Health and Economic Benefits of Improved Injury Prevention and Trauma Care Worldwide

Objectives: Injury is a significant source of morbidity and mortality worldwide, and often disproportionately affects younger, more productive members of society. While many have made the case for improved injury prevention and trauma care, health system development in low- and middle-income countries is often limited by resources. This study aims to determine the economic benefit of improved injury prevention and trauma care in low- and middle-income countries. Methods: This study uses existing data on injury mortality worldwide from the 2010 Global Burden of Disease Study to estimate the number of lives that could be saved if injury mortality rates in low- and middle-income countries could be reduced to rates in high-income countries. Using economic modeling – through the human capital approach and the value of a statistical life approach – the study then demonstrates the associated economic benefit of these lives saved. Results: 88 percent of injury-related deaths occur in low- and middle-income countries. If injury mortality rates in low- and middle-income countries were reduced to rates in high-income countries, 2,117,500 lives could be saved per year. This would result in between 49 million and 52 million disability adjusted life years averted per year, with discounting and age weighting. Using the human capital approach, the associated economic benefit of reducing mortality rates ranges from $245 to$261 billion with discounting and age weighting. Using the value of a statistical life approach, the benefit is between 758 and 786 billion dollars per year. Conclusions: Reducing injury mortality in low- and middle-income countries could save over 2 million lives per year and provide significant economic benefit globally. Further investments in trauma care and injury prevention are needed

Human resources for the control of road traffic injury

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations. RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. Mechanisms to enhance collaboration between these different fields need to be promoted. Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics

Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication La evaluación de los recursos para el tratamiento de heridos en México a la luz de las pautas publicadas por la Organización Mundial de la Salud, Guidelines for Essential Trauma Care

OBJECTIVE: To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries. METHODS: The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status). The sixteen facilities that were assessed included rural clinics, small hospitals, and large hospitals. Site visits incorporated direct inspection of physical resources as well as interviews with key administrative and clinical staff. RESULTS: Human and physical resources for trauma care were adequate in the hospitals, especially the larger ones. The survey did identify some deficiencies, such as shortages of stiff suction tips, pulse oximetry equipment, and some trauma-related medications. All of the clinics had difficulties with basic supplies for resuscitation, even though some received substantial numbers of trauma patients. In all levels of facilities there was room for improvement in administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and uniform in-service training. CONCLUSIONS: This study identified several low-cost ways to strengthen trauma care in Mexico. The study also highlighted the usefulness of the recommended norms in the Guidelines for Essential Trauma Care publication in providing a standardized template by which to assess trauma care capabilities in nations worldwide.<br>OBJETIVO: Identificar formas asequibles y sustentables de reforzar los recursos para la atención de heridos en México aplicando las pautas contenidas en Guidelines for Essential Trauma Care [Pautas para el tratamiento básico de los heridos], publicación de la Organización Mundial de la Salud y de la Sociedad Quirúrgica Internacional que contiene recomendaciones sobre los componentes de la atención de heridos que deben poseer los servicios de salud de distintos niveles en todos los países. MÉTODOS: Las pautas publicadas (Guidelines) sirvieron de base para llevar a cabo evaluaciones de las necesidades en tres estados mexicanos en 2003 y en 2004. Los estados se escogieron con la idea de que estuviese representada la amplia variedad de condiciones geográficas y económicas del país: Oaxaca (en el sur y de estrato económico inferior), Puebla (en el centro y con un estrato económico mediano) y Nuevo León (en el norte y con un estrato económico más alto). Se evaluaron dieciséis centros entre los cuales había puestos de salud rurales, hospitales pequeños y hospitales grandes. Se hicieron visitas a todos los centros para llevar a cabo la inspección directa de los recursos físicos en cada uno y entrevistar a miembros clave del personal administrativo y clínico. RESULTADOS: Los recursos humanos y físicos destinados a la atención de heridos eran de calidad satisfactoria en los hospitales, especialmente los más grandes. La encuesta reveló algunas deficiencias, tales como una escasez de succionadores rígidos, oxímetros de pulso y algunos medicamentos usados para tratar heridos. En todos los puestos se observaron dificultades con los equipos básicos de reanimación, a pesar de que algunos recibían un número bastante alto de heridos. En los centros de todos los niveles había margen para mejorar las funciones administrativas a fin de conseguir una atención de calidad que incluyese el mantenimiento de registros de heridos, programas para mejorar la atención de estos pacientes y uniformidad en el adiestramiento del personal durante el desempeño de sus funciones. CONCLUSIONES: En este estudio se identificaron varias formas baratas de reforzar la atención de pacientes heridos en México. También se subrayó la utilidad de las pautas recomendadas en la obra Guidelines for Essential Trauma Care como modelo estandarizado para evaluar los recursos para el tratamiento de heridos que poseen los países en cualquier parte del mundo

Percentage of total injury deaths by income level and injury type.

<p><b>A)</b> Percentage of total injury deaths by income level for each mechanism of injury. The mechanisms of injury are sorted on the x-axis from greatest-to-least by the percentage of deaths occurring in LMICs. <b>B)</b> Percentage of total injury deaths by injury type in each income group. The mechanisms of injury are sorted in the columns from greatest-to-least by the percentage of total deaths occurring worldwide.</p