Overlap with other activities

The guidelines provided by this manual deal primarily with facility-based trauma care. A very important component of trauma care with which it does not deal is pre-hospital care, or mobile emergency medical services (EMS). The authors acknowledge the great importance of this topic, especially as most trauma deaths in almost all countries occur outside of hospital (/). A WHO publication addressing this area of care is in preparation. Furthermore, there is no hard and fast line between pre-hospital care and hospital-based care, nor between stabilization and definitive care. For example, rural clinics whose staff are not doctors are often the first source of care for injured patients in their communities. These are intermediate between pre-hospital and hospital-based in character, as regards trauma care. Hence, for purposes of these guidelines, the authors have decided not to directly address mobile pre-hospital care, which is usually categorized as EMS. They have decided to consider care at all fixed facilities, whether these be clinics or actual hospitals.

Likewise, the guidelines in this manual deal exclusively with the care of injured patients. It is acknowledged that, except in rare circumstances, the human and physical resources in place will also be utilized for other health problems, including medical, obstetric and other surgical problems. Hence, there is a need to integrate the guidelines with other emergency services. It is hoped that the upgrading of trauma care resources will have the secondary effect of improving other aspects of emergency medical care as well. To increase the probability of this outcome and to decrease the probability that such recommendations might rather have a detrimental effect on other aspects of health care, the authors have sought the input of other departments of the WHO and other groups that are involved in emergency care and health care in general. In other words, these guidelines are vertically oriented with respect to trauma care. However, the authors have taken measures to assure that they are horizontally integrated into the broader functioning of the health care system. In this regard, the guidelines have been developed with the input of persons involved in the following WHO programmes and departments: Essential Drugs and Medicines Policy, Management of Non-communicable Diseases, Disability and Rehabilitation, Essential Health Technologies, Diagnostic Imaging and Laboratory Technology, and Child and Adolescent Health.

The Guidelines for essential trauma care are not clinical algorithms. They represent an attempt to provide sufficient resources that such algorithms can be carried out effectively and safely. For further details of pertinent emergency algorithms, the reader is referred to the Integrated management of adolescent and adult illness, which is in preparation by WHO (http://www.who.int/gtb/publications/whodoc/ imai/cds_stb_2003_22.pdf).

The guidelines are concerned only with the care of the injured, and hence with secondary and tertiary prevention of injury-related death and disability. Obviously, primary injury prevention is of great importance. Clinicians of all types should be strongly encouraged to become involved in promoting primary injury prevention. For further details, readers are referred to the related activities and publications of the WHO's Injuries and Violence Prevention Department (www.who.int/violence_injury_prevention).

Finally, the ultimate utility of these guidelines consists in their ability to actually enact improvements in the process of trauma care that lead to decreases in mortality and disability due to trauma. In order to monitor the success or failure of such efforts and to be able to make modifications when success has not been achieved, it is necessary to have reliable and timely sources of information on the incidence of injury and its outcome. This implies some form of surveillance. For further information on this, the reader is referred to the WHO publication: Injury surveillance guidelines (24).

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