Overview of trauma systems in Uganda: Current state and potential for development Dr. Isaac Alidria - Ezati Accident and Emergency Department Mulago hospital

TRAUMA SYSTEMS An organized approach to acutely injured patient in a defined area Provides full and optimal care The care is integrated in the emergency medical system Must meet the needs of the injured patient regardless of severity of injury Many countries have shown significant improvement of trauma patients USA, UK, ISRAEL

OBJECTIVES OF A TRAUMA SYSTEMS Provide optimal care (acute care and rehabilitation) – match the facility resources to the needs of the patient Enhances the health of the community –Injury documentation –Identification of vulnerable –Identification of risks –Identify solutions Reduce injury related morbidity, disability, mortality and disability Disaster preparedness

TRAUMA SYSTEM COMPONENTS ACCESS TO CARE PREHOSPITAL CARE ACUTE HOSPITAL CARE REHABILITATION

In addition……… Injury prevention Research Disaster response planning Rational financial planning Patient education Evaluation Quality assessment and improvement Surgical leadership

ESSENTIALS FOR DEVELOPING TRAUMA SYSTEM Administrative componentsYesNo –Legislation?? –Systems developmentx –Funds y –Strong leadership?? Directs the trauma programmes Trauma care Trauma PI programmes Advocacy role for the injured patient

Operational and clinical essentials YesNo Injury prevention and controly Human resourcesy Pre-hospital caren Acute care facilities for optimal trauma carey Information systems n Evaluation of caren Researchy

Injured patient management in the system Prehospital care Injured patient Hospital care Rehabilitation Return of the injured patients Injured patient Hospital care Rehabilitation Return of the injured patients Ideal systemUganda today

W AY FORWARD 1.Establish the need or desire for improvement of trauma care and injury prevention. Public has expressed the desire Politicians have expressed concern Desire by hospital workers

Needs assessment Data base for injuries Review outcome of trauma cases in various levels of care Current capabilities Prehospital care Hospital facilities, human resource, specialties, rehabilitation facilities Level of care (grade the hospitals) Provides resource base, Identify gaps and plan for them

Get the Legal Authority To avoid legal challenges to the system For Emergency Medical system in-order to regulate and direct pre-hospital care Establish transport system Prehospital triage Direct patients transfer Trauma registry Performance improvement

Establish criteria for optimal care Acute Trauma Care training Proper triage Guidelines, protocols and standards development Grade the hospitals and determine the role of each hospital – depending on facilities resources and number of trauma patients they receive in a year Trauma teams – Inhouse 24hrs

Mechanisms for monitoring and evaluation Internal monitoring –Performance improvement programs External evaluation

Trauma Audit process Audit committee, Hospital Trauma committee, National Trauma Committee Meets regularly –Checks trauma registry –Case scenarios –Annual or monthly trauma audit –Mortality, morbidity, –Quality of care assessment –Performance improvement programs

Research Trauma epidemiology Trauma outcomes – major trauma outcome Basic science research Shock, Traumatic brain injury Multiple organ failure Advances in management of organ injuries specificity and sensitivity of trauma scores Trauma costs Occupational injuries Missed injuries Clinical trials

What will make it succeed here Strong surgical commitment and leadership Strong management support (centrally and locally) Appropriate assessment of hospitals regarding their capability to provide optimal care. Categorization of health care facilities Establishment of a pre-hospital care system Proper triage and transport Good financial considerations

When the time comes MOH The designated EMS, ICC-U Local surgeons handling trauma Other medical personnel Will meet and further develop trauma system for Uganda

How will collaboration help in developing trauma systems Develop trauma research in the country Strengthen the trauma registry and studies in trauma outcome Develop human resource trauma care and trauma research Needs assessment Capability assessment, categorization of care facilities Development of pre-hospital care Quality monitoring and Quality improvement Support to the development of trauma systems in Uganda.

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