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October 2014, Volume 64, Issue 10

Student's Corner

The decrepit state of trauma care in under-developed healthcare settings

Dania Aijaz Shah  ( Medical Student, Dow Medical College, Karachi. )
Adil Aijaz Shah  ( Aga Khan University, Karachi. )

The escalating number of deaths attributed to injuries in developing countries approximates 90% of trauma-related mortality worldwide.1 Trauma burdens the fragile economic and health environments of developing nations, especially when survival culminates into permanent disability of individuals that contribute to the workforce.1 Timely and adequate provision of trauma care determines the survival and functional outcomes of trauma patients — factors which are grossly overlooked in under-developed healthcare settings.
Injuries are difficult to address in developing countries because of undeveloped trauma care facilities, untrained healthcare personnel and dearth of basic life support systems. Few clinical facilities consist of an emergency department, solely dedicated to serve trauma patients.2 Absence of multidisciplinary trauma teams and surgeons often deters these hospitals from tending to complex trauma cases.2,3 Patients are often transferred to higher-volume facilities which contributes to significant delays in care and increases risk of major complications and poor outcomes.3
Due to a dearth of qualified paramedical personnel, and ambulances that lack basic-life-support systems, pre-hospital care for trauma victims in resource-limited healthcare settings remains non-existent. Moreover, such settings often lack a centralized dispatch center for ambulances, which could serve to provide information to healthcare facilities prior to casualty transfer and to ensure emergency preparedness. In this vein, a retrospective study conducted in Bangladesh exhibited that ambulances were under-utilized for the transportation of patients with spinal injuries.4 In resource-limited settings, spine-boards are scarcely used for the transfer of victims with spinal injuries, in contrast to mandatory spinal immobilization in developed trauma care settings.4 In developing nations, trauma-care has received disproportionately lesser attention and even lower funding for research.5
In absence of dedicated trauma facilities, it is imperative to train all essential and non-essential healthcare personnel in trauma management by mandating basic-life-support training. Furthermore, traumatology should be incorporated within medical syllabi to cultivate the interest of medical and nursing students, as well as physicians in training to pursue careers in emergency medicine. In order to ensure a modicum of pre-hospital care to patients, ambulance services manned by qualified personnel and equipped with basic life support systems should be established. A centralized dispatch system would provide quick and efficient transportation of patients to nearby healthcare facilities. Resource allocation for the establishment of centralized trauma registry would be extremely beneficial towards the study of determinants of outcomes for different types of trauma occurring in the region.



1. Gosselin RA. The Increasing Burden of Injuries in Developing Countries: Direct and Indirect Consequences. Tech Ortho; 24: 230-2.
2. Reynolds TA, Mfinanga JA, Sawe HR, Runson MS, Munfengo V. Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy 2012; 33: S126-37.
3. Hsia R, Razzak J, Tsai AC, Hirshon JM. Placing emergency care on the global agenda. Ann Emerg Med 2010; 56: 142-9.
4. Razzak AT. Early Care following Traumatic Spinal Cord Injury (TSCI) in a Rehabilitation Centre in Bangladesh - An Analysis. DCID 2013; 24: 64-78.
5. Ademuyiwa AO, Usang UE, Oluwadiya KS, Ogunlana DI, Addy HG, Bode CO, et al. Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge, J Emerg Trauma Shock 2012; 5: 55-61.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: