Mock Charles, Nguyen Son, Quansah Robert, Arreola-Risa Carlos, Viradia Ramesh, Joshipura Manjul
Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
World J Surg. 2006 Jun;30(6):946-56. doi: 10.1007/s00268-005-0768-4.
We sought to identify affordable and sustainable methods to strengthen trauma care capabilities globally, especially in developing countries, using the Guidelines for Essential Trauma Care. These guidelines were created by the World Health Organization (WHO) and the International Society of Surgery and provide recommendations on elements of trauma care that should be in place at the range of health facilities globally.
The guidelines were used as a basis for needs assessments in 4 countries selected to represent the world's range of geographic and economic conditions: Mexico (middle income; Latin America); Vietnam (low income; east Asia); India (low income; south Asia); and Ghana (low income; Africa). One hundred sites were assessed, including rural clinics (n=51), small hospitals (n=34), and large hospitals (n=15). Site visits utilized direct inspection and interviews with administrative and clinical staff.
Resources were partly adequate or adequate at most large hospitals, but there were gaps that could be improved, especially in low-income settings, such as shortages of airway equipment, chest tubes, and trauma-related medications; and prolonged periods where critical equipment (e.g., X-ray, laboratory) were unavailable while awaiting repairs. Rural clinics everywhere had difficulties with basic supplies for resuscitation even though some received significant trauma volumes. In all settings, there was a dearth of administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and regular in-service training.
This study identified several low-cost ways in which to strengthen trauma care globally. It also has demonstrated the usefulness of the Guidelines for Essential Trauma Care in providing an internationally applicable, standardized template by which to assess trauma care capabilities.
我们试图利用《基本创伤护理指南》确定经济实惠且可持续的方法，以加强全球尤其是发展中国家的创伤护理能力。这些指南由世界卫生组织（WHO）和国际外科学会制定，就全球各级卫生设施应具备的创伤护理要素提供了建议。
以这些指南为基础，在4个被选中代表世界地理和经济状况范围的国家进行了需求评估：墨西哥（中等收入；拉丁美洲）；越南（低收入；东亚）；印度（低收入；南亚）；以及加纳（低收入；非洲）。共评估了100个场所，包括农村诊所（n = 51）、小型医院（n = 34）和大型医院（n = 15）。实地考察采用直接检查以及与行政和临床工作人员访谈的方式。
大多数大型医院的资源部分充足或充足，但仍存在可改进的差距，尤其是在低收入环境中，如气道设备、胸管和创伤相关药物短缺；关键设备（如X光、实验室设备）在等待维修期间长时间无法使用。各地农村诊所即使有大量创伤患者就诊，在复苏基本用品方面也存在困难。在所有环境中，缺乏确保创伤护理质量的行政职能，包括创伤登记、创伤相关质量改进计划和定期在职培训。
本研究确定了几种在全球加强创伤护理的低成本方法。它还证明了《基本创伤护理指南》在提供一个国际适用的标准化模板以评估创伤护理能力方面的有用性。
