Table 1 Summary of current status and recommendations for Asian Trauma system development
From: Trauma systems in Asian countries: challenges and recommendations
System domain | Status in mature trauma systems | Current status in Asia | Developmental recommendation |
|---|---|---|---|
National Lead Agency | Governance and oversight are provided by a federal (or national) lead agency with statutory/legislative powers to provide the continuum of trauma care, from prevention, through pre-hospital, hospital to rehabilitation. The lead agency to be informed and advised by a national or regional multistakeholder expert advisory group | Lacking appropriate authority, staffing, and funding if exists at all | ∙ Governments must identify and empower a national organization to lead the trauma development process |
Prehospital | ∙ National or regional creation of a lead Emergency Medical Services (EMS) agency to formulate policies, laws, rules and regulations for pre-hospital trauma care ∙ EMS should be activated on universal access number, integrated into inclusive network of healthcare facilities, and connected ∙ There are command and control centers equipped with state-of-the-art information technology to take int patients to correct pre alerted health care facility according to the patient needs by using a predefined triage tool ∙ EMS is resourced with well-equipped land (and air where resources allow air) ambulances and trained licensed crew ∙ Maintain national standards and subjected to continuous process improvement with tracking of key performance indicators | EMS is mature in urban settings but lacks national standards | ∙ A national lead agency should create, certify, and maintain national standards for professional EMS ∙ EMS should coordinate with regional trauma hubs to deliver the right patient to the right hospital ∙ Funding and mechanism to resupply EMS materials used to care for trauma patients |
Facility based care | Availability of specialized level trauma centers (Level 1/Major Trauma Center), designated and verified by national accreditation body, authorized by a statutory document, with resources (human & material) available 24/7 to manage the most severely injured patients | ∙ Lack of trauma trained professionals ∙ Lack of regional trauma hubs | ∙ Establish trauma training programs ∙ Designate and fund hospitals to become the regional trauma facility |
Rehabilitation | ∙ Availability of in-hospital, specialist (e.g., neurotrauma) and community rehabilitation services integrated within a trauma system or network, enacted by law/trauma center accreditation, with oversight by the rehabilitation director ∙ Rehabilitation services and outcome assessment data should be captured by trauma registry and subjected to continuous performance improvement | Injury rehabilitation takes place within the hospital | ∙ Create multidisciplinary teams dedicated to the injured patient ∙ Regional trauma hospitals should have affiliated but separate injury rehabilitation centers |
Trauma quality improvement | National trauma registry with minimal comprehensive data set should be instigated. Data should be captured by trained professionals to include continuum of patient care from prehospital through definitive care to post discharge community care and rehabilitation/recovery outcomes. The registry will facilitate KPI benchmarking, | National trauma statistics, data acquisition, data analysis, data specialists are lacking | ∙ Support a single national trauma registry ∙ Provide mechanism for hospitals to report data that does not rely on healthcare workers ∙ Use information to advocate for injury prevention and legislation development |