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KEY POINTS

KEY POINTS

  • At least 250 million disability-adjusted life-years (DALY) are attributed to traumatic injuries around the world each year.

  • In 2018, an estimated 1,350,000 individuals died from road traffic injuries around the world.

  • Ninety percent of the world’s traffic-related fatalities occur in low- and middle-income countries.

  • In 2015, the World Health Assembly passed Resolution 68.15 calling for emergency surgical care as a part of universal health coverage.

  • The Residency Review Committee and the American Board of Surgery approved international rotations to fulfill graduation requirements for surgical residents in 2011.

  • The “P” values of successful international research collaborations include strong partnerships, knowledge of the people, requirement for patience and diplomacy to build productive programs.

  • Initiatives from the Global Health Advocacy Incubator have resulted in 11 countries passing new or improved road safety laws, thus protecting over 3.36 billion people

“… a new and sweeping utopia of life, … where the races condemned to one hundred years of solitude will have, at last and forever, a second opportunity on earth.”

—Gabriel Garcia Marquez

 

INTRODUCTION

Trauma is a public health challenge of global proportions. Roughly 5 million individuals lose their lives each year from road traffic collisions and interpersonal violence, and most of these events occur in low- and middle-income countries (LMICs).1 The challenges of treating traumatic injury are not divorced from the broader challenges of health systems and lack of surgical access. Much of the death and disability is attributed to inadequate prehospital and hospital systems that are understaffed and unequipped to bring patients to receive care or to provide emergent surgical intervention. Comparing mortality rates for Injury Severity Score–matched injuries between high-income countries (HICs) and LMICs suggests that up to 1.9 million (almost 40%) of these lives could be saved with improved health systems.

Acute care surgeons are well positioned to promote improvements in trauma and emergency surgical care, injury prevention, regionalization of acute care, and implementation of data systems to drive process improvement in global surgery.2 Trauma surgery already has a long history of contributors and beneficiaries of international partnerships.3

Dr. Oswaldo Borraez was a young attending surgeon in Bogota, Colombia, in the 1980s when he first thought of using an inexpensive, sterile plastic bag as a means of temporary coverage of the open abdomen. He showed this to a visiting surgeon from the United States, Dr. David Feliciano, who later introduced the technique to the trauma community as the “Bogota bag” in the United States. Variants of this methodology continue to be used worldwide.4 Similarly, trauma surgeons from LMICs routinely visit major trauma centers in high-resource trauma settings to learn about regionalization and advances in care.5

Unfortunately, for too long surgical care has been considered too expensive for provision in the world’s poorest regions. Surgeons, too, were ...

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