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THE APPROACH TO TRAUMA CARE

RAYMOND R. PRICE MD

DIRECTOR CENTER FOR GLOBAL SURGERY, UNIVERSITY OF UTAHDIRECTOR GRADUATE SURGICAL EDUCATION, INTERMOUNTAIN MEDICAL CENTER

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Professor J. M. K. QuarteyDr Isaac Bentsi

Dr Benjamin Osei-Wiafe

Disaster Strikes Korle-BuRoad tragedy kills three prominent Urologists

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-Two front tires on the saloon car exploded

-Pay to fuel a private ambulance before transporting victims

-All the passing vehicles ignored the signals and pleas for assistance refusing to stop and help

http://ww

w.ghanaiantim

es.com.gh/1634-died-in-road-accidents/

Road Traffic Accidents in LMICs

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INJURY: 5.8 MILLION DEATHS/ YEAR

Injuries and violence: the facts. Geneva, World Health Organization, 2010.

1.24 million deaths from Road Traffic Injuries

$1,073 million

$33 million

US Global Research and Development Funding

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20-50 MILLION NON-FATAL INJURIES

7th Day Adventist Clinic Ethiopia

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Estimated Road Traffic Death Rate(per 100,000 population)

91% of injury-related deaths world-wide occur in low- and middle- income countries (LMICs)

RURAL DISPROPORTIONATELY HIGHER MORTALITY FROM ROAD TRAFFIC INJURIES THAN URBAN

• Vietnam:– 60.7 deaths/100,000 people/ year in the

northern, poorer, rural areas– 36.4 deaths/ 100,000/ year in the

provinces surrounding the larger urban area of Ho Chi Minh City

• People with life-threatening but salvageable injuries from low-income areas: – 6x’s more likely to die than people from

high-income areas (36% vs. 6%, respectively)

“Bronze 2 Days”

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“…the surgery of trauma will, or ought to, shrink in the future as the result of the labours of preventive mediciners applying their methods of investigation both to the causes of accidents and...to the deeper psychological attitudes of a nation which still tolerates too many.”

The Contributions of Surgery to Preventive Medicine

University of London, Heath Clark Lectures( 1949)The London School of Hygiene and Tropical Medicine

Sir James LearmonthScottish Surgeon

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Identify any dangerous behaviors?

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Family Trips

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Nawalparasi, Nepal Bus Accident35 passengers died (2012)

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ROAD TRAFFIC ACCIDENTS (RTAS)• Rome:

– Julius Caesar banned carts and chariots before 3:00 P.M. in the city

• England in the 1700s:– Injuries resulting from carts and

coaches were the leading cause of death

• New York City, 1867:– an average of four pedestrians

per week were trampled by spooked horses

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SURGERY AS A PUBLIC HEALTH STRATEGY

1. Trauma

2. Obstetrical Emergencies

3. Acute Surgical Emergencies

4. Non-acute Surgical Conditions

World Bank (Debas): Disease Control Priorities 2nd ed, chapter 67

Prioritization of Surgical Conditions1. Public health burden2. Surgical procedure successful3. Cost-effective and feasible to promote globally

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REDUCING DEATH AND MORBIDITY FROM TRAUMA

1. Assessment (data collection)

2. Policy Development (design and implement targeted intervention)

3. Assurance (outcome measurements and evaluation)

Integrate the Three Primary Strategies of Public Health:

Dan Egan MD

Bilateral Femur FractureHaiti 2010

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Assessment

Public Health Trauma

Policy Development

Assurance

Monitor Health

Diagnose and Investigate

Injury Data Collection

Gap Analysis Survey

Inform, Educate, Empower

Mobilize Community Partnerships

Develop Policies

Process Improvement and Education Program

Trauma System Advisory Committee

Legislation

Enforce Laws

Link to Provide Care

Ensure Competent WorkforceEvaluate

Rules and Regulations

Pre-hospital and Definitive Care

Human ResourcesEvaluation

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CHANGE IN TRAFFIC FATALITY RISK (DEATHS/ 10,000 PERSONS) 1975-1998

Trauma systems decrease mortality by

15-20% in high-income countries.

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• > 2million deaths/yr could be averted

• Economic benefit of mortality reduction = $245-261 billion

Benefit of Trauma System Development in LMICs

Disease Control Priorities 3rd ed.

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TRAUMA SYSTEMS

Conclusion

Critical for LMICs to create or strengthen existing

trauma systems in order to improve outcomes

Trauma Systems• Prevention• Pre-hospital care

– Standards/ protocols• Definitive Hospital Care

– Network of facilities– Verification trauma centers– Transfer guidelines

• Rehabilitation• Process Improvement

– Trauma registries/ research

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WORLD HEALTH ASSEMBLY RESOLUTIONSWHA 56.24: Strengthen trauma and care services

WHA 57.10: Strengthen emergency and rehabilitation services for victims of RTI’s

WHA 58.23: Address prevention, management (including timely and effective surgery where required) and rehabilitation to prevent disability

WHA 60.22 Strengthen provision of trauma & emergency care

WHA 68.15: Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage

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• By 2030 halve deaths from road traffic accidents

• Strengthen health systems to ensure that they have the resources, capacities, and technologies needed to provide quality, affordable, acceptable and accessible services along the continuum of care including prevention, promotion, early detection, medical and surgical treatment, rehabilitation and palliative care, and monitor health system performance.

3. Attain healthy life for all

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THE APPROACH TO TRAUMA CARE?Create or strengthen existing

trauma systems

EducationImplementation

InnovationResearch Advocacy

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