THE APPROACH TO TRAUMA CARE

Transcription

1 THE APPROACH TO TRAUMA CARE RAYMOND R. PRICE MD DIRECTOR CENTER FOR GLOBAL SURGERY, UNIVERSITY OF UTAH DIRECTOR GRADUATE SURGICAL EDUCATION, INTERMOUNTAIN MEDICAL CENTER

2 Disaster Strikes Korle-Bu Road tragedy kills three prominent Urologists Professor J. M. K. Quartey Dr Isaac Bentsi Dr Benjamin Osei-Wiafe

3 Road Traffic Accidents in LMICs -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

4 INJURY: 5.8 MILLION DEATHS/ YEAR US Global Research and Development Funding $1,073 million $33 million 1.24 million deaths from Road Traffic Injuries Injuries and violence: the facts. Geneva, World Health Organization, 2010.

5 20-50 MILLION NON-FATAL INJURIES 7 th Day Adventist Clinic Ethiopia

6 91% of injury-related deaths world-wide occur in low- and middle- income countries (LMICs) Estimated Road Traffic Death Rate (per 100,000 population)

7 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

8 The Contributions of Surgery to Preventive Medicine Sir James Learmonth Scottish Surgeon 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. University of London, Heath Clark Lectures( 1949) The London School of Hygiene and Tropical Medicine

9 Identify any dangerous behaviors?

10 Katmandu Post

11 Family Trips

12 Nawalparasi, Nepal Bus Accident 35 passengers died (2012)

13 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

14 SURGERY AS A PUBLIC HEALTH STRATEGY 1. Trauma 2. Obstetrical Emergencies 3. Acute Surgical Emergencies 4. Non-acute Surgical Conditions Prioritization of Surgical Conditions 1. Public health burden 2. Surgical procedure successful 3. Cost-effective and feasible to promote globally World Bank (Debas): Disease Control Priorities 2 nd ed, chapter 67

15 REDUCING DEATH AND MORBIDITY FROM TRAUMA Integrate the Three Primary Strategies of Public Health: 1. Assessment (data collection) 2. Policy Development (design and implement targeted intervention) 3. Assurance (outcome measurements and evaluation) Bilateral Femur Fracture Haiti 2010 Dan Egan MD

16 Assessment Policy Development Assurance Public Health Monitor Health Diagnose and Investigate Inform, Educate, Empower Mobilize Community Partnerships Develop Policies Enforce Laws Link to Provide Care Ensure Competent Workforce Evaluate Trauma Injury Data Collection Gap Analysis Survey Process Improvement and Education Program Trauma System Advisory Committee Legislation Rules and Regulations Pre-hospital and Definitive Care Human Resources Evaluation

17 CHANGE IN TRAFFIC FATALITY RISK (DEATHS/ 10,000 PERSONS) Trauma systems decrease mortality by 15-20% in highincome countries.

18 Benefit of Trauma System Development in LMICs Disease Control Priorities 3 rd ed. > 2million deaths/yr could be averted Economic benefit of mortality reduction = $ billion

19 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

20 WORLD HEALTH ASSEMBLY RESOLUTIONS WHA 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 Strengthen provision of trauma & emergency care WHA 68.15: Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage

21 3. Attain healthy life for all 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.

22 THE APPROACH TO TRAUMA CARE? Create or strengthen existing trauma systems Education Implementation Innovation Research Advocacy

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