Global Trauma Care. The Emerging Crisis in Global Injury Maureen McCunn, MD, MIPP, FCCM

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1 Global Trauma Care The Emerging Crisis in Global Injury Maureen McCunn, MD, MIPP, FCCM

2 Years of Life Lost (for entire world) Respiratory infections 2. HIV/AIDS 3. Perinatal conditions 4. Diarrheal diseases 5. Major depression 6. Ischemic heart disease 7. Cerebrovascular dx 8. Malaria 9. Road traffic injuries 10. COPD 2020 (predicted) 1. Ischemic heart disease 2. Major depression 3. Road traffic injuries 4. Cerebrovascular disease 5. COPD 6. Respiratory infections 7. Tuberculosis 8. War/LIC 9. Diarrheal diseases 10. HIV

3 16,000 people die each day from injuries 16% of global BOD

4 Death rate is highest in low middle income countries

5 90% burden of injury exists in low and middle income income countries

6 Lack of Resources Human resources staff not trained in trauma care Physical resources lack of equipment equipment not maintained Organizational resources delay to timing of surgery quality assurance/improvement plans NO TRAUMA SYSTEMS

7

8 Objectives Describe the scope of the problem Describe the projects that I ve I been involved with (the good, the bad and the ugly) Describe how I got involved with these projects, and The pros/cons of this approach

9 R Adams Cowley Shock Trauma Center University of Maryland

10 ITACCS International Trauma Anesthesia and Critical Care Society The society is an international not for for profit scientific foundation and professional association and is active in over 40 countries with over 1,000 members

11 Vietnam Health Volunteers Overseas

12 Vietnam Ø Since 1986, when a market economy was introduced in Vietnam, injury patterns have changed. The number of traffic deaths has increased 3 fold from and the number of traffic injuries more than 4 fold. Ø Injuries are now the leading cause of mortality in hospitals, ahead of circulatory disorders, infectious and parasitic diseases.

13 McCunn M, Fowler C: A centralized system for organized delivery of trauma care in Ho Chi Minh City: a proposal. 7th International Injury Prevention Conf, 2004 Vienna.

14 Trauma in Egypt Mortality rate 50.2/100,000 5th leading cause of death MVC death rate 21/100,000 USA death rate 19/100, times as many cars per person in U.S.

15 An airbag saved the driver. A blood bag saved the passenger. Hess JR. Optimizing the use of blood products in trauma care. Crit Care 2005;9:S10 4. Review.

16 National Institutes Of Health Fogarty International Collaborative Trauma And Injury Research Overall Grant Goal: Training Program To help the Egyptian Ministry of Health and Population and other Egyptian health professionals 1. increase their knowledge and understanding of human trauma and injury prevention, and to 2. apply this knowledge in public health practice to decrease the significant morbidity and mortality caused by injuries.

17 Sequential Trauma Education ProgramS (STEPS) Egypt Focuses on Improving Emergency Care By Challiss McDonough Cairo, 05 May 2006 In recent years, a string of terrorist attacks in Egypt have killed led and wounded hundreds of people, focusing attention on the country's emergency medical system. But the death toll from everyday traffic accidents is much higher, claiming 6,000 lives per year on Egyptian roads. The health ministry is in the midst of a campaign to improve emergency response not only to high profile incidents, but also to more routine emergencies. at the Ministry of Health training center, Dr. Maureen McCunn of the University of Maryland says the issue is global "Right now, in the entire world, the primary cause of death is infectious diseases, but the World Health Organization predicts that by 2020

18 GIEESC WHO meeting towards a Global Initiative for Emergency and Essential Surgical Care (GIEESC) was convened by the WHO Department of Essential Health Technologies It was held at WHO headquarters, Geneva,, 8 98 December 2005; 2 nd meeting Dar es es Salaam, September Participants represented the Ministries of Health (MoH MoH) ) of some countries, international professional societies, non governmental organizations with official relations with WHO, experts in the field of surgery, orthopaedic, paediatrics, anesthesia, trauma,, emergency medicine, and obstetrics, directors of training and education programs (medical, nursing, clinical officers and paramedical personnel).

19 experts in trauma care, public health, injury prevention, telemedicine, pre hospital systems, public policy, developing nation medicine, incident management, business management for trauma systems, trauma nursing evaluation of existing country programs and assistance with implementation of proposed improvements Global Injury Solutions education and training a culturally focused organization that will work within the existing infrastructure to improve upon injury related health care

20 India One person dies from injury every 6 10 min By 2050, India will have the greatest number of automobiles on the planet, overtaking U.S.

21 ITACCS Annual Courses/Conference Met colleagues in MOH and University affiliated faculty

22 McCunn M, Scalea TM, et al: Addressing the components that lead to improvement in emergency trauma care. Indian Emerg Journ : 8 18.

23 Culture & Policy Roadside assistance

24 First emergency call number and organized system in India MOU EMRI + STC + GIS Sarin, P., McCunn, M. Airway Management in the Field in the Setting of Injury from Two and Three Wheelers in India. Society of Airway Management Annual Meeting, September 2008.

25 Well-equipped ambulances Paramedic training Care on arrival to hospital? Satyam Corporation, Baraju Foundation

26 Guerilla Warfare since 1945, most combat casualties are civilians

27 JTTS Get the right patient, to the right place, at the right time. C STARS Mechanism of Injury July, 06 GSW, 59 Fall, 6 Blast, 9 other, 7 RPG, 4 MVC, 21 Mortar, 17 IED, 129 McCunn M, York G, Hirshon JM, et al: Trauma Readiness Training: A Comparison between a U.S. Level One Trauma Center and an Air Force Theater Hospital in Iraq. American Association for the Surgery of Trauma Annual Meeting. Submitted. Sep 2009.

28

29 Pros/Cons Institutional commitment (Global Trauma Group) Textbook chapters, lectures, outreach, papers (academia?) Sustainability, capacity building

30 The way forward: Collaborative approach Multi sectorial /multi disciplinary WHO Standards Technology transfer & adaptation to local needs Integrating training component in education / training programs Commitment MoH / University affiliation? PENN Global Injury Care Initiative THANK YOU

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