RESUMO
BACKGROUND: Trauma systems in high-income countries have been shown to reduce trauma-related morbidity and mortality; however, these systems are infrequently implemented in low- and middle-income countries. Haiti currently lacks a well-resourced and structured trauma system and in turn loses an estimated 800,000 y of healthy life to injuries annually. In the present study, we perform a nationwide trauma capacity assessment, and using the World Health Organization's Guidelines for Essential Trauma Care as a framework, we attempt to identify achievable steps that can be taken toward improving trauma care in Haiti. MATERIALS AND METHODS: This cross-sectional study was performed at 12 facilities nationally using a survey tool assessing the areas of infrastructure, supplies and equipment, personnel and training, and procedural capabilities. Additionally, the total number of trauma cases presenting to each facility was tabulated from emergency room logbooks. RESULTS: A total of six secondary and six tertiary facilities were surveyed. Secondary facilities received an average of 35 trauma cases per week, whereas tertiary facilities received an average of 65 cases per week. Survey results demonstrated a shortage of airway, breathing, and circulation equipment and supplies in both facility levels, particularly in emergency rooms. All facilities lacked access to essential surgical personnel and trauma training. CONCLUSIONS: This study makes recommendations for improvements in trauma care in Haiti in the areas of infrastructure and administration, physical resources, and training and human resources. These recommendations represent feasible steps that can be taken toward the construction of a national trauma system in Haiti.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Estudos Transversais , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Haiti , Número de Leitos em Hospital , Recursos HumanosRESUMO
BACKGROUND: Surgical burden is a large and neglected global health problem in low- and middle-income countries. With the increasing trauma burden, the goal of this study was to evaluate the trauma capacity of hospitals in the central plateau of Haiti. MATERIALS AND METHODS: The World Health Organization Emergency and Essential Surgical Care survey was adapted with a focus on trauma capacity. Interviewers along with translators administered the survey to key hospital staff. RESULTS: Seven hospitals in the region were surveyed. Of the hospitals surveyed, 3/7 had functioning surgical facilities. None of the hospitals had trauma registries. 71% of the hospitals had no formal trauma guidelines. 2/7 hospitals had a general surgeon available 100% of the time. All surgical facilities had oxygen cylinders available 100% of the time, but three of the primary level hospitals only had it available 51%-90% of the time. Intubation equipment was available at 57% of the facilities. Ventilators were only available in the operating room. Only the largest hospital had a computed tomography scanner. Other hospitals (66%) had a functioning x-ray machine 76%-90% of the time. Hospitals (57%) had an ultrasound machine. The most common reasons for referral were lack of appropriate facilities and supplies at the primary level care centers or lack of trained personnel at higher-level facilities. CONCLUSIONS: Trauma capacity in the central plateau of Haiti is limited. There is a great need for more personnel, trauma training at all staff levels, emergency care guidelines, trauma registries, and imaging equipment and training, specifically in ultrasonography. To accomplish this, coordination is needed between the Haitian government and local and international nongovernmental organizations.