TS09TOWARDS A TRAUMA-LESS TIMOR-LESTE: AN EXPLORATION OF HOSPITAL-BASED TRAUMA CARE IN TIMOR-LESTE USING THE 'WHO-IATSC' ESSENTIAL TRAUMA CARE GUIDELINES

To describe current management of hospital-based trauma care in Timor-Leste from both a national and clinical perspective and evaluate the use of the WHO Essential Trauma Care Guidelines (EsTCG). Nationwide mixed-methods study consisting of 3 stages. Stage 1 consisted of 5 in-depth interviews with Ministry of Health officials. Stage 2 involved quantitative audits of all 6 hospital facilities in Timor-Leste, supplemented by 25 semi-structured interviews with administrative and clinical staff involved in trauma care. During Stage 3, results from Stage 2 were presented to participants and findings discussed. Likert scale evaluation of the process was then completed by stage 2 participants to ascertain the value of the EsTCG in Timor-Leste. Interviews revealed that while some elements of a trauma systems approach were present, there was no national coordination. At the hospital level, limited human resources and lack of organized approaches to trauma care severely impacted upon injury management. The audit suggested that while necessary equipment was often present, commonly it was not in working order, and specific weaknesses in capabilities for rehabilitation and blood transfusion were also noted. Participants generally felt that the EsTCG were effective in identifying these deficiencies and possible solutions. The EsTCG were useful in identifying national and clinical weaknesses in trauma care and may provide a framework for trauma system development in the future. However, the local context must be considered before applying recommendations in standard guidelines such as the EsTCG to ensure a "one size fits all" approach does not ensue. [PUBLICATION ABSTRACT]