Essential Trauma Care Guidelines

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Emergency Surgery Workshop Davos 2011: Presentation by Manjul Joshipura, MD, Scientist, Violence and Injury Prevention and Disability (VIP), WHO, Geneva, Switzerland

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Essential Trauma Care Guidelines

  1. 1. Essential Trauma Care Guidelines Strengthening Care of the Injured Globally Manjul Joshipura World Health Orgnization, Genenva
  2. 2. Guidelines <ul><li>Essential Trauma Care </li></ul><ul><li>Essential Emergency Surgery </li></ul><ul><li>Guidelines for Health System at the Disaster </li></ul>
  3. 3. PERCENT OF THOSE WITH LIFE-THREATENING, BUT SALVAGEABLE, INJURIES (ISS 15-24) WHO DIE Percent of injured patients who expire Source: Trauma Outcomes in the Rural Developing World: Comparison with an Urban Level I Trauma Center J Trauma, 35:518 , 1993
  4. 4. PERCENT OF ALL SERIOUSLY INJURED (ISS > 9) WHO DIE Percent of injured patients who expire
  5. 5. If we could eliminate these inequities: Over 2,000,000 of the 5,800,000 injured people who die each year could be saved.
  6. 6. Hospital based care: Working Group for Essential Trauma Care <ul><ul><li>International Society of Surgery (ISS-SIC) </li></ul></ul><ul><ul><li>WHO </li></ul></ul><ul><ul><li>Input from: </li></ul></ul><ul><ul><ul><li>40 experts </li></ul></ul></ul><ul><ul><ul><li>20 countries </li></ul></ul></ul>
  7. 7. <ul><ul><ul><li>E.P.I. </li></ul></ul></ul><ul><ul><ul><li>Global TB Program </li></ul></ul></ul><ul><ul><ul><li>Safe Motherhood </li></ul></ul></ul><ul><ul><ul><li>Trauma System Development </li></ul></ul></ul><ul><ul><ul><li>15-20% decreased mortality </li></ul></ul></ul><ul><ul><ul><li>50% decrease in: </li></ul></ul></ul><ul><ul><ul><li>medically preventable deaths </li></ul></ul></ul>
  8. 8. 11 essential services: Brief examples <ul><li>Assure that obstructed airways are opened </li></ul><ul><li>Assure that bleeding (external or internal) is stopped </li></ul><ul><li>Assure that potentially disabling orthopedic injuries are corrected </li></ul>
  9. 9. Essential Trauma Care: Sample Resource Tables
  10. 10. Breadth of Trauma Care <ul><li>Airway </li></ul><ul><li>Breathing </li></ul><ul><li>Circulation and Shock </li></ul><ul><li>Head </li></ul><ul><li>Neck </li></ul><ul><li>Chest </li></ul><ul><li>Abdomen </li></ul><ul><li>Extremity </li></ul><ul><li>Spine </li></ul><ul><li>Burns and Wounds </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Pain Control and Medications </li></ul><ul><li>Diagnosis and Monitoring </li></ul><ul><li>Security for Health Care Personnel </li></ul>
  11. 11. Guidelines Part planning guide: MOHs, facilities Part advocacy document
  12. 12. ESSENTIAL TRAUMA CARE: Other groups involved <ul><li>World Federation of Societies of Anaesthesiologists </li></ul><ul><li>World Federation of Neurosurgical Societies </li></ul><ul><li>Int. Society of Physical Medicine & Rehabilitation </li></ul><ul><li>International Committee of the Red Cross </li></ul><ul><li>SICOT: Int. Soc Ortho and Traumatology </li></ul><ul><li>Several National Organizations </li></ul>
  13. 13. EsTC Stakeholders Meetings India, April 2003 & February 2005 Mexico, March 2004 Ghana, June 2005 Vietnam, March 2005
  14. 16. Needs assessments as stimulus for action
  15. 17. Guidelines <ul><li>Essential Trauma Care </li></ul><ul><li>Essential Emergency Surgery </li></ul><ul><li>Guidelines for Health System at the Disaster </li></ul>
  16. 18. What are the priorities ? <ul><ul><ul><ul><ul><li>Priority One </li></ul></ul></ul></ul></ul><ul><li>Trauma </li></ul><ul><li>General </li></ul><ul><ul><ul><ul><ul><li>Surgical Airway </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Thoracostomy tube placement </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Exploratory laparotomy </li></ul></ul></ul></ul></ul><ul><li>Burns </li></ul><ul><ul><ul><ul><ul><li>Tangential excision of burn </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Split-thickness skin grafting </li></ul></ul></ul></ul></ul><ul><li>Neurosurgical </li></ul><ul><ul><ul><ul><ul><li>Evacuation of cranial hematoma </li></ul></ul></ul></ul></ul><ul><li>Orthopaedic </li></ul><ul><ul><ul><ul><ul><li>External fixation (pelvic fracture, long bone fractures?) </li></ul></ul></ul></ul></ul>
  17. 19. Collaborative Effort <ul><li>Major International Professional Societies </li></ul><ul><li>UN Agencies </li></ul><ul><li>Disaster & Risk Reduction Stakeholders </li></ul>
  18. 20. Global Alliance for Care of the Injured
  19. 21. Guidelines <ul><li>Essential Trauma Care </li></ul><ul><li>Essential Emergency Surgery </li></ul><ul><li>Guidelines for Health System at the Disaster </li></ul>
  20. 22. Kobi Peleg, PhD MPH National Center for Trauma & Emergency Medicine Research, Israel
  21. 23. Optimizing the response Level I Level I Level I II II II Co-ordination
  22. 24. Guidelines <ul><li>Fundamental Policy Change to Disaster Response </li></ul><ul><li>Role of USR teams ? ?? </li></ul><ul><li>Role for Medical Teams ? </li></ul>

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