Foreword

For too long, trauma has been one of the leading health problems of the world. In addition to all that needs to be done to improve road safety and other aspects of injury prevention, efforts to improve care of the injured are essential. Trauma care represents a major challenge to the clinician, no matter what his or her background. The life- and limb-threatening injuries that are daily parts of trauma care present some of the most difficult decisions that any clinician can face. However, many lives can be saved through inexpensive modifications in education, organization and availability of simple pieces of equipment. Such changes greatly simplify decisions and actions.

The International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC) was founded to confront such difficulties and to improve the care of injured persons around the world. To our knowledge, it is the foremost organization addressing such problems from the vantage point of practising clinicians. Our association of surgeons has been active in many efforts to promote trauma care, including scientific exchanges of information, and the development and promulgation of several training programmes for doctors. We welcome opportunities to work with colleagues in other clinical and non-clinical disciplines.

Our membership is aware of the difficulties that confront trauma care in low-and middle-income countries. Two years ago, we established the Working Group for Essential Trauma Care, which was charged with formulating a plan to address such difficulties on a global scale and was authorized to forge partnerships with other groups that might have similar goals. We are very enthusiastic about the subsequent highly productive partnership with the World Health Organization.

This document, Guidelines for essential trauma care, is the result of a tremendous amount of work on the part of many persons from our two organizations, as well as many other contributors. It has taken into account many, often conflicting opinions. We have made a particular effort to involve clinicians who are in the front line of caring for injured persons in the setting of their home countries in Africa, Asia and Latin America.

The guidelines set forth a list of essential trauma services that we feel are achievable in virtually every setting worldwide, and then lay out the various human and physical resources that are needed to assure that such services are provided.

A central theme of the guidelines is that we can achieve improved outcomes for injured patients through better organization and planning of trauma care services. The benefits of such improvements in organization and planning, in the form of implementation of systems for trauma management in Australia, the United States of America, Canada, the United Kingdom of Great Britain and Northern Ireland and many other high-income countries, are well documented. Many members of IATSIC have led such initiatives.We are very hopeful that similar improvements in organization and planning will result in equally significant improvements in the care of the injured in other countries worldwide. Moreover, the improvements in organization and planning promoted by the Guidelines for essential trauma care are felt to be cost-effective, feasible and sustainable, even in those environments with poorest access to resources.

The members of IATSIC are available to assist, as appropriate, in the implementation of these guidelines in support of WHO and in partnership with governments, health authorities and medical colleges and associations.

On behalf of the membership of IATSIC, I look forward to seeing these Guidelines for essential trauma care put into action, improving the care of the injured around the world.

Stephen Deane, MBBS, FRACS, FRCS(C), FACS

Professor of Surgery, South Western Sydney Clinical School,

University of New South Wales

Director, Division of Surgery, Liverpool Hospital, Sydney, Australia President, IATSIC (2001-2003)

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