Twenty-four Hour Trauma Team at the University Hospital of the West Indies, Kingston, Jamaica – The Time is Now

Abstract

INTRODUCTION The timely and aggressive resuscitation of seriously injured trauma patients requires rapid assessment and efficient management of the injuries. Over the past thirty years, fatalities from trauma have decreased markedly due to the increased awareness of simple trauma care principles, such as those of the American College of Physicians Advanced Trauma Life Support [ATLS] (1). However, the ATLS approach is designed so that tasks are performed in sequence, one after the other, resulting in a ‘vertical organization’. A trauma team employing a ‘horizontal organization’ has been shown to lead to significant reductions in resuscitation times (2). Trauma and injury still remain the most common causes of death under the age of 44 years worldwide and the fourth leading cause of death in the western part of the world (1, 3, 4). The Pan American Health Organization reports that trauma is among the five leading causes of hospitalization, and is estimated to represent approximately 20% of hospital admissions in Jamaica (5). In 2000, the Royal College of Surgeons in England published a report emphasizing the insufficiencies in the management of the trauma patient (6). The report recommended the organization and institution of a trauma system and most importantly “the hospital trauma team” (6). Seven years later the United Kingdom (UK) National Confidential Enquiry into Patient Outcomes and Death reported that only 20% of hospitals in the UK had established trauma teams available, and of these trauma teams, only 59.7% of patients with an injury severity score (ISS) greater than 16 had a “documented trauma team response” (4). Studies have shown that even when a trauma team works in isolation outside a designated trauma system, it is still very effective in decreasing overall patient morbidity and mortality (7–11). The main objective of any trauma care system is to “assure optimal and equitable care for all trauma victims, prevent unnecessary death and disability from trauma, contain cost and assure quality of trauma care throughout the system” (12). The establishment of a trauma team is central to the fulfillment of this objective. This team should be able to i) resuscitate and stabilize patients, ii) determine the nature and extent of injuries in order to prioritize them, and iii) prepare and transport trauma patients for definitive care, whether to an operating theatre, intensive care unit or to another hospital (13, 14). The University Hospital of the West Indies sees approximately 56 000 patients annually (15). Trauma accounts for approximately 40% of the workload in both the Accident and Emergency Unit and the surgical wards (16). Between January 2001 and December 2005, penetrating trauma accounted for almost 50% of cases seen (17). These figures are a direct reflection on the probable societal burden and cost of trauma care in Jamaica. One study showed that only approximately 15% of the total cost for each trauma patient is recovered from the patient, making the care of these patients mainly state funded (17). A more efficient trauma care delivery system will therefore lessen the burden injuries place on the health service (16). The aim of a trauma team is to provide a safe and competent evaluation of a trauma patient within the shortest possible time (2). The following is a proposal to create a functioning trauma team that intends to further decrease preventable deaths utilizing a ‘horizontal organization’ to enhance significant reductions in resuscitation times and survival.