Prehospital trauma care systems - World Health Organization

2. INTRODUCTION
The incidents that produce serious or fatal injuries are not random or unpredictable
events. In many cases, they can be identified and acted upon. During the past few decades,
research has shown that many injuries can be prevented or their severity reduced
through the implementation of simple measures. Innovative solutions that engage different
sectors of society have resulted in cost-effective interventions that can prevent injuries
at work, at home and on the street. Examples include the use of motorcycle helmets
and restraining systems, such as seat-belts and child restraints in automobiles; the design
of safer workplaces; the development of flame-resistant sleepwear; the use of smoke
detectors; and the installation of fencing around hazards such as wells or deep pools of
water. Many of these strategies are highly cost effective. A host of interventions have
also shown promise in reducing violence-related injuries or limiting their severity.These
include programmes on substance abuse, parent training schemes and school-based
violence prevention programmes, as well as the use of home visits and efforts to clear
landmines.
2.2 Prehospital care
2.2.1 The need
Generally, the best way to reduce rates of death or disability from life-threatening injuries
is to prevent them. However, it is often possible to minimize the consequences of serious
injury, including long-term morbidity or mortality, by promptly providing effective
prehospital care.
Deaths from severe injury occur in one of three phases (Figure 1).They:
1. occur immediately or occur quickly as a result of overwhelming injury;
2. occur during the intermediate or subacute phase.These deaths occur
within several hours of the event and are frequently the result of treatable
conditions;
3. are delayed. Deaths during this phase often occur days or weeks after the
initial injury and are the result of infection, multisystem failure or other late
complications of trauma.
Figure 1. Trimodal distribution of deaths from road traffic injuries (4). (This curve does not represent actual quantitative
data.Time is represented on a logarithmic basis).
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