Regional Trauma Initiative Saves Lives Through Training and Coordination
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Minimizing morbidity and mortality due to trauma in humanitarian emergencies
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Regional Trauma Initiative Saves Lives Through Training and Coordination
- 1. Minimizing morbidity and mortality due to trauma in humanitarian emergencies Proposal for regional action Richard Brennan Regional Emergency Director, WHO Health Emergencies Programme
- 3. Public health burden of trauma in humanitarian emergencies in the Region Fragile and conflict-affected contexts ◉ Afghanistan ◉ Iraq ◉ Lebanon ◉ Libya ◉ Pakistan ◉ Palestine ◉ Sudan ◉ Somalia ◉ Syrian Arab Republic ◉ Yemen Conflict and other man-made disasters ◉ 50 children killed every month in Yemen ◉ Bombings in Pakistan >60 dead and >150 injured ◉ Beirut port blast in 2020
- 4. Global trends indicate a rise in conflict and trauma Number of conflicts and conflict-affected countries, 1989–2022. Source: UCDP/PRIO Armed Conflict Dataset and UCDP Battle-Related Deaths Dataset (Davies, Pettersson & Öberg, forthcoming)
- 5. Public health burden of trauma in humanitarian emergencies in the Region Examples of countries prone to natural disasters ◉ Afghanistan ◉ Islamic Republic of Iran ◉ Jordan ◉ Libya ◉ Palestine ◉ Pakistan ◉ Syrian Arab Republic Natural disasters Earthquake in Syrian Arab Republic has resulted in >8400 dead and >14 500 injured Earthquake in Morocco left >2900 dead
- 6. Public health burden of trauma in humanitarian settings in the Region Fatality rates in low-income countries are triple those in high-income countries > 60% of trauma deaths occur before reaching the hospital yet there are limited prehospital services 25% deaths could be avoided with basic haemorrhage control
- 7. The impact of trauma Children <15 (paediatric age) account for 40% of the trauma case load Young adults, the most economically productive demographic, are disproportionately affected, facing lifelong disability
- 8. What is the status of trauma care services across the Region in fragile settings? PHASE 1 PREHOSPITAL CARE PHASE 2 2 HOSPITAL CARE PHASE 3 POSTHOSPITAL CARE Limited or no prehospital care services Poorly staffed Often entirely dependent on iNGOs
- 9. Strategic Direction A regional approach to trauma care in humanitarian settings to save lives and to reduce disabilities Mission The Solution: Regional Trauma Initiative Leadership from Ministry of Health at the national level Invest in the health care workforce through dedicated training programmes Coordinate with partners building a collective response
- 10. Examples of progress Support to 5 priority fragile countries in the Eastern Mediterranean Region and other regions in humanitarian emergencies 5 70 150 70 hospitals trained on mass casualty management. Hosted in Qatar 150 paramedics trained and prehospital services strengthened in Palestine, Somalia, Yemen Trauma is the entry point for emergency care systems
- 11. Discussion points for Member States Dedicated approach to trauma care Investing in prehospital care through to rehabilitation Develop accredited training To build the skillset of the health care workforce through accredited courses utilizing the Arab Board Utilize regional expertise To support low-income and fragile contexts
Editor's Notes
- PURPOSE OF SLIDE: to start with a story of a child to capture the attention of the audience. Key points to say: Gul, aged 12, is from Kandahar Afghanistan. He picked up an improvised device thinking it was a toy. The device exploded and he was left with injuries to the limbs and torso. Despite his critical state, Gul and his family were unable to access an ambulance because prehospital care services did not exist. They borrowed money from neighbours to take a taxi to the closest hospital, 5 hours away. Today Gul suffers from life-long disabilities. His family say that he is a burden as they cannot access any rehabilitation or longer-term care.
- PURPOSE OF SLIDE: demonstrate that violent trauma and man-made disasters are a major epidemic across the region Key points to say: 1. The story of Gul is not unique to Afghanistan. 9/22 countries in our region face some kind of violence within their borders. 2. Three examples that stand out: 50 children are killed every month in Yemen from the conflict alone. The likelihood of disabilities will be much higher. Earlier this year, in Pakistan the bombings in Peshawar resulted in over 60 dead and 150 injured. Sadly, since then there have been multiple bombings in the North Western Areas of the country. And the Beirut blast, demonstrated that man made disasters can happen at any point. In 2020, over 2000 people were injured and over 6500 hospital beds were wiped out in a single bast that took place by the port. Mass casualties, be it from conflict or other man-made events, are an inherent risk across our region.
- KEY MESSAGE: global trends indicate that conflict is on the rise, and trauma among civilians cannot be ignored. 1. Afghanistan and Yemen, both countries in our region, were the two leading conflicts in 2021-2022. Closely followed by Ukraine and Ethiopia
- PURPOSE OF SLIDE: it is not only violent trauma that gives rise to injuries in some of these fragile contexts, but also natural disasters. Natural disasters, particularly earthquakes also give rise to traumatic injuries. Our region is prone to earthquakes. The earthquake in Turkiye had a devastating impact in Syria, with the death toll being significantly higher than expected. Over 6000 died and over 10,000 were injured. Even today, those with complex injuries are continuing to be a burden on the health care system as they require multiple surgeries and reconstruction. Some examples of countries that are prone to earthquakes include: Iran, Pakistan, Afghanistan, Syria, Palestine and Jordan.
- PURPOSE OF SLIDE: to demonstrate the growing divide between low and high income and to show the audience that with simple low-cost solutions, we can save lives Key points: WHO research shows that fatality rates in low income countries are triple those in high-income globally. We predict that the real gap in our region between low and high income is even greater. Our research has shown that in humanitarian settings, over 60% (and in some contexts, as high as 85%) of trauma deaths occur before before the hospital and yet prehospital services are either non existent or limited. At least a quarter of these deaths could be avoided with basic heamorrhage control. As basic as a training communities on how to stop bleeding using a torniquet and safely transporting the injured could save a significant number of lives. You may mention the photo of the right; Somalia double bomb blast in October 2022 resulted in over 500 dead, but there was organized ambulance service and many died at the scene.
- PURPOSE OF SLIDE: children and young adults are disproportionally affected. This is the future society of the EMR. Key points: WHO has demonstrated that children of paediatric age range (below 15) account for 40% of violent trauma in humanitarian emergencies. This research demonstrates that the future of any society, are being affected by traumatic injuries and potentially premature death and disability. Second, we know that young adults that are the most economically productive are the second largest group to be disproportionally affected by violent trauma Traumatic injuries in humanitarian emergencies is not just a health issue, they result in a burden on the economical and social fabric of our countries in the region.
- PURPOSE OF SLIDE: introduce the trauma care pathway and illustrate the gaps in our region. Trauma care in such settings require a closely coordinated set of interventions, from prehospital care, which includes care at the scene, paramedical services and transportation, through to hospital care, encompassing triage, definitive surgery and finally, phase 3, post hospital care, rehabilitation and reintegration back into society and the community. Patient outcomes are dependent on the weakest point in the chain of care. Unfortunately, the majority of fragile countries in our region where there is a humanitarian emergency, there is a lack an organized prehospital service, and paramedics as a healthcare workforce are not professionalized. Examples include Yemen, Somalia and Afghanistan. Second, where hospitals exist, a team of surgeons, anaesthetists and nurses are limited. To give you some examples across the region, to provide safe anaesthesia there should be a minimum of 5 physician anaesthetists per 100,000 population and many countries in the EMR do not have anywhere near that number. Somalia, for example, has no physician anaesthetists with any formalized training and Iraq, has only 1.34 per 100,000. Finally, rehabilitation services are often non-existent or entirely dependent on NGOs.
- PURPOSE: present the Regional Trauma Initiative Key Points: The Regional Trauma Initiative here in EMRO, is the first of its kind, established as a pilot programme at the end of 2020. We take a regional approach to preparing, responding, and recovering from humanitarian emergencies. By embedding trauma care into the humanitarian cycle, our mission is to respond to the immediate needs to save lives and reduce disabilities. There are three key pillars at the heart of this Initiative: A strong commitment from the Ministry of Health and leadership at the national level. The positive engagement from MoH in our contexts has already demonstrated its importance; from Palestine, Sudan, Syria and others. An investment in the health care workforce. These chronic humanitarian contexts have left a brain drain on the health systems. Where health systems were once the pride of the country, they are now struggling to cope, and in particular trauma specialists, aneasthetists, paramedics and allied healthcare professional are far and few between. We strongly believe in investing in a healthcare workforce that is fit to serve the populations needs, and with trauma on the rise, it is vital that the planning and implementation begins today. We recognize that partners, such as the red crescent societies, IFRC and others have a role to play in the delivery of trauma care; particularly in areas where access is curtailed. Our ambition is to engage them and work collectively towards improving patient outcomes.
- PURPOSE OF SLIDE: we have already achieved so much in such little time. The momentum is already there. But we need to scale up further. Trauma care is an entry point in fragile contexts to eventually developing emergency care systems long term. Examples where we have already demonstrated progress is: Key Points: In its early inception, this initiative has also provided significant support to 5 priority fragile countries in the EMR and extended its support to other regions where such as Initiative does not exist, including AFR. For example, in Somalia, where the trauma caused by violence is on the rise, we have supported the development of paramedics and a mass casualty management system across 14 regional hospitals. This has built a more resilient and responsive trauma care service. In Palestine, almost all the major hospitals have been trained on mass casualty management and developed a unified plan, an activity that has helped the response to the recent escalation of violence with Israel. Back in June this year, with Qatar, we hosted the first regional training on mass casualty. Bringing together over 7 countries in the region. And finally, another example, recognising that prehospital car services are critical, we have trained over 150 paramedics across the region. In the coming months, we will be working closely with our colleagues in Geneva (Integrated Health Services Department) to build an accredited 6-week paramedic course.
- KEY PURPOSE: open up the discussion points to the audience Our region has expertise on trauma care, from Qatar’s trauma Centre, to Moroco’s level 1 trauma hospitals and Iran’s trauma education system. There is a wealth of resources available within our region. Using this Initiative as a bridge, we believe we can support low income and fragile countries to develop their trauma care services. Second, this initiative presents an opportunity to speak the same language when it comes to trauma care and develop a nomenclature that is regionally accepted by all, from prehospital through to rehabilitation And finally, the opportunities to work with institutions such as the Arab board of specialization, and Universities across the EMR, to develop longer term accredited training opportunities to build a healthcare workforce fit for purpose and responsive to the trauma needs in humanitarian emergencies.