Overview of trauma systems in Uganda: Current state and potential for development

1. Overview of trauma systems in Uganda: Current state and potential for development Dr. Isaac Alidria - Ezati Accident and Emergency Department Mulago hospital

2. TRAUMA SYSTEMS • An organized approach to acutely injured patient in a defined area • Provides full and optimal care • The care is integrated in the emergency medical system • Must meet the needs of the injured patient regardless of severity of injury • Many countries have shown significant improvement of trauma patients USA, UK, ISRAEL

3. OBJECTIVES OF A TRAUMA SYSTEMS • Provide optimal care (acute care and rehabilitation) – match the facility resources to the needs of the patient • Enhances the health of the community • Injury documentation • Identification of vulnerable • Identification of risks • Identify solutions • Reduce injury related morbidity, disability, mortality and disability • Disaster preparedness

4. TRAUMA SYSTEM COMPONENTS • ACCESS TO CARE • PREHOSPITAL CARE • ACUTE HOSPITAL CARE • REHABILITATION

5. In addition……… • Injury prevention • Research • Disaster response planning • Rational financial planning • Patient education • Evaluation • Quality assessment and improvement • Surgical leadership

6. ESSENTIALS FOR DEVELOPING TRAUMA SYSTEM • Administrative components Yes No • Legislation ? ? • Systems development x • Funds y • Strong leadership ? ? • Directs the trauma programmes • Trauma care • Trauma PI programmes • Advocacy role for the injured patient

7. Operational and clinical essentials Yes No • Injury prevention and control y • Human resources y • Pre-hospital care n • Acute care facilities for optimal trauma care y • Information systems n • Evaluation of care n • Research y

8. Injured patient management in the system Ideal system Uganda today Injured patient Injured patient Prehospital care Hospital care Hospital care Rehabilitation Rehabilitation Return of the injured patients Return of the injured patients

9. W AY FORWARD • Establish the need or desire for improvement of trauma care and injury prevention. Public has expressed the desire Politicians have expressed concern Desire by hospital workers

10. Needs assessment • Data base for injuries • Review outcome of trauma cases in various levels of care • Current capabilities • Prehospital care • Hospital facilities, human resource, specialties, rehabilitation facilities • Level of care (grade the hospitals) • Provides resource base, Identify gaps and plan for them

11. Get the Legal Authority • To avoid legal challenges to the system • For Emergency Medical system in-order to regulate and direct pre-hospital care • Establish transport system • Prehospital triage • Direct patients transfer • Trauma registry • Performance improvement

12. Establish criteria for optimal care • Acute Trauma Care training • Proper triage • Guidelines, protocols and standards development • Grade the hospitals and determine the role of each hospital – depending on facilities resources and number of trauma patients they receive in a year • Trauma teams – Inhouse 24hrs

13. Mechanisms for monitoring and evaluation • Internal monitoring • Performance improvement programs • External evaluation

14. Trauma Audit process • Audit committee, Hospital Trauma committee, National Trauma Committee • Meets regularly • Checks trauma registry • Case scenarios • Annual or monthly trauma audit • Mortality , morbidity, • Quality of care assessment • Performance improvement programs

15. Research • Trauma epidemiology • Trauma outcomes – major trauma outcome • Basic science research • Shock, • Traumatic brain injury • Multiple organ failure • Advances in management of organ injuries • specificity and sensitivity of trauma scores • Trauma costs • Occupational injuries • Missed injuries • Clinical trials

16. What will make it succeed here • Strong surgical commitment and leadership • Strong management support (centrally and locally) • Appropriate assessment of hospitals regarding their capability to provide optimal care. • Categorization of health care facilities • Establishment of a pre-hospital care system • Proper triage and transport • Good financial considerations

17. When the time comes • MOH • The designated EMS, ICC-U • Local surgeons handling trauma • Other medical personnel • Will meet and further develop trauma system for Uganda

18. How will collaboration help in developing trauma systems • Develop trauma research in the country • Strengthen the trauma registry and studies in trauma outcome • Develop human resource trauma care and trauma research • Needs assessment • Capability assessment, categorization of care facilities • Development of pre-hospital care • Quality monitoring and Quality improvement • Support to the development of trauma systems in Uganda.

19. THANK YOU