Trauma care and development assistance: opportunities to reduce the burden of injury and strengthen health systems

Injury is one of the most neglected health crises of our time, yet in 2106 it accounted for 32% more than the global number of fatalities that result from malaria, tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) combined. The effects of early mortality and prolonged disability due to injury also mean that injury places staggering economic burdens on countries. For instance, the annual cost of road traffic injuries alone, which constitute less than a third of injuries globally, is approximately 1.0% of the gross national product in low-income countries, 1.5% in middle-income countries, and 2.0% in high-income countries. Notwithstanding the magnitude of the problem, well-established and relevant solutions exist, including organized trauma care. Organized trauma care is a coordinated effort to deliver the full spectrum of care to injured patients, from the time of the injury through community reintegration.4 The organization of pre-hospital care, acute care (that is, hospital-based care, including emergency, critical and surgical care) and rehabilitation services is typically administered by a public agency. The responsibilities of such agencies are to provide leadership, governance and appropriate finances, support prevention initiatives, coordinate service delivery, establish minimum standards of care, designate trauma centres, enable quality improvement programming and ensure system evaluation. Organized trauma care, particularly when combined with multisectoral injury control initiatives, saves lives, limits disability, promotes productivity and lessens individual, community and national economic burdens. However, despite the human costs of trauma and the existence of evidenced-based and affordable interventions, national and global health agendas have failed to give priority to injury control and trauma care.