergencies, including fractures, dislocations, open wounds, spinal injuries, and severe musculoskeletal trauma, represent a significant portion of emergency room visits globally and require timely recognition and management to prevent long-term disability or death. In low- and middle-income countries like India, where healthcare access and infrastructure vary widely between urban and rural areas, delays in responding to orthopaedic emergencies are frequently attributed not only to systemic gaps but also to a lack of public awareness. Despite advancements in emergency medical services (EMS), the average community member's knowledge regarding first response, immobilization, or when to seek urgent care for orthopaedic  injuries   remains   limited   and  inconsistent.

Mismanagement or neglect of such emergencies—particularly in pre-hospital settings—can lead to preventable complications, including neurovascular compromise, chronic deformity, or infection [1-5].

Himachal Pradesh, a hilly and predominantly rural state in northern India, presents unique challenges in emergency orthopedic care. The region’s difficult terrain, frequent road traffic accidents on mountainous roads, and prevalence of physically demanding occupations such as farming, construction, and manual labor increase the risk of orthopaedic trauma. However, limited public transport, difficult weather conditions, and the sparsity of trauma centers in rural areas often delay medical attention. In such scenarios, the first response by community members plays a critical role in minimizing damage and improving outcomes. Yet, there exists a conspicuous gap in community-level preparedness and knowledge regarding orthopaedic emergencies, particularly in recognizing red flags, practicing safe handling of injured persons, and accessing care in a timely manner [6-10].               

From an orthopedic and public health perspective, strengthening community-level awareness is a foundational step in building a responsive and resilient emergency care system. Empowering adults with basic knowledge of orthopaedic first aid, signs of critical injuries, and the importance of early referral can drastically reduce complications and enhance recovery [11,12]. Unfortunately, there is a dearth of research examining the population's understanding of orthopaedic emergencies in the Indian context, especially in geographically complex regions like Himachal Pradesh. To bridge this knowledge gap, the present study was conducted to assess the awareness and understanding of orthopaedic emergencies among adults in Himachal Pradesh. The findings aim to inform community health programs, guide emergency preparedness initiatives, and contribute to reducing the burden of disability resulting from delayed or inappropriate management of musculoskeletal trauma.

Study Design and Objective

This descriptive, cross-sectional study was undertaken to assess the level of awareness and knowledge regarding orthopaedic emergencies among the adult population in Himachal Pradesh. The primary objective was to evaluate the public’s understanding of common musculoskeletal emergencies, essential first aid responses, and the need for prompt orthopedic care in acute scenarios such as fractures, dislocations, spinal injuries, and open wounds.

Study Area and Population

The study was conducted across various districts of Himachal Pradesh, ensuring participation from both urban and rural communities. Adults aged 18 years and above, from diverse educational, occupational, and socio-economic backgrounds, were invited to participate. Individuals with formal medical or paramedical training were excluded to maintain the focus on general community awareness.

Sample Size and Sampling Technique

A total of 400 participants were included in the study. The sample size was calculated based on a 95% confidence level, 5% margin of error, and an assumed 50% knowledge rate to ensure adequate representation. A purposive and convenience sampling approach was used. The survey was digitally disseminated through WhatsApp, Facebook, email, and community networks to encourage voluntary participation.

Data Collection Tool

A structured, bilingual (English and Hindi) questionnaire was developed using Google Forms. The tool was designed with input from orthopaedic surgeons, public health professionals, and trauma care experts to ensure medical accuracy and public relevance. The questionnaire consisted of three key sections:

• Socio-Demographic Information: Including age, gender, education level, occupation, and residence (urban/rural).

• Knowledge Assessment: Comprising 20 multiple-choice questions covering the identification of orthopedic emergencies, immediate actions during accidents or falls, and first-response protocols such as immobilization, bleeding control, and signs of neurological damage.

• Experience and Awareness: Assessing whether participants had previously witnessed or responded to an orthopedic emergency and their sources of information (e.g., internet, healthcare providers, media).

Pilot Testing

A pilot study involving 30 adults from different districts was conducted to assess clarity, digital accessibility, and contextual relevance. Minor revisions were made based on feedback, particularly in simplifying medical terminology and ensuring user-friendly language.

Scoring and Classification

Each correct response in the knowledge section received one point, with total possible scores ranging from 0 to 20. Knowledge levels were classified as follows:

• Very Good Awareness: 17–20

• Good Awareness: 13–16

• Fair Awareness: 9–12

• Poor Awareness: 0–8

This stratification enabled comparative analysis based on socio-demographic characteristics.

Ethical Considerations

Participation was voluntary, and informed electronic consent was obtained before the survey began. The purpose of the study, confidentiality measures, and anonymity of responses were explained at the start of the form. Ethical guidelines were followed in accordance with the principles of the Declaration of Helsinki.

Data Analysis

Responses collected via Google Forms were exported to Microsoft Excel and analyzed using Epi Info Version 7. Descriptive statistics (frequencies and percentages) were used to summarize participant demographics and knowledge scores. Chi-square tests were used to examine associations between knowledge levels and socio-demographic factors, with a p-value<0.05 considered statistically significant.

Table 1 outlines the socio-demographic profile of the 400 adult participants involved in the study on orthopaedic emergency awareness in Himachal Pradesh. The age distribution revealed that the largest group was aged 46 and above (30.7%), followed by those aged 26–35 years (29.5%), reflecting a balanced representation across both working-age and older populations. The gender distribution was relatively even, with 52.8% males and 47.3% females. Education levels varied widely; 33.8% had completed secondary education, while 29.0% held undergraduate degrees, and 14.8% were postgraduates, though 7.3% had no formal education—indicating significant diversity in literacy and potential exposure to health education. The occupational spread included private sector employees (22.0%), self-employed individuals (17.8%), and government workers (16.5%), with homemakers and students also substantially represented. More than half the respondents (54.8%) were from rural areas, ensuring inclusivity of hard-to-reach communities. Regarding marital status, 66.5% were married, 27.0% unmarried, and 6.5% widowed or separated. This diversity provides a robust demographic base for analyzing variations in knowledge levels across different population groups.

Table 2 presents the results of the 20-item awareness questionnaire designed to assess participants' understanding of orthopaedic emergencies and appropriate first aid responses.

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

Table 2: Awareness Questions on Orthopaedic Emergencies Among Adults (n = 400)

Table 3: Knowledge Score Classification Among Participants (n = 400)

Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)

Overall, the correct response rates ranged from 61.5% to 72.8%, suggesting moderate to good awareness in the population. Notably, 72.8% correctly identified open fractures with bleeding as an emergency, and 72.0% understood the importance of immobilization in suspected fractures. Awareness was also strong for the role of trained responders in spinal injuries (67.3%) and the importance of early treatment to prevent disability (70.3%). However, knowledge was slightly weaker on questions related to pressure application during bleeding (61.5%) and the dangers of incorrect transport (67.5%). Encouragingly, most respondents were aware of the life-threatening nature of spinal injuries if mishandled (70.8%) and the critical "golden hour" after trauma (65.3%). These findings highlight a reasonable baseline knowledge of orthopaedic first aid, though targeted education is needed for more technical and situational aspects of emergency response

Table 3 summarizes the overall distribution of knowledge scores among the 400 participants. A majority of the respondents demonstrated either Very Good (29.8%) or Good (35.3%) knowledge, indicating that roughly two-thirds of the sample had above-average awareness regarding orthopaedic emergencies. Meanwhile, 23.3% fell into the Fair category, and 11.8% had Poor knowledge. This spread suggests a meaningful knowledge gap in nearly one-third of the population, which could negatively impact emergency response behaviors in real-life situations. While the presence of high-scoring individuals indicates growing public understanding, the proportion in lower categories emphasizes the need for widespread awareness campaigns, especially among underserved or lower-educated groups.

Table 4 displays the associations between participants’ knowledge levels and their socio-demographic variables. Age was significantly associated with awareness (p = 0.028), with those in the 26–35 and 36–45 age brackets performing better than the oldest cohort (46+), which had the highest proportion of Fair and Poor scores. Education level was the most influential factor (p<0.001), as participants with postgraduate and undergraduate education overwhelmingly clustered in the Very Good and Good categories, while those with little or no education largely fell into Fair or Poor awareness. Occupation also showed a significant correlation (p = 0.036), with students, government employees, and private sector workers exhibiting higher awareness compared to homemakers and the retired group. Urban residents performed better overall (p = 0.043), reinforcing the urban–rural disparity in access to health education and emergency preparedness. Interestingly, no statistically significant difference was observed between genders (p = 0.211), indicating relatively uniform awareness across male and female respondents. These results underscore the need for targeted interventions focused on older adults, rural populations, and those with lower education to ensure equitable access to orthopaedic emergency knowledge.

The findings of this community-based study highlight both encouraging levels of general awareness and critical knowledge gaps regarding orthopaedic emergencies among adults in Himachal Pradesh. With nearly two-thirds of participants scoring in the “Very Good” and “Good” categories, it is evident that a foundational understanding of orthopedic emergencies exists within the population. Respondents demonstrated relatively high accuracy on questions addressing open fractures, spinal injury risks, immobilization protocols, and the need for early intervention—key aspects that can significantly affect outcomes in trauma care. These results likely reflect a gradual improvement in public health literacy, possibly driven by digital media, increased interaction with healthcare systems, and informal knowledge-sharing in communities.

Despite these positive trends, the data also revealed significant deficits in essential first aid knowledge and situational judgment during orthopedic trauma. For instance, only around 61.5% of participants knew the appropriate steps for managing bone-related bleeding, and many were uncertain about critical concepts such as the golden hour or safe transport techniques for injured individuals. These knowledge gaps are particularly concerning in a hilly region like Himachal Pradesh, where delays in reaching medical facilities are common due to terrain and infrastructure limitations. In such contexts, immediate community response becomes even more critical, and mismanagement during the pre-hospital phase can lead to preventable complications like infection, long-term disability, or even mortality.

Socio-demographic analysis further underscored inequities in awareness. Education was the most influential determinant of knowledge, with those having secondary or higher education levels significantly outperforming less-educated respondents. This supports the broader public health consensus that literacy and educational attainment are strongly correlated with health knowledge and behavior. Age was also significantly associated with awareness levels, with younger and middle-aged adults demonstrating better understanding than older participants, potentially due to greater digital engagement and exposure to modern health information. Occupation and residence had additional influence, as urban dwellers and those in professional or student roles exhibited higher scores than rural residents, homemakers, or retired individuals. This urban–rural divide emphasizes the continuing challenge of ensuring equitable health communication across geographically and socioeconomically diverse populations.

Gender differences, while statistically insignificant, showed a slightly higher representation of men in the higher knowledge brackets, which may be influenced by differences in mobility, employment, and access to public information channels. However, the close distribution suggests that awareness programs can be equally effective across genders when designed inclusively.

These findings collectively point to the need for structured, context-specific health education strategies that not only raise awareness about orthopedic emergencies but also focus on empowering individuals with actionable knowledge. Training programs at the community level—especially in rural and underserved areas—should prioritize practical first aid, safe handling techniques, recognition of red flags, and the importance of early referral. Utilizing platforms like ASHA workers, local self-help groups, village health committees, and digital outreach can help tailor the message effectively for different literacy levels and cultural backgrounds. In geographically isolated regions like Himachal Pradesh, where medical access is inherently limited, community preparedness must be treated as a frontline defense in emergency orthopaedic care [9-12].

Limitations

While this study offers valuable insights into community awareness of orthopaedic emergencies in Himachal Pradesh, certain limitations must be acknowledged. The data was collected using an online Google Forms questionnaire, which may have inadvertently excluded individuals without internet access or digital literacy—particularly older adults or those from remote rural areas. Additionally, the self-reported nature of the responses may introduce bias due to social desirability or misinterpretation of questions. The use of a convenience sampling method, while practical for digital distribution, limits the generalizability of findings to the broader population. Moreover, the study focused only on knowledge and not on observed practices or outcomes, which could have provided a more comprehensive picture of real-world emergency response behavior.

This study reveals that although a considerable portion of the adult population in Himachal Pradesh possesses a foundational understanding of orthopaedic emergencies, substantial knowledge gaps remain—especially concerning first aid procedures, critical response timing, and the handling of spinal and complex trauma cases. Educational background, age, occupation, and place of residence significantly influenced awareness levels, highlighting disparities that warrant attention. Given the region's challenging geography and limited access to immediate trauma care, empowering the general public with accurate, practical knowledge is crucial for minimizing injury-related complications and fatalities. The findings underscore the need for community-level interventions that bridge the knowledge gap and foster a culture of preparedness for orthopedic emergencies.

Recommendations

To enhance community preparedness and reduce preventable disability from orthopedic trauma, targeted public health initiatives should be prioritized in Himachal Pradesh. Government health departments, NGOs, and local healthcare providers should collaborate to develop and disseminate culturally sensitive, multilingual training programs focused on orthopaedic first aid, fracture immobilization, and spinal injury precautions. Mobile health units and digital platforms can be leveraged to reach rural populations, while incorporating emergency preparedness modules into school curricula and adult education programs can foster long-term impact. Furthermore, capacity-building among frontline workers like ASHA and Anganwadi staff should be emphasized to ensure that correct information and basic care techniques are accessible even in the remotest areas. Continuous monitoring and evaluation should be built into these programs to ensure efficacy and sustained engagement.

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