Essential trauma services needs of the injured patient

This section contains a list of those services which the authors feel are essential to prevent death and disability in injured patients. They might be considered as the "needs of the injured patient." These can be categorized into three broad sets of needs:

1. Life-threatening injuries are appropriately treated, promptly and in accordance with appropriate priorities, so as to maximize the likelihood of survival.

2. Potentially disabling injuries are treated appropriately, so as to minimize functional impairment and to maximize the return to independence and to participation in community life.

3. Pain and psychological suffering are minimized.

Within these three broad categories, there are several specific medical goals that are eminently achievable within the resources available in most countries.

• Obstructed airways are opened and maintained before hypoxia leads to death or permanent disability.

• Impaired breathing is supported until the injured person is able to breathe adequately without assistance.

• Pneumothorax and haemothorax are promptly recognized and relieved.

• Bleeding (external or internal) is promptly stopped.

• Shock is recognized and treated with intravenous (IV) fluid replacement before irreversible consequences occur.

• The consequences of traumatic brain injury are lessened by timely decompression of space occupying lesions and by prevention of secondary brain injury.

• Intestinal and other abdominal injuries are promptly recognized and repaired.

• Potentially disabling extremity injuries are corrected.

• Potentially unstable spinal cord injuries are recognized and managed appropriately, including early immobilization.

• The consequences to the individual of injuries that result in physical impairment are minimized by appropriate rehabilitative services.

• Medications for the above services and for the minimization of pain are readily available when needed.

The precise procedures that can optimally be applied to achieve these goals, as well as the human and physical resources needed to optimally carry out these procedures, will vary across the spectrum of economic resources of the nations of the world and the geographic location of the facilities concerned. However, these goals should be achievable for most injured patients in most locations.

The provision of these services should not be dependent on ability to pay. Hence, cost recovery schemes, necessary though they may ultimately be, should not preclude the provision of initial emergency care nor of critical elements of definitive care.

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