Development process for essential trauma care

In developing the Guidelines for essential trauma care, the authors sought to define inexpensive, feasible, minimal standards that would be applicable virtually everywhere in the world. They also sought to identify ways of reinforcing existing systems of trauma care in all locations in the world, including the spectrum of conditions found in both low- and middle-income countries.

In this process, the authors developed a list of medical goals that should be feasible for most injured persons everywhere. These can be viewed as the "needs of the injured patient" (chapter 3). In order to assure the achievement of such goals, the inputs of human and physical resources must be utilized in an optimal process. To this end, the authors have developed a template for the resources that are needed. These are described in chapters 4 and 5. These are based conceptually on a similar template developed for the book, Resources for optimal care of the injured patient (17). However, they are significantly amended to reflect the realities of low- and middle-income countries.

The authors envision that the template presented in this manual will be used as a guide for those planning trauma treatment services across a wide spectrum of low- and middle-income countries. These guidelines will hopefully be of relevance to planners in ministries of health, to hospital administrators, to nursing service directors and to clinicians, both individually and collectively, through organizations such as societies of surgery, anaesthesia, traumatology and other disciplines that deal with the injured patient. These groups constitute the target audience for the guidelines.

The use of the template will require adaptation for use in individual countries. The authors envision that this would ideally occur in a collaborative, consensus-driven process, with input from clinicians involved in the care of injured patients, officials in ministries of health, and health service administrators. The category of clinicians would include both those who are primarily devoted to the field of traumatology and generalists such as general surgeons, anaesthetists and emergency physicians. In countries in which a large percentage of rural trauma is handled by general practitioners and non-doctor providers of health care, these groups should be included as well, to assure the feasibility of recommendations for rural areas.

As part of the process of national level adaptation and implementation, there could reasonably be a role for a Needs Assessment of trauma treatment services nationwide. This would involve a survey of the capabilities of the range of facilities caring for injured persons. It would help to identify the potential deficiencies in human resources, physical resources and organization that would be targeted by subsequent improvements.

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