Evaluation of Trauma Care Capabilities in Four Countries Using the WHO-IATSIC Guidelines for Essential Trauma Care
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We sought to identify affordable and sustainable methods to strengthen trauma care capabilities globally, especially in developing countries, using the Guidelines for Essential Trauma Care. These guidelines were created by the World Health Organization (WHO) and the International Society of Surgery and provide recommendations on elements of trauma care that should be in place at the range of health facilities globally.
The guidelines were used as a basis for needs assessments in 4 countries selected to represent the world’s range of geographic and economic conditions: Mexico (middle income; Latin America); Vietnam (low income; east Asia); India (low income; south Asia); and Ghana (low income; Africa). One hundred sites were assessed, including rural clinics (n = 51), small hospitals (n = 34), and large hospitals (n = 15). Site visits utilized direct inspection and interviews with administrative and clinical staff.
Resources were partly adequate or adequate at most large hospitals, but there were gaps that could be improved, especially in low-income settings, such as shortages of airway equipment, chest tubes, and trauma-related medications; and prolonged periods where critical equipment (e.g., X-ray, laboratory) were unavailable while awaiting repairs. Rural clinics everywhere had difficulties with basic supplies for resuscitation even though some received significant trauma volumes. In all settings, there was a dearth of administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and regular in-service training.
This study identified several low-cost ways in which to strengthen trauma care globally. It also has demonstrated the usefulness of the Guidelines for Essential Trauma Care in providing an internationally applicable, standardized template by which to assess trauma care capabilities.
KeywordsTrauma Care Large Hospital Trauma Registry Small Hospital Preventable Death
We thank all who took part in the study for their time, helpfulness, and insights.
- 1.Peden M, Scurfield R, Sleet D, et al. World report on road traffic injury prevention. Geneva, World Health Organization, 2004Google Scholar
- 2.Goel A, Kumar S, Bagga M. Epidemiological and trauma injury and severity score (TRISS) analysis of trauma patients at a tertiary care centre in India. Nat Med J India 2004;17:186–189Google Scholar
- 16.Mock C, Arreola-Risa C, Vega F, et al. Fortaleciendo la atencion del trauma en Mexico y a nivel mundial: Proyecto Atencio Esencial en Trauma [Strengthening trauma care in Mexico and globally: the Essential Trauma Care Project]. Trauma: La Urgenica Medica de Hoy 2004;7:5–14Google Scholar
- 17.Mock C, Lormand JD, Goosen J, et al. Guidelines for Essential Trauma Care. Geneva, WHO, 2004Google Scholar
- 18.Arreola-Risa C, Mock C, Vega Rivera F, et al. Evaluation of trauma care capabilities in Mexico Using the Guidelines for Essential Trauma Care. Pan Am J Public Health 2005; in PressGoogle Scholar
- 19.Quansah R, Mock C, Abantanga F. Status of trauma care in Ghana. Ghana Med J 2004;38:149–152Google Scholar
- 20.Nguyen S, Mock C. Improvements in trauma care capabilities in Vietnam through use of the WHO-IATSIC Guidelines for Essential Trauma Care. In Control Saf Promot 2005; in PressGoogle Scholar
- 21.American College of Surgeons. Advanced Trauma Life Support: Student Course Manual. Chicago, American College of Surgeons, 2004Google Scholar
- 22.Emergency Nurses Association. Trauma nursing core course. http://www.ena.org (Accessed on 9 March, 2005)
- 23.Academy of Traumatology. National Trauma Management Course. Ahmedabad, Academy of Traumatology, 2001Google Scholar
- 29.World Health Organization. The Burden of Musculoskeletal Conditions at the Start of the New Millenium: WHO Technical Report Series 919. Geneva, WHO, 2003Google Scholar
- 33.American College of Surgeons Committee on Trauma. Resources for the optimal care of the injured patient: 1999, American College of Surgeons, 1999Google Scholar
- 38.Chardbunchachai W, Suppachutikul A, Santikarn C. Development of Service System for Injury Patients by Utilizing Data from the Trauma Registry (ISBN: 974-294-569-1). Khon Kaen, Thailand, Office of Research and Textbook Project, Khon Kaen Hospital, 2002Google Scholar
- 39.Fort M, Mercer M, Gish O. Sickness and wealth. Cambridge, MA, South End Press, 2004Google Scholar