Abstract
Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. To describe a consensus framework for surgical care designed to respond to this emerging need. An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.
Highlights
MethodsThirty-five participants were invited to the Stanford Humanitarian Surgical Response in Conflict Working Group
Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation
Evidence suggests that modern trauma systems save lives
Summary
Thirty-five participants were invited to the Stanford Humanitarian Surgical Response in Conflict Working Group. Contributors were selected on the basis of sector expertise, organization leadership, publication record in trauma care, trauma systems development, and humanitarian surgical care This multinational group included senior representatives from civilian and military trauma systems, international humanitarian nongovernmental organizations, such as Médecins Sans Frontières, Samaritan’s Purse, International Committee of the Red Cross, World Health Organization, and academic trauma system and research centers. The working group’s process incorporated core elements of a modified Delphi process combined with formal consensus development methods with iterative rounds of inclusive, anonymized input leading to a transparent derivation of final decisions.[13] Group members received a compilation of current protocols, resource lists, and relevant health services research on humanitarian and military trauma care in conflict settings. The group organizer prepared a final set of documents based on all feedback that served as the basis for discussion at the in-person convening
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