Each year, injuries cause around 4.4 million deaths globally and are responsible for an estimated 10% of all years lived with disability. Across the world, injury remains the leading cause of death in the young ( 5-29 years). Patients who are critically injured present at all levels of the health system and need to receive timely, quality care wherever they are in order to reduce morbidity and mortality.
Background
Injury affects people worldwide but has a particularly high burden in low- and middle-income countries where the resources to treat it are more limited. Almost 90% of injury deaths take place in low- and middle- income countries. While the ultimate goal must be to prevent injuries from happening at all, much can be done to minimize the disability and ill-health arising from the injuries that do occur despite the best prevention efforts.
For every person dying as a result of injury, hundreds more that sustain non-fatal injuries and other health consequences. Strengthening the emergency care systems that serve as the first point of contact for patients is essential to ensuring timely and equitable access to care for the injured. Well planned services for the injured can prevent future fatalities, reduce the amount of short-term and long-term disability, and help those affected to cope with the impact of the injury event on their lives.
The 76th World Health Assembly WHA resolution 76.2 recognized that robust emergency, critical and operative care services are core to national health systems’ ability to respond effectively to emergencies on a daily basis, and form the foundation of effective planning for, and response to, large scale emergencies.
Integrated Clinical Care for Trauma
While a comprehensive approach to strengthening the health system for injury care may be desirable , such an approach can be challenging in areas experiencing acute or protracted crises, e.g., during conflict. In these situations, prioritisation is given to activities focused on emergency life and limb-saving actions for injured patients such as:
To achieve these goals and maintain essential health services, the provision of trauma services should not be decoupled from the provision of emergency medical, surgical or obstetric care for non-trauma patients. Wherever possible, the same trauma management resources and learning programs should be utilized during times of crisis.
Resources for Care of the Injured
The UHC Service Planning & Implementation Platform (SPDI) supports countries in designing and implementing service packages for UHC and support countries to respond more effectively to emergencies. The SPDI Platform supports countries in understanding current service delivery for injury and encourages explicit inclusion of integrated services for injury in national packages of services for UHC.
The Core Clinical Care Readiness (C3R) tool is designed to help health systems deliver vital services through a structured approach to key clinical pathways. C3R identifies essential functions for acute response and continuity of health services, enabling countries to identify gaps, assess barriers, and develop strategic actions to mitigate them. Injury is a key condition in C3R that allow countries to evaluate and plan for enhancing injury care at every level of the health system.
Early recognition and response for injury begins in the community. The WHO Community First Aid Response training for non-health professionals and the WHO Prehospital Toolkit for ambulance providers emphasize early recognition and initial interventions for injury. Ambulance protocols within the Prehospital Toolkit provide structured guidance for key procedures for injury care and transport.
The Interagency Integrated Triage Tool (IITT) is a multi-agency triage tool developed by WHO, the International Committee of the Red Cross, and Médecins Sans Frontières and offers an objective approach to patient prioritisation to save the maximum number of lives by sorting patients according to their acuity. High risk trauma criteria is defined and flagged as requiring immediate interventions to ensure best outcomes.
BEC Extended Modules: Conflict-Related Injuries support the delivery of quality emergency care for patients with conflict-related trauma, covering penetrating injury, blast injury and burns. These extended modules follow the BEC systematic approach to the initial assessment and management of time-sensitive critical conditions where early intervention saves lives.
The Standardized Clinical Forms (SCF) assist with ease of clinical documentation in emergency units while providing a systematic data collection tool for the WHO Clinical Registry. The forms are presented in a format that helps prompt clinicians to perform key assessment and clinical care of the critically ill, including those with injuries. The information gathered by the SCF may be used with the WHO Clinical Registry for targeted quality improvement activities.
Designed to be used in emergency units, the Trauma Care Checklist is a simple, evidence-based tool that uses a structured approach to ensure key lifesaving elements are provided for critically ill trauma patients. The checklists help clinicians to review specific actions at critical points during care of the injured ensuring lifesaving interventions are not overlooked.
The WHO Basic Critical Care (BCC) course is a competency-based training designed to strengthen the capacity of health workers to deliver basic critical care. Building on the skills and knowledge in the BEC, BCC focuses on life-saving interventions during the crucial first days of critical illness, emphasising treating life-threatening syndromes and maintaining organ function while initiating definitive treatment for key conditions. Trauma considerations in critical care are a key focus and emphasized throughout the course via specific learning modules, case discussion, skills and simulation cases.
WHO’s Operative Care at the First Level Hospital learning program (under development) will help providers of surgical and anaesthesia care to better able to meet the essential and acute surgical care needs of patients. Operative care for injury modules teach core content for quality surgical and anaesthesia care for trauma patients.
The lack of standardized case-based data on initial patient presentation and management in emergency units leaves limited opportunity for comparison, aggregation and performance monitoring at facilities and across levels of the health system. The WHO Clinical Registry is a platform for systematically collecting, aggregating and analysing case-based emergency care encounters. The platform is free to users and built on the open-source DHIS2 software. The registry offers modules on emergency care, trauma care, and operative encounters.
The WHO's approach to safe surgery aims to improve surgical outcomes by promoting standardized safety protocols and fostering a culture of safety within healthcare facilities. The WHO Surgical Safety Checklist is a vital tool designed to improve the safety of surgical procedures by ensuring critical safety steps are not missed, including those with acute injuries.
Mass casualty incidents can rapidly overwhelm the ability of local resources to deliver care. Effective mass casualty management can minimize disruption of essential health services and save lives. WHO’s Mass Casualty Management (MCM) learning program, and associated guidance, focusses on preparation for, and response to, mass casualty incidents in emergency units. It addresses the complete cycle of preparedness, response, and recovery.
