Pre-hospital and hospital trauma care

For every person dying in traffic as a result of injury, there are hundreds more injured. Although the ultimate goal is to prevent road crashes and hence injuries from happening in the first place, much can be done to minimize the consequences of injuries that do occur. Providing quality support and care services to victims is therefore essential for responding to injuries. Appropriate services for the injured can prevent future fatalities, reduce the amount of short-term and long-term disability, and help those affected to cope with the impact of the injury event on their lives.

One of the most common causes of death for victims of a road crash is anoxia - a lack of oxygen supply - caused by a blocked airway. On average, it takes less than four minutes for a blocked airway to be fatal. Even in areas with highly structured emergency care, the norm for ambulance response to a road crash is ten minutes. Many people will die if nothing is done to correct the slow response time to anoxia. The application of first aid techniques, in particular the proper positioning of the victim prior to the arrival of the emergency response teams, can mean the difference between life and death in a road crash. The British Red Cross published in 2004 a report: Anyone can save a life: Road safety and road accidents recommending developing greater first aid knowledge amongst the general population be they drivers, car-users or pedestrians involved in, or bystanders to, road accidents. More information on first aid and its importance can be found following this link.

Pre-hospital care
There is a pressing need to strengthen the quality and availability of pre-hospital trauma care systems throughout the world. To achieve this goal, leading experts in the field proposed a collaborative effort to define a minimum acceptable level of pre-hospital care that could save lives, including the definition of core strategies, relevant equipment, and needed supplies and organizational structures. The World Health Organization (WHO) has been a central coordinator for this collaborative effort to achieve consensus around a simple but sustainable set of interventions that should constitute the "decent minimum" of pre-hospital trauma care that all countries should aspire to provide. Achieving this goal could save many lives and prevent countless disabilities worldwide.

The Prehospital trauma care systems manual focuses on the most promising interventions and components of pre-hospital trauma care systems. The manual provides guidance for what can be done to improve care of the injured in the field under a wide range of circumstances, including: how to strengthen existing basic ambulance services; how to initiate new ambulance services (if it would be cost-effective to do so); or how to strengthen existing informal systems of pre-hospital care (such as first aid training of the lay public).

Essential Trauma Care
Equally there is general agreement amongst a range of international experts that there is a pressing need to strengthen the quality and availability of trauma care at hospitals and clinics. There are notable disparities in mortality rates for injured patients around the world. For example, one study looked at the mortality rates for all seriously injured adults in three cities, in countries at different economic levels. The mortality rate (including both pre-hospital and in-hospital deaths) rose from 35% in a high-income setting to 55% in a middle income setting, to 63% in a low-income setting.

In terms of treatment, there are many low-cost improvements that could be made to enhance the care of injured persons. In 2004, WHO published the Guidelines for essential trauma care to promote such low-cost improvements. These guidelines seek to set achievable standards for trauma treatment services which can be made available to almost every injured person in the world. The guide defines the resources that would be necessary for such care including human (training and staffing) and physical resources (infrastructure, equipment and supplies). To access this manual follow the knowledge link on the right.

Psychological support
Apart from the physical trauma, every road incident with injuries has psychological consequences. Victims of a road crash need to regain an acceptable physical quality of life as well as heal emotional scars. For severe injuries and in case of fatalities psychological support is essential for both the person having been involved in the road crash and for the family/relatives of the injured or killed. Stress-related emotions can overwhelm people's capacity to overcome personal grief and begin rebuilding their lives. If ignored, these psychological symptoms can progress into more severe disorders. Psychological support can help prevent this from occurring.

The key components of psychological assistance for victims are ongoing interaction and presence with the aim of build up feelings of security and hope. This strengthens the affected person coping capacities and reinforce support from family members and friends. Psychological support deals with basic human feelings and needs - shock, loss, bereavement, and powerlessness. These feelings are common to everyone, but coping mechanisms vary with different cultures.

Support groups are established to help solve common problems, allow for emotional ventilation, improve communication skills, develop social networks, and build trust, empathy, and understanding. The European Federation of Road Traffic Victims is an example of a large network, but many local community groups offer great support too.

Case Studies

Key Documents