Strengthening trauma and critical care globally

Abstract

Trauma is an increasingly significant health problem globally, especially in low-income and middle-income countries. Trauma care is often compromised by economic restrictions. Many capable individuals are attempting to meet this challenge in their own countries, however. This review summarizes such efforts and assesses how they might be expanded in a comprehensive, global fashion. Options for improving trauma care in the prehospital setting have been explored, including strengthening existing, basic formal emergency medical services (including ambulances); instituting new formal emergency medical services, where none had previously existed; and exploring novel ways to strengthen existing, although informal, systems of prehospital care when formal emergency medical services would be unfeasible. Affordable ways by which to strengthen hospital care have been addressed for several specific injuries, including open fractures, burns, and vascular injuries. Especially notable are growing efforts to better monitor outcomes and address factors contributing to preventable deaths. The Essential Trauma Care Project has defined and promoted core essential trauma care services that every injured person in the world realistically can and should be able to receive. This project is a collaborative effort of the World Health Organization and the International Society of Surgery. Individual efforts must be built upon to make progress in a comprehensive, global fashion. This review summarizes the background, achievements, and future potential of the Essential Trauma Care Project and several related efforts.