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Care of the Victims

For every person dying as a result of injury, there are hundreds more injured or suffering other health consequences. Although the ultimate goal is to prevent 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.

Case study: Romania - Integrated emergency dispatch in Mures county

In Mures county, Romania, until 2001, emergency calls were received by different dispatch centres, one serving each emergency response agency (police, medical and fire).There were 27 independent dispatch centres throughout the county. In March 2001, with funds received mainly from local authorities, a single county-level integrated emergency dispatch centre was created; those needing to use the system dial 112 for all emergencies. The old emergency numbers have been kept in place but are diverted to the new centre. The implementation of the single dispatch centre proved to be an economical solution, replacing the multiple, inefficient and expensive centres with one that was less costly, more efficient and equipped to a higher level. From an operational point of view, the new centre allows county-level coordination and management of emergency vehicles and responses between different agencies.

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.

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. However, the lack of empirical data on the benefit of many pre-hospital care interventions is a serious problem. For this reason, the recommendation given by the group should not be considered an "evidence based" review but rather as a product of expert consensus.

The 'decent minimum' is published in the WHO publication Pre-hospital trauma care systems. It is organised around three fundamental principles:

  1. an effective pre-hospital trauma care system should be simple, sustainable, practical, efficient, and flexible;
  2. whenever possible, pre-hospital care should be integrated into a country's existing healthcare, public health, and transportation infrastructures;
  3. wherever effective systems for pre-hospital trauma care are established, it can be expected that they will be quickly tasked with responsibility to address a broader range of health concerns, including paediatric, adult medical and obstetrical emergencies.

The Prehospital trauma care systems manual focuses on the most promising interventions and components of pre-hospital trauma care systems, particularly those that require minimal training and relatively little in the way of equipment or supplies.

The main areas covered include the organization of the pre-hospital trauma care system, capacity development, data collection, transportation and communication, as well as ethical and legal considerations.

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).

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. Therefore there is a whole section in the knowledge base dedicated to the importance of first aid.

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 throughout the world.

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. Considering only patients who survive to reach the hospital, a similar study demonstrated a six-fold increase in mortality for patients with injuries of moderate severity. Such mortality increased from 6% in a hospital in a high-income country to 36% in a rural area of a low-income country.

In part, the improved survival and functional outcome among injured patients in developed countries comes from high-cost equipment and technology. Unfortunately, much of this may be unaffordable to the average injured person in the world. However, much of the improvement in patient outcome in higher-income countries has come from improvements in the organization of trauma care services. Improvement in the organization of trauma services should be achievable in almost every setting and may represent a cost effective way of improving patient outcomes.

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).

The guide contains a series of resource tables that detail the human and physical resources needed for optimal care of the injured patient at the range of health facilities, from rural health posts whose staff do not have training as doctors, to small hospitals staffed by general practitioners (known as GP-staffed hospitals), to hospitals staffed by specialists (specialist-staffed hospitals), to tertiary care centres. They take into account the varying resource availability world.

In Ghana, in June 2005, GRSP organised, with local counterparts, a workshop on road safety and essential trauma care, with Standard Chartered funding. Below see an article summarizing the outcome from GRSP NEWS - Issue 16, October 2005:

To get access to the full essential trauma care document on WHO website please click here.

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.