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Objective: Between 2004 and 2010, the World Health Organization (WHO) released three publications intended to provide guidance to policymakers in low- and middle-income countries towards system-wide improvements in trauma care. We sought to understand the degree to which these guidelines have been implemented globally, including understanding location and type of implementation. We thus hoped to identify priorities for future implementation and dissemination strategies. Methods: We conducted a systematic review in which the titles of the WHO trauma care guidelines were used as the search terms: "Guidelines for Essential Trauma Care", "Prehospital Trauma Care Systems", "Guidelines for Trauma Quality Improvement Programmes". Nineteen databases were queried, validation of results was performed through citation analysis and expert consultation. Two reviewers independently scored sources. Findings: The search returned 112 sources describing 140 implementation events in 51 countries. These were divided between those that described needs assessments (45%), endorsement by stakeholders (27%), educational interventions (14%), and incorporation into policy (14%). There was evidence of implementation in 40% of low-income countries, 32% of lower-middle, and 28% of upper-middle income countries. Conclusions: The WHO trauma care guidelines are widely implemented in meaningful ways. However, given the substantial disparities that remain in trauma care, efforts to bring the standards described in the publications to the remaining 143 WHO member states are needed. Particular emphasis should be on: serial needs assessments for ongoing monitoring of capacity for trauma care in health systems, incorporation of guidelines into formal education of healthcare providers, and incorporation of the guidelines into health policy.
Developed by WHO and the International Committee of the Red Cross in collaboration with the International Federation for Emergency Medicine Basic Emergency Care (BEC): Approach to the acutely ill and injured is an open-access training course for frontline healthcare providers who manage acute illness and injury with limited resources. BEC teaches a systematic approach to the initial assessment and management of time-sensitive conditions where early intervention saves lives. It includes modules on: the ABCDE and SAMPLE history approach trauma difficulty in breathing shock and altered mental status. The practical skills section covers the essential time-sensitive interventions for these key acute presentations. The BEC package includes a Participant Workbook and electronic slide decks for each module. BEC integrates the guidance from WHO Emergency Triage Assessment and Treatment (ETAT) for children WHO Pocket Book of Hospital Care for Children WHO Integrated Management of Pregnancy and Childbirth and the Integrated Management of Adult/Adolescent Illness (IMAI).
These WHO mhGAP guidelines were developed to provide recommended management strategies for conditions specifically related to stress, including symptoms of acute stress, post-traumatic stress disorder and bereavement. The guidelines were developed by an independent Guidelines Development Group and inform a new mhGAP module on the Assessment and Management of Conditions Specifically Related to Stress.
Injury is an increasingly significant health problem throughout the world, accounting for 16 per cent of the global burden of disease. The public health burden of death and disability from injury is particularly notable in low and middle income countries. These guidelines seek to establish practical and affordable standards applicable to injury or trauma care worldwide, whether in rural health posts, small hospitals, hospitals staffed by specialists or tertiary care centres. It sets out a list of key trauma treatment services designed to be achievable in all settings, and defines the various human and physical resources required. It also includes a number of recommendations for methods to promote such standards including training, performance improvement, trauma team organisation and hospital inspection.
With “groundbreaking research on the psychology of resilience” (Adam Grant), a top expert on human trauma argues that we vastly overestimate how common PTSD is in and fail to recognize how resilient people really are. After 9/11, mental health professionals flocked to New York to handle what everyone assumed would be a flood of trauma cases. Oddly, the flood never came. In The End of Trauma, pioneering psychologist George A. Bonanno argues that we failed to predict the psychological response to 9/11 because most of what we understand about trauma is wrong. For starters, it’s not nearly as common as we think. In fact, people are overwhelmingly resilient to adversity. What we often interpret as PTSD are signs of a natural process of learning how to deal with a specific situation. We can cope far more effectively if we understand how this process works. Drawing on four decades of research, Bonanno explains what makes us resilient, why we sometimes aren’t, and how we can better handle traumatic stress. Hopeful and humane, The End of Trauma overturns everything we thought we knew about how people respond to hardship.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
A health-care provider is likely to be the first professional contact for survivors of intimate partner violence or sexual assault. Evidence suggests that women who have been subjected to violence seek health care more often than non-abused women, even if they do not disclose the associated violence. They also identify health-care providers as the professionals they would most trust with disclosure of abuse. These guidelines are an unprecedented effort to equip healthcare providers with evidence-based guidance as to how to respond to intimate partner violence and sexual violence against women. They also provide advice for policy makers, encouraging better coordination and funding of services, and greater attention to responding to sexual violence and partner violence within training programmes for health care providers. The guidelines are based on systematic reviews of the evidence, and cover: 1. identification and clinical care for intimate partner violence 2. clinical care for sexual assault 3. training relating to intimate partner violence and sexual assault against women 4. policy and programmatic approaches to delivering services 5. mandatory reporting of intimate partner violence. The guidelines aim to raise awareness of violence against women among health-care providers and policy-makers, so that they better understand the need for an appropriate health-sector response. They provide standards that can form the basis for national guidelines, and for integrating these issues into health-care provider education.
In response to the call of the 48th World Health Assembly for a substantial revision of the International Health Regulations, this new edition of the Regulations will enter into force on June 15, 2007. The purpose and scope of the Regulations are "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade." The Regulations also cover certificates applicable to international travel and transport, and requirements for international ports, airports and ground crossings.
Injuries are the leading cause of death and disability among people under age 35 in the United States. Despite great strides in injury prevention over the decades, injuries result in 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to the emergency room each year. Reducing the Burden of Injury describes the cost and magnitude of the injury problem in America and looks critically at the current response by the public and private sectors, including: Data and surveillance needs. Research priorities. Trauma care systems development. Infrastructure support, including training for injury professionals. Firearm safety. Coordination among federal agencies. The authors define the field of injury and establish boundaries for the field regarding intentional injuries. This book highlights the crosscutting nature of the injury field, identifies opportunities to leverage resources and expertise of the numerous parties involved, and discusses issues regarding leadership at the federal level.