Professor Derek O’Reilly Photo: Courtesy of BJU
The injury burden is a universal public health challenge that afflicts every country in the world with cases spread across all ages and both genders. Among the various causes of injury in China, the most common are traffic accidents, falls and drowning. Violence is not a common cause, unlike, for example, in the United States, and when it does occur, self-harm is much more common than interpersonal violence.
In China, rapid economic development, urbanization, motorization, aging and environmental and lifestyle changes over the past three decades have made injuries the fifth leading cause of death, said Professor Derek O ‘Reilly from Beijing United Family Hospital (BJU) said.
A recent “Global Burden of Health” study showed that although the incidence of injuries in China has increased, with the expansion of the economy, death and disability rates have decreased. “This suggests that rapid socio-economic development in China may have increased injury risk, but improvements in health care have led to large improvements in injury mortality,” the professor noted.
The BJU has had a rapid response policy and trauma team system in place for many years, Dr. Martin Springer said, adding that the emergency room doctor, when realizing that If a trauma patient is present, either upon arrival or by notification from the emergency medical service, activates the trauma code.
The following additional members of the trauma team must be present in the emergency room within five minutes: the front-line general surgeon, the intensive care physician, the anesthesiologist, the laboratory and blood bank technician, the radiology, hospital supervisor and patient services staff. It is expected that senior surgical and anesthetic personnel will be called early during trauma resuscitation. Senior physicians from different specialties (such as ENT, plastic surgery, ophthalmology, neurosurgery, orthopedics and cardio-thoracic surgery) are called in as needed.
Recently, a severe earthquake occurred in Luding, Sichuan Province (southwest China). Martin said the disaster is an example of how improving trauma care can help reduce death and disability rates from a natural occurrence. Trauma care begins at the time of injury, and the sooner effective treatments are started, the better the outcomes, he said.
According to the doctor, the most immediate life-threatening injury is catastrophic bleeding and increasingly hospital care is shifting to the pre-hospital setting. The first “golden” hour of care after an injury is characterized by the need for rapid assessment and resuscitation, which are the fundamental principles of trauma management.
“Members of the public can also provide life-saving treatment, simply by applying pressure to an obviously bleeding wound or by applying a tourniquet, which may be a belt or tie, over a bleeding wound in the arms or legs,” he added. .
Trauma management is particularly challenging for clinicians, Derek said, because trauma patients present with life-threatening injuries. The standard sequence of medical practice is not possible due to the critical urgency with which these patients present. This led to the development of Advanced Trauma Life Support (ATLS) and other courses which emphasized the need to address the greatest threat to life first.
“The Beijing Great Wall Practical Trauma Course is a unique and tailor-made training to meet the needs of our frontline physicians at BJU as well as other hospitals across China. Our international lecturers were able to put the emphasis on newer, up-to-date strategies for dealing with trauma patients that other courses may not yet have incorporated,” the professor noted.
For example, Dr Feng Juefei from Singapore emphasized teamwork and preparation before the trauma patient arrives, and Professor Karim Brohi from London, UK spoke about the concept of counter- intuitive “hypotensive resuscitation” – do not over-resuscitate in order to protect blood clots that have already formed. Professor Mark Midwinter from Sydney, Australia, spoke about the new concept of ‘damage control’ – addressing the physiological consequences of trauma, particularly aimed at failure of blood clotting, from the onset of resuscitation, coupled with surgery early or concurrent.
“These developments have the potential to significantly improve outcomes in trauma management,” Derek said.