Resource matrix designation of priorities

For each cell within the matrix, the authors recommend those resources (vertical axis) that should be available at a specific level of the health care system (horizontal axis). The priority of each item was given a designation according to the following criteria.

"Essential" (E) resources

The designated item should be assured at the stated level of the health care system in all cases. As this Essential Trauma Care Project covers the spectrum of facilities across the world, the E designation represents the "least common denominator" of trauma care common to all regions, including even those where access to resources is most severely restricted. It is felt that these services could and should be provided to injured patients at the level of health facility concerned, even in countries whose ministries of health have a total budget of only $3-4 per capita per year. Moreover, the authors feel that the essential items could be provided primarily through improvements in organization and planning, with a minimal increase in expenditure.

"Desirable" (D) resources

The designated item represents a capability that increases the probability of a successful outcome of trauma care. It also adds cost. Such items are not likely to be cost-effective for all facilities of a given level in environments with the poorest access to resources. Hence, they are not listed as essential. However, for countries with greater resource availability, such items may ultimately be designated essential in their own national plans. Likewise, there are some services for which only low-cost physical resources would be required and for which training of health care personnel at the level in question would be feasible. However, in order for this training to be considered essential, mechanisms would need to be in place to ensure that it is provided for all health care workers at the level in question, within the time constraints of all else for which they must be trained. In cases where it did not seem reasonable to assure such training nationwide, such services have been designated as desirable. Individual countries may wish to upgrade these to essential, either at all such facilities or at a subset of those with high trauma volume.

"Possibly required" (PR) resources

In environments with poorer access to resources, some trauma treatment capabilities might need to be shifted to lower levels of the health care system in order to increase their availability. Such services usually represent only minimal increased cost, relative to the provision of such services only at higher levels of the health care system. Shifting to a lower level in the health care system would usually imply that a provider with less advanced trauma-related training and skills would be performing procedures that might otherwise be performed by more highly trained personnel. Hence, it is to be emphasized that the "PR" designation is different from the "desirable" designation. PR represents a potential necessity to increase availability of trauma care services in environments with poorer access to resources. It is anticipated that the PR designation will apply primarily to low-income countries, but not to middle-income.

"Irrelevant" (I) resources

This implies that one would not ordinarily expect this capability at the given level of the health care system, even with full availability of resources.

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