Upload
vuongquynh
View
212
Download
0
Embed Size (px)
Citation preview
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
THE APPROACH TO TRAUMA CARE
RAYMOND R. PRICE MD
DIRECTOR CENTER FOR GLOBAL SURGERY, UNIVERSITY OF UTAHDIRECTOR GRADUATE SURGICAL EDUCATION, INTERMOUNTAIN MEDICAL CENTER
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Professor J. M. K. QuarteyDr Isaac Bentsi
Dr Benjamin Osei-Wiafe
Disaster Strikes Korle-BuRoad tragedy kills three prominent Urologists
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
-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
http://ww
w.ghanaiantim
es.com.gh/1634-died-in-road-accidents/
Road Traffic Accidents in LMICs
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
INJURY: 5.8 MILLION DEATHS/ YEAR
Injuries and violence: the facts. Geneva, World Health Organization, 2010.
1.24 million deaths from Road Traffic Injuries
$1,073 million
$33 million
US Global Research and Development Funding
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
20-50 MILLION NON-FATAL INJURIES
7th Day Adventist Clinic Ethiopia
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Estimated Road Traffic Death Rate(per 100,000 population)
91% of injury-related deaths world-wide occur in low- and middle- income countries (LMICs)
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”
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
“…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.”
The Contributions of Surgery to Preventive Medicine
University of London, Heath Clark Lectures( 1949)The London School of Hygiene and Tropical Medicine
Sir James LearmonthScottish Surgeon
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Identify any dangerous behaviors?
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7Katmandu Post
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Family Trips
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Nawalparasi, Nepal Bus Accident35 passengers died (2012)
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
SURGERY AS A PUBLIC HEALTH STRATEGY
1. Trauma
2. Obstetrical Emergencies
3. Acute Surgical Emergencies
4. Non-acute Surgical Conditions
World Bank (Debas): Disease Control Priorities 2nd ed, chapter 67
Prioritization of Surgical Conditions1. Public health burden2. Surgical procedure successful3. Cost-effective and feasible to promote globally
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
REDUCING DEATH AND MORBIDITY FROM TRAUMA
1. Assessment (data collection)
2. Policy Development (design and implement targeted intervention)
3. Assurance (outcome measurements and evaluation)
Integrate the Three Primary Strategies of Public Health:
Dan Egan MD
Bilateral Femur FractureHaiti 2010
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
Assessment
Public Health Trauma
Policy Development
Assurance
Monitor Health
Diagnose and Investigate
Injury Data Collection
Gap Analysis Survey
Inform, Educate, Empower
Mobilize Community Partnerships
Develop Policies
Process Improvement and Education Program
Trauma System Advisory Committee
Legislation
Enforce Laws
Link to Provide Care
Ensure Competent WorkforceEvaluate
Rules and Regulations
Pre-hospital and Definitive Care
Human ResourcesEvaluation
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
CHANGE IN TRAFFIC FATALITY RISK (DEATHS/ 10,000 PERSONS) 1975-1998
Trauma systems decrease mortality by
15-20% in high-income countries.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
• > 2million deaths/yr could be averted
• Economic benefit of mortality reduction = $245-261 billion
Benefit of Trauma System Development in LMICs
Disease Control Priorities 3rd ed.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
WORLD HEALTH ASSEMBLY RESOLUTIONSWHA 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 60.22 Strengthen provision of trauma & emergency care
WHA 68.15: Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
• 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.
3. Attain healthy life for all
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7
THE APPROACH TO TRAUMA CARE?Create or strengthen existing
trauma systems
EducationImplementation
InnovationResearch Advocacy
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7