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Primary prevention remains one of the most important ways to reduce the burden of injuries. However, much death and disability could be prevented by strengthening trauma and emergency care services. Research has shown that there are very large discrepancies in outcome among the injured in countries at different economic levels. For example, one study showed that mortality among the seriously injured increased from 35% in the US to 55% in middle‐income Mexico to 63% in low‐income Ghana. These results show that similarly injured people are nearly twice as likely to die in a low‐income setting than in a high‐income setting.1
Many injury deaths in low‐income settings could probably be treated well, and economic constraints are only part of the reason for the disparities in trauma outcomes between countries at different economic levels. There is much that can be done to strengthen trauma and emergency care services through improved organization and planning. Studies of the effect of improving organization and planning of trauma care in high‐income countries have consistently shown survival gains of 8–50% through the improved organization and planning that comes with trauma systems.2
Strengthening trauma and emergency care services could have an important public health benefit. Even under the conservative assumption of reducing mortality among all injured patients by only 8%, an estimated 400000 lives could be saved each year. Even more lives would be saved by strengthening trauma and emergency care services in low‐ and middle‐income countries to a point where injury‐related mortality approaches that observed in high‐income settings.
There is indeed much being done to strengthen trauma and emergency care services in many low‐ and middle‐income countries. There are many dedicated, capable people working against considerable difficulties to improve trauma care in their own institutions and countries. Pilot programs in some countries have documented decreased mortality through cost‐effective and sustainable improvements in training, equipment, and organization and planning.3,4 The question becomes how to build on such examples and make more progress globally. In an effort to do this, in May the World Health Assembly (WHA) adopted a resolution on Emergency Care Systems (Resolution WHA 60.22). The WHA is the governing body of the World Health Organization (WHO). It consists of every Minister of Health, or their designees, from all 192 WHO Member States. Each year in May, the WHA meets in Geneva. At this time, delegates discuss a broad range of health topics based on an agenda that they adopt at the beginning of the session. The objective of the discussion is often to arrive at a consensus on actions to address important public health topics. If an agreement is reached, a resolution may be adopted. A resolution typically urges Member States to take certain actions related to a particular health problem. A resolution also requests the WHO itself to carry out certain activities, usually in support of Member States. Resolutions are usually developed after years of preliminary discussions and negotiations. Although not legally binding, resolutions are important international policy documents that set the stage for public health actions conducted by governments, civil society, and WHO staff. They also influence funding decisions by donors. Resolutions are considered the main policy tools for guiding WHO programs. They provide WHO with a mandate to undertake activities in a specific area.5
A variety of previous resolutions have addressed injury control, especially road safety and violence. These resolutions have included brief mentions of trauma care.5 However, no previous resolution has been specifically dedicated to trauma care services. That changed this year. On 23 May, the 60th WHA adopted a resolution on emergency trauma care systems. This first ever WHA resolution on this topic, initially proposed by Romania and Thailand, draws the attention of governments to the need to strengthen pre‐hospital and emergency trauma care systems (including mass casualty management efforts) and describes a number of steps governments could take. In addition, it invites WHO to scale up its efforts to support countries.
The resolution stresses the importance of the topic of trauma and emergency care services in general. It also provides details on a variety of actions that governments could take, such as: improving pre‐hospital care services by instituting new formal ambulance services (eg, emergency medical services) where none previously exist; building on existing informal systems of pre‐hospital care by such things as first aid training for first responders, in circumstances where formal ambulance services would be impractical; and improving the coordination and organization of existing emergency medical services. It also addresses facility‐based care, such as through the development of a core set of essential trauma care services to be assured to all injured people, institution of trauma quality improvement programs, and more regular provision of trauma‐related continuing (in‐service) education.
During the WHA, 27 governments spoke in support of the resolution, underlining the importance of the issue. Many countries highlighted the growing burden of injuries and violence and the challenge to develop adequate responses in low‐resource settings. Others drew attention to the role of the international community, noting in particular WHO's role in compiling and sharing best practices and developing guidelines. Many noted that the issue needs to be placed higher on the agenda of development agencies.
The resolution is an important commitment from senior public health and development officials around the world to increase efforts to strengthen trauma care systems.
So, now that it has been adopted, what can people concerned with trauma and emergency care services around the world do to put this resolution to good use in improving care of the ill and injured? A variety of actions that can be taken include:
Taking such actions will help to ensure that the resolution delivers its full potential to improve the care of the injured in real life circumstances globally.
For further information, please contact Charles Mock (firstname.lastname@example.org) or go to http://www.who.int/violence_injury_prevention/services/en/ where documents related to WHO trauma and emergency care services activities can be found; or go to http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_R22‐en.pdf for the full text of resolution WHA60.22.