ON TRAUMA CARE 2009 Outline 1. Overview: history, burden, - - PowerPoint PPT Presentation

INCREASING POLITICAL COMMITMENT FOR MSK & TRAUMA CARE

WHO / BJD GLOBAL FORUM ON TRAUMA CARE 2009

Outline

• 1. Overview: history, burden, challenges and gaps
• 2. Current progress and Goals
• 3. Role of Global Forum on Trauma Care
• 4. Next steps, Actions

THE INJURY PYRAMID

The millions of deaths that result from injuries represent

• nly

a small fraction

• f those

injured. Tens of millions of people suffer injuries that lead to hospitalization, emergency department , general practitioner

• r
• ther

treatment .

Burden of Injury: Deaths

• Source: Injuries and Violence: The Facts,

WHO, 2010. Available from www.who.int

Spectrum of Injury Control

Surveillance Prevention Pre-Hospital Care Hospital Care

Acute care Rehabilitation

PERCENT OF ALL SERIOUSLY INJURED (ISS > 9) WHO DIE

Percent of injured patients who expire

35 55 63 10 20 30 40 50 60 70 80 Seattle, USA Monterrey, Mexico Kumasi, Ghana

If we could eliminate these inequities:

Over 2,000,000 of the 5,800,000 injured people who die each year could be saved.

35 55 63 10 20 30 40 50 60 70 80 USA Mexico Ghana

Spectrum of Trauma Care

Pre-Hospital Care Hospital Care

Facility- Community- based based

Rehabilitation

Tier 1 First responders Bystanders Tier 2 Formal EMS Ambulance

CHALLENGES AND GAPS

• A. Human Resources:

Example: Surgeons per 100,000 USA 50 Latin America 7 Africa 0.5

• B. Physical Resources

(supplies, equipment)

Shortages in many essential items, even those that are low cost.

IMPROVEMENTS POSSIBLE despite financial restrictions

GNP Per capita Health $ Per capita High income (e.g. USA) $40,000 $5,000 Middle income (Latin America) $4,000 $100 - 500 Low income (Africa, Asia) $300 $10

• A. Improving existing ambulance service (EMS)

Monterrey, Mexico Improve training and EMS infrastructure Mortality: 8.2% to 4.7%

• B. Innovative programs for areas without formal EMS

Northern Iraq / Cambodia Improve first aid capabilities of village volunteers Mortality: 40% to 9%

• C. Hospital based improvements: Quality

Khon Kaen, Thailand: QI program Mortality: 6.1% to 4.4%

• 3. Current progress:

Local programs

3.Current progress: Global WHO/BJD efforts

Define basic essential services. Delineate resources necessary to provide essential services to all injured.

• Human resources (skills, training, staffing)
• Physical resources (equipment, supplies)

Prehospital Facility based

Emphasizes simple techniques: Getting more out of M & M Preventable death panel reviews Corrective action and closing the loop Case studies: All WHO regions All economic levels Prehosp, hosp, rehab, system-wide

CONCRET ACTIONS CONCRET ACTIONS

Global Forum on Trauma Care

Rio de Janeiro: 28 – 29 October, 2009

Broad Goals of the Forum

• Develop a strategy to promote greater

political commitment to affordable and sustainable improvements in trauma care.

• Promote greater uptake of

recommendations of WHA 60.22.

What determines political priority given to different global health issues?

Shiffman J. Generating political priority for maternal mortality reduction in 5 developing countries Am J Public Health. 2007;97:796–803. Shiffman J. A social explanation for the rise and fall of global health issues Bull WHO 2009;87:608–613 Shiffman J, Smith S. Generation of political priority for global health initiatives. Lancet 2007; 370: 1370 – 79.

TheNew England Journal of Medicine

n engl j med 360;5 nejm.org January 29, 2009

special article

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Alex B. Haynes, M.D., M.P.H., Thomas G. Weiser, M.D., M.P.H., William R. Berry, M.D., M.P.H., Stuart R. Lipsitz, Sc.D., Abdel-Hadi S. Breizat, M.D., Ph.D., E. Patchen Dellinger, M.D., Teodoro Herbosa, M.D., Sudhir Joseph, M.S., Pascience L. Kibatala, M.D., Marie Carmela M. Lapitan, M.D., Alan F. Merry, M.B., Ch.B., F.A.N.Z.C.A., F.R.C.A., Krishna Moorthy, M.D., F.R.C.S., Richard K. Reznick, M.D., M.Ed., Bryce Taylor, M.D., and Atul A. Gawande, M.D., M.P.H., for the Safe Surgery Saves Lives Study Group*

UN General Secretary Ban Ki Moon asking all country members to ACT

Conclusions

Agreement on WHA 60.22 as foundation for advocacy Concise key messages need refining:

– Basic life saving care in the field and rapid transport to a site of definitive care. – Access to adequate, timely, essential care that is life or limb saving at hospitals and clinics. – Access to adequate, essential rehabilitation services for those with disabilities resulting from their injuries.

Time to think and reflex to develop tools for advocacy -

• Be consistent and use strong and safer strategies to influence the

decision makers in Economy to convince them: Trauma is a PRIORITY.

Conclusions

• Need for global network to unite different groups

and promote advocacy.

• Debate on name and topics to encompass

– Trauma – Trauma and emergency care – Emergency care – “Trauma” does not resonate with public.

• Synergies, but not to directly work on prevention

and Core Group leaders creation; Marketing;

• Trauma Care Checklist; Communication; Data

Trauma care technical support political support financial support

BJD INSTITUTIONS NGOs PARTNERS

Collaborative Efforts

RIO DE JANEIRO

11-13 July, 2013 BJD

RIO DE JANEIRO

11-13 July, 2013 BJD

THANK YOU

Marcos Musafir