Trauma Care in Low- and Middle-Income Countries

Shanthakumar, Dhurka; Payne, Anna; Leitch, Trish; Alfa-Wali, Maryam

doi:10.1055/s-0041-1732351

Cited by 26 publications

(23 citation statements)

References 45 publications

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“…For example, the foreign physicians might perform all the procedures without teaching pre- and postoperative care, and much of their added benefit is lost when they leave the location [ 22 ]. In the other scenario local surgeons and anaesthesiologists would be trained in more complex procedures, but a growing number of poor outcomes result due to poor screening, post-surgical complications, and poor support in the convalescing period [ 55 ]. In our implementation, the GSD practitioners were crucial in these aspects of the model.…”

Section: Discussionmentioning

confidence: 99%

Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project

Frechette¹,

Colas²,

Augustin³

et al. 2023

Global Health Action

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In response to the 2010 earthquake and subsequent cholera epidemic, St Luke’s Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke’s become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the ‘delay framework’ to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.

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Section: Discussionmentioning

confidence: 99%

Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project

Frechette¹,

Colas²,

Augustin³

et al. 2023

Global Health Action

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“…The importance of consistent and higher-level evaluation of the translation of knowledge into good patient outcomes has been emphasised in literature [ 39 , 40 ]. Yearly course evaluations have contributed to improvements in the course structure over time.…”

Section: Discussionmentioning

confidence: 99%

The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course

et al. 2023

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Background Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. Methods A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. Results The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College’s yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. Conclusions Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.

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“…At present, high energy traumatic events occur frequently in developing countries, which seriously affect the survival prognosis of trauma patients and the burden of family life [ 1 ]. There are about 10 million deaths due to severe trauma in the world every year, and trauma treatment around the world is facing huge challenges [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Early Mortality Risk in Acute Trauma Patients: Predictive Value of Injury Severity Score, Trauma Index, and Different Types of Shock Indices

Dai

Xing

et al. 2022

JCM

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Objective: This study aimed to explore the predictive value of the Injury Severity Score (ISS), Trauma Index (TI) and different types of shock indices (SI) on the early mortality risk of acute trauma patients. Methods: Clinical data of acute trauma patients who met the inclusion and exclusion criteria of this study and were treated in the hospital from January 2020 to December 2020 were retrospectively collected, including gender, age, trauma mechanism, severe injury site, ISS, TI, admission vital signs, different types of shock indices (SI), death within 7 days, length of hospital stay, and Glasgow Outcome Score (GOS). The predictive value of the Injury Severity Score, Trauma Index, and different types of shock indices on the risk of early mortality in patients with acute trauma were compared using relevant statistical methods. Results: A total of 283 acute trauma patients (mean age 54.0 ± 17.9 years, 30.74% female) were included, and 43 (15.19%) of the patients died during 7 days of hospitalization. The admission ISS, TI, SI, MSI, and ASI in the survival group were significantly lower than those in the death group, and the difference was statistically significant (p < 0.05). Meanwhile, different trauma assessment tools included in the study have certain predictive value for early mortality risk of trauma patients. Conclusions: The TI indicates a better capability to predict the risk of early death in patients with acute trauma. As the most sensitive predictor, the SI has the greatest reference value in predicting the risk of early death in patients with traumatic shock.

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Trauma Care in Low- and Middle-Income Countries

Cited by 26 publications

References 45 publications

Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project

Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project

The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course

Early Mortality Risk in Acute Trauma Patients: Predictive Value of Injury Severity Score, Trauma Index, and Different Types of Shock Indices

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