Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres

Abstract

It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030—healthcare and economic milestones—require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders—from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres—both healthcare and economic—can facilitate achieving the 2030 UN SDGs.

Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region

“…Significant synergy exists between emergency trauma response and routine surgical system strengthening. 94 , 97 For example, when not deployed, the Fiji Emergency Medical Assistance Team (FEMAT) is integrated into routine surgical service delivery by providing outreach surgical services in district hospitals. This strengthens both first-level hospital surgical capacity and keeps FEMAT in a state of constant readiness for deployment.…”

Perspective on COVID-19: Finally, Telemedicine at Center Stage

“…40 In addition, telemedicine has great potential for large scale manmade or natural disasters and emergencies that are characterized by unpredictability to place, time, and the number of injured people as well as their injury severity score, when other mode of transmission of information is not possible, or when the terrestrial infrastructure is lacking or has been destroyed by war or neglect, or simply did not exist at all. [41][42][43][44][45] As a result of these studies, a number of nation-wide telemedicine programs have been established 46,47 and have successfully increased access to care, particularly, specialized care. Telemedicine for disaster should be part of the nation-wide mass casualties structured centers that mimic trauma and stroke centers in high-income countries.…”

The Importance of Surgical Care to Achieve the United Nations Sustainable Development Goal for Healthy Lives by 2030

“…In the US, trauma accounts for nearly half of all deaths among those younger than 50 years, and integration of civilian and military resources to improve trauma outcomes has been advocated. 4 Trauma and stroke centers have been proven to be associated with reduced morbidity and mortality and improved outcomes for a wide range of conditions, including major trauma, cardiovascular events, complicated childbirth, and acute abdominal conditions. 4 A full-service trauma or stroke center provides community prevention programs, enhanced prehospital transport, immediate surgical and intensive care, rehabilitation, personnel training, and research-all as integral parts of the established health care system.…”

“…By integrating all health care resources-civilian, military and/or security, nongovernmental organizations, as well as national and international organizations (eg, UN, World Health Organization)-more efficient use of limited resources can be realized. 4,[7][8][9] By making the health care infrastructure more mobile and resilient (eg, battery-powered computed tomography, portable operating rooms), areas where power outages are routine and logistics are difficult can provide more consistent surgical care, as well as respond to mass casualties. 9 By sharing expertise and technology across low-, middle-and high-income countries, the global surgical talent pool can be tapped for innovative solutions that benefit care in all countries.…”

“…2 In addition, disasters-both natural (eg, earthquakes, storms, flooding) and "unnatural" or caused by humans (eg, infrastructure failures, terrorist events, armed conflict)-create mass casualties requiring urgent surgical care for hundreds of thousands of people annually. 3,4 The benefits of improved surgical care for both mass-casualty disasters and daily health care have been documented in the UN Sendai Framework for Disaster Risk Reduction 5 and the National Surgical, Obstetric, and Anesthesia Plan 6 developed by the Lancet Commission on Global Surgery.…”