Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation

Abstract

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care—from prevention to acute care to rehabilitation. Integration of the various healthcare systems—governmental, non-governmental and military—is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds—trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration—creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

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.…”

Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives

“…Aguilera et al (137) recently discussed the potential of telementoring for low-income and middle-income countries with limited-resource settings, in addition to its integration with trauma mass casualty centers.…”

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

“…8 Health care professionals in low-and middle-income countries can offer clinical expertise and costeffective solutions to health care challenges; health care professionals in high-income countries offer clinical expertise and technology that support those cost-effective solutions. 8,9 An example of expertise sharing is the collaboration between Hawassa University in Ethiopia and the American College of Surgeons (more than a dozen US university medical centers) to train general surgeons in Africa. 9 Examples of technology sharing include smartphone and Uber-like motorcycle taxis to improve prenatal and postnatal care in Kenya; drones to deliver blood products, antibiotics, vaccines, and laboratory specimens to remote sites in Ghana and Rwanda; and telemedicine to alleviate unnecessary patient transport and to improve communication in Cabo Verde.…”

“…8,9 An example of expertise sharing is the collaboration between Hawassa University in Ethiopia and the American College of Surgeons (more than a dozen US university medical centers) to train general surgeons in Africa. 9 Examples of technology sharing include smartphone and Uber-like motorcycle taxis to improve prenatal and postnatal care in Kenya; drones to deliver blood products, antibiotics, vaccines, and laboratory specimens to remote sites in Ghana and Rwanda; and telemedicine to alleviate unnecessary patient transport and to improve communication in Cabo Verde. 9 The National Surgical, Obstetric, and Anesthesia Plan 6 provides indicators for assessing progress in global surgery, with targets to be reached by 2030.…”

“…9 Examples of technology sharing include smartphone and Uber-like motorcycle taxis to improve prenatal and postnatal care in Kenya; drones to deliver blood products, antibiotics, vaccines, and laboratory specimens to remote sites in Ghana and Rwanda; and telemedicine to alleviate unnecessary patient transport and to improve communication in Cabo Verde. 9 The National Surgical, Obstetric, and Anesthesia Plan 6 provides indicators for assessing progress in global surgery, with targets to be reached by 2030. 2 These indicators include: (1) 80% of the population within 2 hours of a facility providing basic surgical care; (2) minimum provider density of 20 per 100 000 population; (3) annual surgical volume minimum of 5000 per 100 000 population; (4) perioperative mortality rate documentation; (5) affordability metrics (100% of the population protected against impoverishing or catastrophic expenditure related to surgery).…”