Complexity and simplicity: FG to create seven trauma centres across Nigeria
The trauma center also received a lot of referrals from both private and public hospitals, however because there is no coordinating and supervising body, clear referral criteria, protocol and communication, there were unnecessary delays, preventable complications and even death. In addition, no uniform criteria for regulation and audit of services.
The West African College of Surgeons WACS in recognition of the need of expanding horizon of knowledge and skills needed for advanced trauma care and surgical critical care, initiated a Fellowship in Trauma and Surgical Critical Care to train surgeons with advanced knowledge and high level of skills in the management of trauma and critically ill surgical patients and to be in a position to provide leadership in care, teaching and research in trauma and surgical critical care. To date, the National Trauma Center has been accredited for this training.
The challenges faced by the trauma center in addition to the myriad of problems of any health care institution in Nigeria; little consideration has been given to optimizing the training of medical and nursing staff for the care of the injured patients, lack of important equipment, some of which are inexpensive like chest tubes, airway materials etc which are vitally important for the treatment of life-threatening chest injuries and airway obstruction. The reason for absence of such equipment is often the lack of organization and planning, rather than resource restrictions. In addition, there are also significant problems with the process of trauma care like prolonged times to surgery and medical auditing.
The provision of medical services at the trauma center had been dependent on the ability to pay. Hence, cost recovery schemes, had precluded the adequate provision of initial emergency care and of critical elements of definitive care.
The Essential Trauma Care Project
There are notable differences in death rates for injured patients around the world. With significant more likelihood of dying if you sustain injury in a poor country. A study looked at the mortality rates for all seriously injured adults in three cities, in countries at different economic levels. The death rate increased from 35% in a high-income setting to 55% in middle-income setting to 63% in low-income setting. Considering only patients who survive to reach the hospital, a similar study demonstrated a six-fold increase in death for patients with injuries of moderate severity. Such death increased from 6% in a hospital in a high-income country to 36% in a rural area of a low-income country. In addition to excess death, there is tremendous burden of disability from extremity injury in many developing countries. By comparison, head and spinal cord injuries contribute a greater percentage of disability in highincome countries
In part, the improved survival and functional outcome among injured patients in developed countries comes from highcost equipment and technology. Unfortunately much of these may be unaffordable to the average injured person in the developing world for the foreseeable future. However, much of the improvement in patient outcome in higher-income countries has come from improvements in the organization of trauma care services.
The department of injury and violence prevention of the World Health Organization (WHO) has spearheaded efforts to improve the spectrum of injury control activities all over the world. These include improving and standardizing injury surveillance systems, promoting injury control initiatives for violence, traffic and other major sources of injury; and promoting lowcost improvements in injury care, in both the pre-hospital and hospital-based arenas.
The Essential Trauma Care is a Project drawn-up by a collaboration between the Department of Injuries and Violence Prevention (VIP) of the World Health Organization WHO, members of the working group of the International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC), representatives of the Department of Essential Health Technologies of the WHO and trauma care clinicians from Africa, Asia and Latin America. The document tackles promoting inexpensive improvements in facility-based care by setting achievable standards for trauma treatment services, which could realistically be made available to almost every injured person around the world.
The authors developed a series guidelines for essential trauma care that detail the human and physical resources that should be in place to assure optimal care of the injured patient at the range of health facilities throughout the world, from rural health posts whose staff does not have training as doctors, to small hospitals staffed by general practitioners to hospitals staffed by specialists to tertiary care centers. They also take into account the varying resource availability across the spectrum of low- and middleincome countries. Finally a series of recommendations is made on methods to promote such standards including training, performance improvement, trauma team organization and hospital inspection. The resource tables and associated recommendations are intended to provide a template to assist individual countries in organizing and strengthening their own trauma treatment systems. This could be adapted to suit local circumstances. Endorsement Trauma care in Nigeria is currently receiving an unprecedented attention, which had been due to it over a long time. It is most imperative for the government to chart a carefully informed plan in collaboration with relevant stakeholders, to ensure success and sustainability, in a trauma center, by a trauma system or through essential trauma care.