Executive summary

Injury1 has become a major cause of death and disability worldwide. Organized approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made to enhance the care of injured persons.The goal of the Guidelines for essential trauma care is to promote such low-cost improvements. These guidelines seek to set achievable standards for trauma treatment services which could realistically be made available to almost every injured person in the world. They then seek to define the resources that would be necessary to assure such care. These include human resources (staffing and training) and physical resources (infrastructure, equipment and supplies). By more clearly defining such services and resources, we hope these guidelines will facilitate the strengthening of trauma treatment services worldwide. The basic premise of these guidelines is that improvements in organization and planning can result in improvements in trauma treatment services and hence in the outcome of injured persons, with minimal increases in expenditures.

The authors of the guidelines have developed a series of resource tables for essential trauma care that detail the human and physical resources that should be in place to assure optimal care of the injured patient at the range of health facilities throughout the world, from rural health posts whose staff do not have training as doctors, to small hospitals staffed by general practitioners (known as GP-staffed hospitals), to hospitals staffed by specialists (specialist-staffed hospitals), to tertiary care centres. They also take into account the varying resource availability across the spectrum of low- and middle-income countries.2 Finally, a series of recommendations is made on methods to promote such standards including training, performance improvement, trauma team organization and hospital inspection. The resource tables and associated recommendations are

1 The terms "injury" and "trauma" are used interchangeably throughout these guidelines.

2 In these guidelines, mention is made of the categorization of countries by economic level according to the criteria of the World Bank (www.worldbank.org/data/countryclass/coun-tryclass.html), based on 2002 gross national income (GNI) per capita: low-income, US$735 or less; lower-middle-income, US$736-2935; upper-middle-income US$2936-9075; and high-income, US$9076 or more.

intended to provide a template to assist individual countries in organizing and strengthening their own trauma treatment systems. It is anticipated that the template will be adapted to suit local circumstances.

These recommendations have been drawn up in collaboration between the following parties:

— the Department of Injuries and Violence Prevention (VIP) of the WHO

— members of the Working Group for Essential Trauma Care of the International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC), which is an integrated society within the broader International Society of Surgery/Societe Internationale de Chirurgie (ISS/SIC);

— representatives of other organizations and other departments of WHO, such as the Department of Essential Health Technologies, which are involved in developing training materials on essential surgical care and trauma; and

— trauma care clinicians from Africa, Asia and Latin America.

The guidelines are written in a style oriented primarily towards health care planners and administrators. In many circumstances, these may include clinicians who are involved in the care of injured patients but also have administrative duties. The guidelines are also intended for use by clinicians who might use them to demonstrate to planners and administrators the need to make improvements to the resources that are available for trauma care. Thus, the target audience for these guidelines includes planners in ministries of health, hospital administrators, nursing service directors, medical service directors and clinicians, both individually and collectively, through organizations such as societies of surgery, anaesthesia, traumatology and other disciplines that deal with the injured patient. Broadly construed, these guidelines are of relevance to anyone involved in planning trauma care services or anyone who might wish to promote improvements in the care of the injured in their country.

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