Impacting Global Emergency Care

Innovative strategies and sustainable solutions


 
 

CDC | | Monday, February 7, 2011


The impact of injuries is felt on every continent. Regardless of gender, race, or economic status, injuries remain a leading cause of death worldwide, accounting for more than 5.8 million deaths each year.

However, injury deaths are only part of the picture. Millions more are injured each year and many are left with disabilities for the rest of their lives.

For those who are seriously injured, trauma care is critical not only to improving their chances for survival, but also for averting many lifelong injury-related disabilities and improving services provided to people with disabilities so they can engage more fully in daily life. However, currently, the vast majority of people across the globe have little or no access to appropriate trauma care.

What is Being Done to Address this Problem?
A significant portion of the deaths and disabilities caused by injuries could be eliminated by improvements in trauma care, but there is often a sense that such improvements are too difficult, complicated or expensive to institute widely, especially in low- and middle-income countries.

With this is in mind, the World Health Organization (WHO), with support from the Centers for Disease Control and Prevention (CDC), responded by supporting countries in planning and setting up trauma care programs to strengthen their capacity to care for the injured. Through perseverance, detailed planning and organization, training opportunities, and a groundswell of commitment at the local, national, provincial or institutional levels, this collaboration is leading to improvements across the globe. Below are just a few highlights from these activities, which focus on practical, affordable and sustainable efforts: that help dispel the view that little can be done to improve trauma care, especially in low- and middle-income countries.

Cambodia and Iraq: Building a Safety Net of Unique Emergency Responders
In post-conflict, landmine-ridden rural areas of Cambodia and Iraq, there were no formal emergency medical services (EMS). An innovative program created a two-tier network of village ‘first responders’ (villagers who had completed a 2-day basic first aid course) and paramedics (trained on a 450-hour course). Mortality among injured people declined dramatically, from 40% to 8%. This program supplied training and basic equipment, but no ambulances or other vehicles. Over time, the system grew and adapted to a changing epidemiological pattern of increasing numbers of road traffic crash victims and other medical emergencies.

Ghana: Creation of a National Ambulance Service
In Ghana, a large number of injured people die before even arriving at a hospital for care. In response, the government created the National Ambulance Service. This was created with a well-organized structure of administration, clearly defined standards for staff training and for equipment carried in ambulances, well-defined operating procedures, accurate recording of data of cases handled, and use of that data for management and quality improvement. Since its inception, use of the service has grown steadily and key performance indicators, such as response time has consistently improved.

Colombia and Romania: National Policies Pave the Way for Improving Care
In both Colombia and Romania, nationwide legislation on EMS has been enacted. This established more uniform and nationwide standards for training levels for prehospital EMS staff, for equipment in ambulances, and for operating procedures for ambulance systems. Mechanisms were put in place to allow government to enforce these standards. Development of the legislation involved close collaboration between government and EMS professionals.

Thailand: Basic Quality and System Review Led to a Reduction in Injury Deaths
Thailand instituted a quality improvement program at one of the main hospitals. The hospital administration set up a trauma audit committee and gave it the power to make changes. It used a trauma registry to identify correctable problems, including insufficient resuscitation of patients in shock and prolonged time to reach emergency head surgery. Corrective actions included increasing senior staffing levels in the emergency department at peak times, and a radio system in the hospital to better alert neurosurgeons and other specialists when they were needed. Preventable deaths decreased from 8% to 4.6% and overall trauma mortality decreased from 3.2% to 1.3% in 2000.

Vietnam: Low Cost Education and Training Improve Trauma Care Capabilities
In Vietnam, a citywide assessment of trauma care capabilities in the network of clinics and hospitals located in the capital city Hanoi, and surrounding rural areas, identified several low-cost improvements. Training programs were instituted and greater attention to detail was given to the stocking and procurement of trauma care equipment and supplies. There had been considerable improvement in trauma care capabilities when the assessment was completed the following year, despite no extra budget being allocated to trauma care.

India: Rehabilitation Services Drastically Reduce Mortality in a Devastated Region
The earthquake in Gujarat, India, left a large number of people with paraplegia, for whom existing rehabilitation services were minimal. A program developed by the state health services, nongovernmental organizations and civil society led to better availability of rehabilitation services (including expertise, affordable wheelchairs and other assistive devices) in hospitals, clinics, and in the community. Five-year mortality among paraplegic people declined from 60% to 4%. The program was scaled-up across the entire state and grew to include a wide range of disabilities.

Canada: Reduction in Injury Deaths Emphasizes the Power of Guidelines
Trauma mortality rates in Quebec Province, Canada, were higher than many other places in North America. This was believed to be the result of disjointed and non-standardized care by the many different ambulance services and hospitals. Province-wide improvements included creating guidelines for prehospital triage, care at the scene (to decrease prehospital times) and inter-hospital transfer. Criteria were established for trauma care capabilities at hospitals of varying levels and enforced through an external review board. A statewide trauma registry provided data to monitor these changes and confirmed that mortality rates among the severely injured decreased from 52% prior to initiation of the system in 1990 to 8% from 1998 onward.

How Does this Impact EMS in the United States?
These changes did not happen overnight. There were many ups and downs and frustrations along the way. The improvements were accomplished by people working in the system who, despite frustrations and short-term failures, persevered in order to make gradual, but steady progress. Improvements can be made even in the poorest and most difficult of circumstances, such as post-conflict, landmine-ridden areas of Cambodia and Iraq. Conversely, even well¬-resourced environments can benefit from improved organization and monitoring of trauma care services, such as in the United States and Canada.

There is significant progress being made in strengthening care of the injured, in countries at all economic levels and across the spectrum of prehospital care, acute hospital care, and rehabilitation. Further collaborations and exchange of ideas among those working in the field can help lead to more widespread and systematic efforts to strengthen trauma care services in all countries. In so doing, the lives of many injured people will be saved, many injury-related disabilities averted, and people with disabilities will receive better services and be integrated back into active life more fully.

Content for this fact sheet is based on the WHO report, (WHA60.22) “Strengthening care for the injured: Success stories and lessons learned from around the world.”

To view the full report from WHO or to learn more about trauma care worldwide, go to: www.cdc.gov/TraumaCare.
 




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