Blog by Matthew Fuller, MD
Nov 1, 2016 12:00 PM
Globally, trauma kills more people every year than AIDS, Tuberculosis and Malaria. COMBINED.
Let me say that again - every year, more than 5 million people worldwide die of traumatic disease. That means that every day, 14,000 people worldwide die of trauma, nearly ten deaths a minute. And yet, discussion regarding the impact of trauma, particularly on developing nations, which shoulder a disproportionate amount of trauma deaths when compared to richer nations, is virtually non-existent. As developing societies become more dependent on mechanized travel, trauma related deaths increase proportionately.
Published data from the World Health Organization suggest an even more appalling trend; these deaths disproportionately affect the young, and trauma is the most common killer for peoples aged 15-29, who represent a significant portion of the working population. Moreover, deaths represent the smallest fraction of those injured by trauma. The vast majority of those affected are instead left maimed and disabled, unable to work or provide for their dependents. Recognizing the downstream economic impact that one of these working age deaths or disabilities has on these developing economies, one begins to understand the impact that trauma has worldwide. Perhaps more distressing is that the WHO predicts that injuries will continue to rise unless something is done to confront these trends.
There are a myriad of reasons for the asymmetric effect of trauma on poorer nations, including lack of organized EMS systems, inadequate trauma care infrastructure or simply lack of standardized medical training. Ho Chi Minh City, Vietnam. The Sacred Valley, Peru. Rural India. These places are no strangers to the burden of traumatic disease. The Division of Emergency Medicine at the University of Utah has instituted a number of projects aimed at slowing this epidemic of trauma, and has partnered with institutions and organizations in these areas to help address health disparities, with a particular focus on educating health care providers-traditional and lay person alike.
Vietnam, like many developing nations, lacks dedicated specialty specific Emergency Medicine residency training. The vast majority of practitioners providing Emergency Care have received little to no formal training with specific regard to the evaluation, resuscitation, and triage of traumatically injured patients. Through ongoing partnerships with the largest trauma receiving center in Southern Vietnam, the Division of EM has made strides in providing ongoing annual web based curricula as well as hands on lo-fi simulation for colleagues there, fostering the development of a community of Vietnamese physician who are contributing to the growth of an ever larger contingent of in country experts.
On the sub-continent of India, many medical school students graduate and take positions in rural clinics with little to no supervision and virtually no training or experience in providing acute, emergent care to patients. Faculty within the UU Division of Emergency Medicine have developed a week long training course targeting these providers to improve their basic assessment and treatment skills for particularly ill patients, with a focus on providing stabilizing care and directed transport to facilities better equipped to provide care for critically ill patients. This program has expanded state wide, and is being considered for adoption country wide in India.
Road traffic accidents make up the majority of trauma deaths in developing countries. Peru is no different. And while it has rapidly developed its urban infrastructure, including EMS, the countryside has lagged far behind. The majority of patients experiencing traumatic injury in the rural parts of Peru, like most developing nations, are initially provided first aid and transport by lay providers, with little to no medical knowledge, and often, little to no literacy. Utilizing a flip book designed for a largely illiterate population, a 1 day lay provider course was developed and is currently being implemented for members of the public in rural Peru who often provide the initial care and transport for patients in the absence of formal EMS.
The University of Utah has an extremely rich tradition of pursuing global partnerships and the Division of EM is just one of many departments within the larger University working towards health equity, both locally and globally. The Division of Emergency Medicine is proud to be one small part of this supportive academic home.