Health and economic benefits of improved injury prevention and trauma care worldwide.

Objectives: Injury is a significant source of morbidity and mortality worldwide, and often disproportionately affects younger, more productive members of society. While many have made the case for improved injury prevention and trauma care, health system development in low- and middle-income countries is often limited by resources. This study aims to determine the economic benefit of improved injury prevention and trauma care in low- and middle-income countries.

An estimate of the number of lives that could be saved through improvements in trauma care globally.

Background: Reducing the global burden of injury requires both injury prevention and improved trauma care. We sought to provide an estimate of the number of lives that could be saved by improvements in trauma care, especially in low income and middle income countries.

Methods: Prior data showed differences in case fatality rates for seriously injured persons (Injury Severity Score ≥ 9) in three separate locations: Seattle, WA (high income; case fatality 35%); Monterrey, Mexico (middle income; case fatality 55%); and Kumasi, Ghana (low income; case fatality 63%).

Effect of emergency medical technician certification for all prehospital personnel in a Latin American city.

Background: In Mexico and most other Latin American countries, many emergency medical services (EMS) systems rely on employees and volunteers with only on-the-job training and without formal Emergency Medical Technician (EMT) certification. This study sought to evaluate the costs and effectiveness of providing EMT certification to all personnel working in an EMS service in a Mexican city.

Methods: At baseline, only 20% of the prehospital personnel (medics) working for the EMS service in Santa Catarina, Nuevo Leon, Mexico had EMT certification.

Emergency Medical Service (EMS) systems in developed and developing countries.

Objectives: To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries.

Method: We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries.

Advancing injury prevention and trauma care in North America and globally.

Injury is a major global health problem. This article reviews ways in which the toll from injury can be lowered through the spectrum of injury control, including surveillance, prevention, and trauma care. There is room for improvement in the application of scientifically based, proved interventions at all points in the spectrum in all countries.

Evaluation of Trauma Care capabilities in four countries using the WHO-IATSIC Guidelines for Essential Trauma Care.

Background: We sought to identify affordable and sustainable methods to strengthen trauma care capabilities globally, especially in developing countries, using the Guidelines for Essential Trauma Care. These guidelines were created by the World Health Organization (WHO) and the International Society of Surgery and provide recommendations on elements of trauma care that should be in place at the range of health facilities globally.

Methods: The guidelines were used as a basis for needs assessments in 4 countries selected to represent the world's range of geographic and economic conditions: Mexico (middle income; Latin America); Vietnam (low income; east Asia); India (low income; south Asia); and Ghana (low income; Africa).

Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication.

Objective: To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries.

Methods: The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status).

Strengthening trauma and critical care globally.

Purpose Of Review: Trauma is an increasingly significant health problem globally, especially in low-income and middle-income countries. Trauma care is often compromised by economic restrictions. Many capable individuals are attempting to meet this challenge in their own countries, however.

Human resources for the control of road traffic injury.

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified.

Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico.

Introduction: In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.

Strengthening the prevention and care of injuries worldwide.

The global burden of injuries is enormous, but has often been overlooked in attempts to improve health. We review measures that would strengthen existing efforts to prevent and treat injuries worldwide. Scientifically-based efforts to understand risk factors for the occurrence of injury are needed and they must be translated into prevention programmes that are well designed and assessed.

Injury prevention counselling to improve safety practices by parents in Mexico.

Objectives: To evaluate the effectiveness of educational counselling programmes aimed at increasing parents' practice of childhood safety in Monterrey, Mexico, and to provide information aimed at helping to improve the effectiveness of future efforts in this field.

Methods: Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata. Evaluation involved the use of baseline questionnaires on parents' existing safety-related practices for intervention and control groups and the administration of corresponding questionnaires after the programmes had been carried out.

Strengthening care for injured persons in less developed countries: a case study of Ghana and Mexico.

In all countries, the priority for reducing road traffic injuries should be prevention. Nonetheless, there are low-cost ways to strengthen the care of injured persons, that will help to lower the toll from road traffic. The purpose of this review was to elucidate ways to accomplish this goal in the context of less developed countries.

Pedestrian traffic injuries in Mexico: a country update.

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000.

Low-cost improvements in prehospital trauma care in a Latin American city.

Objective: Prehospital care is a critical component of efforts to lower trauma mortality. In less-developed countries, scarce resources dictate that any improvements in prehospital care must be low in cost. In one Latin American city, recent efforts to improve prehospital care have included an increase in the number of sites of ambulance dispatch from two to four and introduction of the Prehospital Trauma Life Support (PHTLS) course.

Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development.

Background: Whereas organized trauma care systems have decreased trauma mortality in the United States, trauma system design has not been well addressed in developing nations. We sought to determine areas in greatest need of improvement in the trauma systems of developing nations.

Methods: We compared outcome of all seriously injured (Injury Severity Score > or = 9 or dead), nontransferred, adults managed over 1 year in three cities in nations at different economic levels: (1) Kumasi, Ghana: low income, gross national product (GNP) per capita of $310, no emergency medical service (EMS); (2) Monterrey, Mexico: middle income, GNP $3,900, basic EMS; and (3) Seattle, Washington: high income, GNP $25,000, advanced EMS.

Permissive hypercapnia in trauma patients.

The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS).

Trauma care systems in urban Latin America: the priorities should be prehospital and emergency room management.

Trauma is a significant cause of premature death in developing nations, but financial resources to deal with it are extremely limited. To determine which segments of a developing nation's trauma system would be most amenable to improvements, we compared management and outcome of all seriously injured patients (Injury Severity Score of > or = 9 or died) treated over 1 year by the trauma systems associated with an urban hospital in Latin America, Regional Trauma Center 21 (n = 545) in Monterrey, Mexico, and a level I trauma center in the United States, Harborview Medical Center (n = 533) in Seattle, Wash. Mortality was higher in Monterrey (55%) than in Seattle (34%, p < 0.

Thoracoscopic Heller's myotomy. Treatment of achalasia by the videoendoscopic approach.

In summary, the authors believe that minimally invasive surgery has added a new dimension to the treatment of achalasia. Thoracoscopic myotomy is feasible, safe, and effective in relieving dysphagia in the great majority of individuals affected with this disease without the many problems associated with dilatation; thus, the authors offer it to patients with achalasia as the initial and preferred form of treatment. Whether an antireflux procedure should be routinely added and whether a laparoscopic rather than a thoracoscopic approach is preferred, remains unanswered questions at this time.

Factors influencing outcome in stab wounds of the heart.

Background: The purpose of this study was to identify factors associated with unfavorable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from aggressive resuscitative efforts.

Methods: Preoperative and operative variables were reviewed for all patients treated for cardiac stab wounds at a level I trauma center from 1987 to 1993 in an attempt to identify factors influencing survival.

Results: Twenty-nine (53%) of the 55 patients who were resuscitated following stab wounds to the heart during the study period survived.