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Appropriate care for injured people can reduce mortality and long-term disability. Care for victims of injury is an issue upon which member states frequently turn to the World Health Organization (WHO) for support and guidance, which constitutes an important part of a comprehensive approach to injury prevention.
For the past few years the WHO has collaborated with a group of trauma and emergency care specialists in order to address trauma and emergency care issues. The main objective has been to provide a contribution to improved trauma and emergency care through normative guidance at a global level that is suited to the needs of low- and middle-income countries, and to support implementation of this guidance at country level.
The work of the WHO and partners worldwide has led to the development of guidance documents entitled Guidelines for essential trauma care1 and Prehospital trauma care systems.2 These guidance documents address fixed facilities (hospitals and clinics) and prehospital care strengthening, respectively.
The logical underpinning for both documents is based on a wide body of evidence showing that improved organization and planning of trauma care in high-income countries has consistently shown survival improvements of 8–50% through related activities such as trauma centre designation and verification, prehospital care planning and triage criteria, inter-facility transfer protocols and other mechanisms. Accordingly, a common orientation throughout both documents is towards cost-effective, evidence-based and affordable strategies to assure effective trauma and emergency care service provision including through human resources, physical resources and appropriate transport systems.
Country-level activities to strengthen trauma and emergency care have taken place in a range of countries since the publication of these two documents. Illustrative examples of just a few of these efforts include Mozambique, where the WHO and partners have participated in a technical assessment and review of prehospital care systems in Maputo. In Ghana, a national needs assessment for essential trauma care based on the Guidelines for essential trauma care was undertaken and highlighted priorities for low-cost improvements. In Mexico, the WHO and the Ministry of Health convened a stakeholder conference to adapt the Guidelines for essential trauma care to the Mexican situation and this has been followed by a three-state needs assessment and the development of trauma care legislation. Finally, in Sri Lanka a national trauma care stakeholders meeting in 2005 led to the initiation of a policy dialogue process that in turn has resulted in a pilot test of improved trauma care systems within four hospitals.
An important recent development at a global level has been the adoption by the WHO's Executive Board in January 2007 of a resolution on emergency care systems (EB120/R4). This resolution will be presented to the WHO member states during the 60th World Health Assembly in May 2007 for adoption, and calls on member states to comprehensively assess and strengthen their prehospital and emergency care systems. Provided this resolution is passed by the World Health Assembly, it will provide an important impetus and a targeted framework for national and WHO action to develop more effective trauma and emergency care systems.
Another development at a global level has been the initiation of a collaboration within the WHO between the Department of Injuries and Violence Prevention and the Department of Health Action in Crises to develop WHO guidelines for mass-casualty management. This collaboration has been informed by a global consultation on mass-casualty management held in September 2006 and was attended by a number of trauma and emergency care specialists who have worked with the WHO on trauma and emergency care, as well as a number of other international specialists in mass-casualty management. WHO guidance addressing administrative and policy aspects of preparing for, and responding to, mass-casualty incidents is now nearing completion. The next step in this collaborative process will be to provide guidance that focuses more on technical aspects of responding to mass-casualty incidents.
An important connection between this work and the work the WHO has already undertaken to provide normative guidance on prehospital and essential trauma-care systems is that a fundamental part of responding to mass-casualty incidents is scaling up the capabilities and effectiveness of existing systems in order to meet the higher demand imposed on emergency systems. A corollary is that a fundamental part of preparation for mass-casualty incidents is the presence of a robust, well-organized prehospital and essential trauma care system that can cope with the daily burden of injury.