Efforts to improve trauma care in individual countries

As an example of this, the American College of Surgeons (ACS) Committee on Trauma has significantly advanced the care of the injured in the United States and Canada by creating and promulgating the Advanced Trauma Life Support course (ATLS) and by the publication of Resources for optimal care of the injured patient (17). This 100-page book contains guidelines for what hospitals at varying levels should have in place in terms of resources such as staffing, continuing education, supplies, equipment, administrative functions and quality assurance programmes. Basically, it has applied an essential services approach. Equally important to the existence of these standards is the fact that they have been enforced through a programme of trauma centre verification, as described in section 2.5. Similar organized measures have been successfully implemented in many other high-income countries (18—21).

In addition to efforts to improve care at individual hospitals, progress has been made by addressing the entire spectrum of the development of systems for trauma management. This involves political jurisdictions designating hospitals to fill the roles of trauma centres at varying levels of complexity, ranging from large urban centres to small rural hospitals. It also implies planning of emergency medical services, pre-hospital triage, transfer criteria and transfer arrangements between hospitals.

It should also be noted that every country has capable, dedicated individuals working to reduce the burden of injury, both by planning and administration and by the direct provision of clinical services. The Essential Trauma Care Project and this manual are meant to assist and reinforce such work.

The Essential Trauma Care Project seeks to blend the perspectives of the two foundations noted above.The project is based on the premise that improved organization of trauma care services can be a cost-effective way of improving care of the injured worldwide. Before going further, evidence for the effectiveness of such improved organization is presented.

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