An Introduction to Our Approach:
Given the creation of this initiative by two trauma surgeons (one practicing, one aspiring), our focus is very clear: decrease death from traumatic events. When considering traumatic deaths (from road traffic accidents, stabbings, shootings, falls, etc.), there are three primary areas of intervention that can decrease fatalities: (1) prevent traumas from occurring, (2) prevent victims from dying on their way to the hospital (pre-hospital/ambulance care), and (3) prevent victims from dying once they reach the hospital (trauma care). It is with this in mind that we have worked with local Bolivian physicians to develop our projects.
An Introduction to Trauma Care in Bolivia:
Like most other low, middle-income countries (LMIC), Bolivia has no organized pre-hospital system. While there do exist select few ambulances in La Paz, many are underequipped and staffed by an untrained team. Add to this an unaffordable price for the average Bolivian and the incredible length of time it takes for an ambulance to simply reach the patient, and it’s no surprise that the majority of patients arrive at the hospital by alternate means. The alternate means available in Bolivia tend to be (1) taxi drivers and (2) “bomberos,” or volunteer firemen. These individuals lack any training in even the most basic first aid or pre-hospital trauma care…they are simply “good Samaritans” who extract the victims and throw them in the back seat, hoping they can reach a hospital before the patients die. [See the picture I posted on 02/17 of the bomberos rescuing a survivor after a major crash in Chirupaya: https://stevenjschuetz.wordpress.com/2013/02/17/chirupaya-rescue-012213/] Given this lack of trained pre-hospital care providers, it is not surprising that an estimated 80% of trauma deaths in countries like Bolivia occur in the pre-hospital setting. Many of these deaths are preventable, and it has been estimated that 1-2 million deaths worldwide could be prevented through improvements in pre-hospital care.
Our long-term goal is to develop the pre-hospital and trauma-care systems in Bolivia so that these preventable deaths can be avoided. To begin this work, we have partnered with Hospital Arco Iris (HAI) in the capital city of La Paz. HAI is a nonprofit tertiary care hospital built in 2001 by the Fundación Arco Iris, a German nonprofit founded in 1994 to meet the basic needs of homeless children in the city. As one of two tertiary care centers in La Paz, HAI is considered the premiere trauma center and consequently manages the majority of trauma patients in the city and surrounding region. Despite an estimated 60% of its patients presenting with some sort of trauma, the hospital has just one orthopedic-traumatologist on staff, and the rest of its staff lack any sort of formal training in trauma care. According to the traumatologist, HAI’s trauma care is “[…] all heart. There is no organization or process; they simply try everything they can to keep the patient alive.”
An Introduction to Our Initiatives:
Based on these needs, we have developed our Bolivian trauma initiative:
- To develop the pre-hospital and in-hospital trauma infrastructure (initially through implementation of an ED triage system and development of a neurosurgical/neurotrauma ICU)
- To train physicians, nurses, students, and taxi drivers/bomberos in gradated levels of trauma care (ranging from first-response to ATLS)
- To conduct research on the epidemiology of trauma and trauma care that can guide future interventions
[To keep this blog a reasonable length, I’ll save the detailed description of our projects for the next few installations.]