Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

BACKGROUND: Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. METHODS: A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. RESULTS: Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. CONCLUSIONS: Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process

Mortes evitáveis em vítimas com traumatismos

OBJETIVO: Descrever métodos e estimativas de mortalidade proporcional por mortes evitáveis e tipos de não conformidades do atendimento relacionadas a esses eventos. MÉTODOS: Revisão sistemática de publicações sobre mortes evitáveis em vítimas com traumatismos entre 2000 e 2009. Foi realizada pesquisa nas bases de dados Lilacs, SciELO e Medline utilizando-se a estratégia de busca com as palavras-chave "trauma", "avoidable", "preventable", "interventions" e "complications", e os descritores em ciências da saúde "death", "cause of death" e "hospitals". RESULTADOS: Identificaram-se 29 artigos publicados no período, com predomínio de estudos retrospectivos (96,5%). Os métodos mais comumente utilizados para definir a evitabilidade do óbito foram painel de especialistas ou pontuação de índices de gravidade, tendo sido empregadas as seguintes categorias: evitável, potencialmente evitável e não evitável. A média da mortalidade proporcional por mortes evitáveis dos estudos foi de 10,7% (dp 11,5%). As não conformidades mais comumente relatadas nas publicações foram sistema inadequado de atendimento ao traumatizado e erro na avaliação e tratamento. CONCLUSÕES: Observaram-se falhas na uniformização dos termos empregados para categorizar as mortes e as não conformidadades encontradas. Portanto, sugere-se a padronização da taxonomia da classificação das mortes e dos tipos de não conformidades observadas

Thoracic trauma: severity of injury in 342 patients

"nBackground: Trauma is a common problem in the world, predominately affecting young adults. Considering the high mortality rate in patients suffering from thoracic trauma, the condition is considered to be extremely important. The purpose of this study was to evaluate the prevalence and the epidemiology of chest trauma as well as the severity of the resulted injury in Tehran, Iran. "nMethods: This prospective, descriptive study was conducted on patients admitted to three medical centers in Tehran during June 1997 and 1998 due to chest trauma. The data on the demographic information of the patients, the mechanism of the trauma and the severity of the injury were collected and analyzed. "nResults: Three hundred forty two patients were admitted to hospital due to thoracic trauma; the majority of which were male adults. Blunt trauma especially secondary to motor vehicle accidents were the most frequent cause of chest injury in the studied patients. In 280(82%) of the cases, another form of trauma was also reported. Chest wall injury was the most common type of thoracic trauma in these patients. The trauma was reported to be mild in 181(53%) of the patients (ISS<7). Only 42(12%) patients required surgical intervention. The overall mortality rate was 14% which was reported to be ISS- related. "nConclusion: Chest injury is quite prevalent among trauma patients and is associated with other injuries in a considerable number of the patients. This type of trauma is associated with a high mortality rate among elderly and therefore needs special attention and care