On May 23, 2007, the World Health Assembly (WHA) adopted WHA Resolution 60.22, "Health Systems: Emergency Care Systems," which called on the World Health Organization (WHO) and governments to adopt a variety of measures to strengthen trauma and emergency care services worldwide. This resolution constituted some of the highest level attention ever devoted to trauma care worldwide. This article reviews the background of this resolution and discusses how it can be of use to surgeons, emergency physicians, and others who care for the injured, especially in low- and middle-income countries.
A national programme for PPCI in STEMI patients was started in Romania in August 2010, based on an integrated and well-trained pre-hospital emergency medical system. Ten national centres experienced in PPCI were organised in a 24/7 system in five regional networks, in order to assist STEMI patients from areas offering PPCI within the first two hours after the first medical contact. For centres located further away, a strategy of local thrombolysis followed by transfer to the closest PCI centre was recommended. The total number of PPCI procedures increased from 1,289 in 2010 to 4,209 in 2011. The percentage of PPCI increased from 25.0% in 2010 to 49.32% in 2011. From 40 PPCI/million inhabitants in 2009, we reached 64/million in 2010 and 210/ million in 2011. In the Bucharest area there were 640 PPCI/ million in 2011. The global in-hospital mortality decreased from 13.5% in 2009 to 9.93% in 2011. In 2011 in-hospital mortality was 4.39%, 8.32% and 17.11% for PPCI, thrombolysis and no-reperfusion, respectively. In-hospital mortality was 7.28% in the PCI centres but 14.20% in centres without PCI facilities. The national programme for PPCI had a major impact on STEMI in-hospital mortality in Romania.
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