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countries have a telephone number with national coverage to activate the emergency care

of countries have a formal

55%

process to train and certify prehospital providers

45%

of countries have national or subnational

trauma registries

• Simple and affordable post-crash care interventions save lives.

• Effective care for the injured requires timely care at the scene, prompt transport to appropriate emergency and surgical care at hospital, and early access to rehabilitation services.

• The proportion of patients who die before reaching a hospital in low-income countries is over twice that in high-income countries.

• Bystanders contribute by activating the emergency care system and taking simple, potentially life-saving actions until professional help is available.

Key messages

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A broad and integrated approach to post-crash care can save millions of lives and mitigate the short- and long-term effects of experiencing a crash to help survivors return to function and independence at h e d t r e e e e ts p st cr sh c re ide tified in the Decade of Action include structures to allow timely delivery of health services, data to inform policy and support quality care delivery, and legislation to ensure access to emergency care without regard to ability to pay (4).

Building systems to ensure timely care for the injured

Emergency care is at the core of the post-crash response. There is a series of time sensitive actions that are essential to provide effective care for the injured, beginning with activation of the emergency care system and continuing with care at the scene, transport, and facility- based emergency care. Rehabilitation – both in hospital and beyond, is essential to maximise the impact of emergency and surgical care and to limit the physical and psychological impact of injuries (18). Ideally, countries should designate a lead government agency with the authority to set system-wide standards and to coordinate prehospital and hospital-based care for the injured.

Role of bystanders in the emergency care system

Even the most sophisticated emergency care system is ineffective if bystanders fail to recognize a serious injury or do not know how to call for help. Bystanders contribute by activating the emergency care system and taking simple, potentially life-saving actions until professional help is available (80–82). To facilitate the important contribution of bystanders it is important that there is legislation in place to protect those who assist the injured. WHO’s Emergency Care System Assessments, carried out in over 30 countries worldwide,

Countries should set up lead

agencies to set

standards and

coordinate care

for those injured

in r a ra fic

crashes.

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GLOBAL STATUS REPORT ON ROAD SAFETY 2018

55% of countries have a formal process to train and certify prehospital care providers.

found that many countries have no bystander protection laws or limited enforcement, and many countries report that those who ssist the i ured e perie ce r e seri us fi ci e d social consequences.

To activate the emergency care system, ideally there should be a single telephone number that is valid throughout the country, easy to remember and available as a free call (6,80,83). This current report found that 109 countries have a telephone number with full national coverage. Among the countries that have conducted the WHO Emergency Care System Assessment, several report that less than half the population know the emergency care access number by memory.

Care at the scene

The proportion of patients who die before reaching a hospital in

middle-income countries is over twice that in high-income countries

(84). Despite the enormous potential impact of prehospital care,

the current report shows that 55% of countries have a formal

process to train and certify prehospital providers. In addition,

the WHO Emergency Care System Assessments data show that

most countries report either no ambulances available to travel to

the scene of the crash or that the number of ambulances available

is grossly inadequate to meet population needs. It is important to

recognise that while the optimal system may be one that can quickly

dispatch equipped ambulances with trained providers to the scene

of the injury, there are many ways to improve care at the scene of a

crash (3,80). For example, simple systems using mobile phones and

targeted training of key lay groups (e.g. community leaders, police,

and professional drivers) to provide basic interventions can bridge

to professional care and improve outcomes (3,80).

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Hospital-based emergency care for the injured

Even short delays to care for the injured can mean lives lost.

The WHO Emergency Care System Assessments have found that first-level hospitals in many countries lack dedicated emergency units altogether. Where these units exist, many lack essential equipment for diagnosis and treatment of injuries, and few have the protocols and checklists needed to ensure a systematic approach to every injured patient. They are often staffed only by providers working on a rotational basis who may or may not have the benefit of dedicated training in the care of emergencies: indeed, this report found that just more than half (54%) of countries have speciality training pathways in emergency medicine and trauma surgery.

Beyond a staffed and equipped emergency unit, any facility that is certified to care for the seriously injured should have 24-hour access to operative and critical care services. However, most countries who have conducted the Emergency Care System Assessment report that less than a quarter of the population overall would be able to access a staffed operating theatre within two hours of serious injury. In addition, all assessed countries report inadequate numbers of qualified rehabilitation providers and long delays in accessing community-based rehabilitation services.

Data and information to guide post- crash response

Systematic hospital-based data collection is critical to both clinical

quality improvement activities and targeted planning and prevention

initiatives. Trauma registries are case-based databases that gather

information on injury epidemiology, clinical interventions and health

outcomes in order to identify and address specific gaps in care. In both

high- and limited-resource settings, registries have been shown to

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GLOBAL STATUS REPORT ON ROAD SAFETY 2018

improve the quality of care and clinical outcomes, as well as allow for the identification of high-yield targets for prevention.

Overall, the current report found that fewer than half (45%) of countries had national or subnational trauma registries in place.

Over half of the world’s countries either have registries only in a

few scattered facilities or no registry at all. To address this gap,

WHO has recently established a Global Registry for Emergency and

Trauma Care, and implementation has been initiated in a number

of middle-income countries. In addition, it is essential for countries

to establish policies that ensure effective crash investigation and

equitable access to information for survivors and their families.

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Box 12: A simple low-cost emergency care package in Uganda

Emergency care in health facilities across Uganda is improving following a

Ministry of Health scale-up of a WHO pilot intervention that halved the number

of hospital deaths from emergency conditions (road traffic injuries, childhood

diarrhoea, pneumonia, asthma and postpartum haemorrhage). Executed at a cost

of US$ 3500 per hospital, this pilot included WHO basic emergency care training for

hospital staff, the introduction of simple WHO emergency unit protocols (including

checklists and triage) and identifying and organizing a simple resuscitation area

with existing resources. In addition, Uganda has undertaken pilot implementation

of the WHO Global Registry for Emergency and Trauma Care at regional hospitals

around the country. The registry’s automated reporting functions allow data to be

used to improve the quality of clinical care as well as to inform policy and planning.

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