On the vertical axis of each matrix are listed the specific elements of trauma care that are needed.These are divided into two categories: (1) knowledge & skills and (2) equipment & supplies. See Table 1 as an example.
Knowledge and skills imply that the staff (medical, nursing and others) have the requisite training to perform such diagnostic and therapeutic activities safely and successfully. This implies not only the requisite training in their basic education (school and postgraduate training), but also continuing education to maintain these skills. Training issues are comprehensively addressed in chapter 6 of this manual.
Equipment and supplies imply that these items are available to all who need them, without consideration of ability to pay, especially in true life-threatening emergencies. This implies not only having them physically present in the facility but having them readily available on an ongoing basis; where appropriate, 24 hours a day, 7 days a week. It thus implies that organizational and administrative mechanisms exist to quickly replace depleted or expired stocks of supplies and medications, and to quickly repair non-functioning equipment. The quality control mechanisms necessary to assure such provision of supplies and to assure the quality of medical care provided are addressed in chapter 6.
The EsTC resource matrix goes into depth on the simple, vital services and related equipment.This is especially so for the immediately life-threatening injuries to be addressed in the initial evaluation and resuscitation, such as the management of airway, breathing and circulation (sections 5.1-5.3). For more complicated services, such as operative care of head, torso or extremity injuries (sections 5.4-5.14), the EsTC resource matrices go into less detail. For most of these more complicated issues, the elements of care to be provided are listed as a general service (e.g. laparotomy for trauma), with a basic discussion of what broad skills and equipment need to be available, but without a detailed, separate delineation of the specific skills or physical materials needed. Details of operating theatre instruments, equipment, supplies and infrastructure, and of anaesthetic capabilities are beyond the scope of this publication. The availability of a clinical service in these guidelines implies the expertise and physical materials to carry out that service successfully and safely. In this regard, the reader is also referred to WHO publications on broader surgical and anaesthetic issues (25), including the recently released Surgical care at the district hospital (26).
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