Preventing death and disability through the timely provision of prehospital trauma care

Abstract

Injury remains a major cause of death and disability worldwide, and places an enormous burden on countries with limited resources. The optimal way to reduce life-threatening injuries is through primary prevention efforts that decrease the incidence and severity of injuries. When prevention fails, however, it is often possible to minimize the consequences of injury through effective prehospital and hospital-based trauma care. Unfortunately, much of the world's population does not have access to prehospital trauma care, particularly in low income countries. In many parts of the world, few victims receive treatment at the scene and fewer still receive safe transport to the hospital in an ambulance. Transport, when available, is usually provided by relatives, untrained bystanders, commercial drivers (minibus, taxi or truck drivers), or by public safety officers (police and firefighters). Many high-income countries have developed technically complex and costly prehospital trauma care systems to provide care for acutely ill or injured patients. While these systems are impressive and they undoubtedly benefit some patients, there is little evidence that they are inherently superior to less costly systems that provide a more basic level of prehospital care. The start-up and maintenance costs of advanced life support systems place them out of the reach of all but a few countries, effectively eliminating them as a practical, sustainable option in many parts of the world. Expensive systems are not necessarily the best. With few exceptions, most advanced prehospital interventions have not been scientifically proven to be effective because the necessary randomized trials have not been conducted. In fact, most of the benefits of prehospital trauma care can be readily realized if basic, vital interventions are quickly and consistently applied, utilizing a country's existing resources and health-care infrastructure. Considerable good may be accomplished by ensuring that victims receive life-sustaining care within a few minutes of injury. Even in countries with limited resources, many lives may be saved and disabilities prevented by teaching individuals what to do at the scene of an injury. The foundations of an effective prehospital system can be laid by recruiting carefully selected volunteers and non-medical professionals, and providing them with training as well as the basic supplies and equipment they need to provide effective prehospital care. Most severely injured patients who die in the first few hours after injury succumb to airway compromise, respiratory failure or uncontrolled haemorrhage. All of these conditions can be treated using basic first aid measures. The challenge, however, is to promote sustainable and affordable prehospital trauma care systems that provide services to everyone. To do this, each system must be defined by local needs and capacity and must be developed with due regard for local culture and health-care capacity. …