Northwell Health

MODEL ACCIDENT CENTERS FOR ASSESSMENT AND RESUSCITATION OF TRAUMA (MACART)

Emergency care

To address a global crisis, we will create trauma systems that will save thousands of lives and maximize recovery from injury in the developing world.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Death and disability from traumatic injuries have dramatically declined in developed nations due to well-organized trauma care systems. However, the opposite is true in low and middle-income countries (LMICs). Countless victims and their dependents have suffered dearly, but now can benefit from the implementation of effective systems and the application of trauma management lessons previously learned. We therefore plan to create evidence-based, high-quality and low-cost Model Trauma Systems (MTS) tailored to the needs of developing countries. An outstanding team of US, Australian and Indian experts in trauma and global medicine will guide this initiative. In the first two years, the anchor MTS will be established in Vellore, India, with the Christian Medical College and Hospital (CMCH) serving as its hub. In Years 3-5 we will create five additional systems across India, simultaneously training trauma professionals, holding annual international conferences and serving as a resource for all LMICs, maximizing global impact.

Problem Statement

WHO IS IMPACTED? Injury is an enormous global health burden. It causes approximately five million deaths annually, more than HIV, TB and malaria combined, and amongst the survivors, many are left permanently disabled. The burden is particularly onerous in resource-limited settings. WHY DOES THE PROBLEM EXIST? The burden of injury is particularly huge in Asia, including in India, where injury is amongst the greatest causes of death and hospitalization. Like in most low- and middle income countries, India has rudimentary trauma and emergency quality improvement programs and limited access to useful trauma and emergency care data. This is a major health challenge which needs to be addressed; it affects patients (and their communities) seeking emergency and trauma care everywhere, but particularly the rural poor. WHAT WILL INFLUENCE AND EFFECT CHANGE? Integrated trauma and emergency care systems will deliver access to pre-hospital care and transport, facility-based emergency and definitive care plus proper physical and cognitive rehabilitation. To ensure the successful implementation of any type of trauma system, trauma care data (trauma registries) must be used to inform rigorous trauma quality improvement (TQI).WHAT ARE THE KEY LEVERAGE POINTS? (1) Proper resuscitation and stabilization during the “Golden Hour”. (2) Ensuring that patients are transported quickly to the appropriate hospital, and that the hospital is adequately staffed and equipped. (3) Since Traumatic brain Injury (TBI) is the most significant contributor to trauma-related death and long-term disability, TBI treatment protocols must be deeply integrated into a trauma system to significantly reduce mortality and morbidity.

Solution Overview

PROBLEM RESOLUTION: Three tiers of medical capabilities are established for hospitals in trauma systems: Level I provides the most comprehensive facilities and greatest expertise, including immediate surgery and neuro-critical care when needed; Level II provides prompt assessment, resuscitation, stabilization, basic trauma surgery and general intensive care; and Level III provides initial diagnosis, emergency stabilization and, if needed, transfer to a higher-level care. A centralized triage system will guide ambulances to the appropriate level of care. The CMCH Trauma Center will serve as the Level I facility and the other regional hospitals will be designated as per their capabilities. In Years 3-5, this process will be replicated in five additional cities around India.TRACKING PROGRESS: Progress will be tracked through our Center for Outcomes Measurement and Improvement (COMI). This core facility, located at CMCH, will serve as the central repository for data capture and analysis. Detailed demographic, logistic, clinical, radiographic and laboratory data will be collected on all trauma patients by a team of Clinical Coordinators. The MACART-gathered baseline data will serve as a basis for comparison as we progress through each phase of the program.ANTICIPATED IMPACT: The deliverables from the six (6) MTS networks will include: better trained trauma personnel, effective triage to the right facility, high-quality medical and surgical care in a low-cost environment, new approaches to rehabilitation, progressive reduction in mortality and morbidity, and the sharing of expertise with other LMICs. MACART will have a broad impact on large populations.

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