Articles

Designing a Model for Trauma System Management Using Public Health Approach: The Case of Iran

Abstract

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

Peden M, Scurfield R, Sleet D, Hyder AA, Jarawan E, Mathers C. World report on traffic injury prevention. World Health Organization; 2004.

Mock C, Kobusingye O, Joshipura M, Nguyen S, rreola-Risa C. Strengthening trauma and critical care globally. Curr Opin Crit Care 2005;11(6):568-75.

Mock C, Quansah R, Krishnan R, rreola-Risa C, Rivara F. Strengthening the prevention and care of injuries worldwide. Lancet 2004;363(9427):2172-9.

Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002;324(7346):1139-41.

Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000;90(4):523-6.

Naghavi M. Profile of Death in 29 Provinces of Iran in Year 2004 [In Persian]. Tehran: Ministry of Health and Medical Education; 2007.

Naghavi M, Shahraz S, Bhalla K, Jafari N, Pourmalek F, Bartels D, et al. Adverse health outcomes of road traffic injuries in Iran after rapid motorization. Arch Iran Med 2009;12(3):284-94.

Saadat S, Soori H. Epidemiology of Traffic Injuries and Motor Vehicles Utilization in the Capital of Iran: A population based study. BMC Public Health 2011;11(1):488.

Soori H, Royanian M, Zali AR, Movahedinejad A. Road traffic injuries in Iran: the role of interventions implemented by traffic police. Traffic Inj Prev 2009;10(4):375-8.

Mathers C LASJEM. National Burden of Disease Studies: A Practical Guide Geneva. : World Health Organization; 2002. Available from: URL:http://www.who.int/healthinfo/nationalburdenofdiseas manual.pdf [cited on May 10, 2011]

Naghavi M, Abolhassani F, Pourmalek F, Lakeh M, Jafari N, Vaseghi S, Niloufar Mahdavi Hezaveh N, Kazemeini H. The burden of disease and injury in Iran 2003. Popul Health Metr 2009;7:9.

Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA 2000;283(15):1990-4.

Nathens AB, Jurkovich GJ, Rivara FP, Maier RV. Effectiveness of state trauma systems in reducing injuryrelated mortality: a national evaluation. J Trauma 2000;48(1):25-30.

Natioal Highway Traffic safety administration. Trauma System Agenda for the Future. 2003. Available from: URL:http://www.nahsta.gov/people/injury/ems/emstraumasy stem03 [cited on May 10, 2011]

The Forth Economic, Social and Cultural Development Plan of The Islamic Republic of Iran 2005-2009, Article 85 [In Persian]. Available from: URL:http://tarh.majles.ir [cited on May 12, 2011]

The Third Economic, Social and Cultural Development Plan of The Islamic Republic of Iran 2000-2004, Article 193-A, Note [In Persian]. Available from: URL:http://tarh.majles.ir [cited on May 12, 2011]

Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJ. Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med 2009;9:8.

Tarighi P, Alamdari Sh, Samadi A, Motevalian SA, Moradi Lakeh M, Setayesh A, et al. Trauma System Essential Model [In Persian]. National Research Center for Mrdical Sciences; 1383.

Zargar M, Modaghegh MH, Rezaishiraz H. Urban injuries in Tehran: demography of trauma patients and evaluation of trauma care. Injury 2001;32(8):613-7.

20. Zargar M, Kalantar Motamedi SM, Karbakhsh M, Ghodsi SM, Rahimi-Movaghar V, Panahi F, Saadat S, Khaji A, Davachi SM, Ganji S, Khodabandeh M, Abdollahi Far Sh, Abdollahi M, Zarei MR. Trauma care system in Iran. Chin J Traumatol 2011;14(3):131-6.

Zargar M, Tarighi P, Roudsari B. Trauma National Research Project: The Report of Tehran [In Persian]. Sina Trauma and Surgery Research Center; 1380.

US Department of Health and Human Services. Model Trauma System Planning and Evaluation. 2006. Available from: URL:http://www.ncdhhs.gov/dhsr/EMS/trauma/pdf/hrsatrau mamodel.pdf [cited on May 15, 2011]

Leppaniemi A. Trauma systems in Europe. Curr Opin Crit Care 2005;11(6):576-9.

Nathens AB, Brunet FP, Maier RV. Development of trauma systems and effect on outcomes after injury. Lancet 2004;363(9423):1794-801.

Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Guidelines for essential trauma care. Geneva: World Health Organization; 2004. Available from: URL:http://whqlibdoc.who.int/publications/2004/924154640 9.pdf [cited on May 15, 2011]

Mock C, Joshipura M, Goosen J, Lormand JD, Maier R. Strengthening trauma systems globally: the Essential Trauma Care Project. J Trauma 2005;59(5):1243-6.

Eastman AB, Lewis FR, Jr., Champion HR, Mattox KL. Regional trauma system design: critical concepts. Am J Surg 1987;154(1):79-87.

Sampalis JS, Denis R, Lavoie A, Frechette P, Boukas S, Nikolis A, Benoit D, Fleiszer D, Brown R, Churchill-Smith M, Mulder D. Trauma care regionalization: a processoutcome evaluation. J Trauma 1999;46(4):565-79.

Simons R, Kasic S, Kirkpatrick A, Vertesi L, Phang T, Appleton L. Relative importance of designation and accreditation of trauma centers during evolution of a regional trauma system. J Trauma 2002;52(5):827-33.

American College of Surgeons Committee on Trauma. Resources for the Optimal Care of the Injured Patient:1999. Chicago: American College of Surgeons; 1998.

West JG, Williams MJ, Trunkey DD, Wolferth CC, Jr. Trauma systems. Current status--future challenges. JAMA 1988;259(24):3597-600.

Bazzoli GJ. Community-based trauma system development: key barriers and facilitating factors. J Trauma 1999;47(3 Suppl):S22-S24.

Haghparast-Bidgoli H, Hasselberg M, Khankeh H, Khorasani-Zavareh D, Johansson E. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach. BMC Emerg Med 2010;10:20.

Hoyt DB, Coimbra R. Trauma systems. Surg Clin North Am 2007;87(1):21-vi.

Pfohman M, Criddle LM. A comparison of five state trauma systems meeting all eight essential ACS criteria: a descriptive survey. J Emerg Nurs 2004;30(6):534-41.

Emergency Medical Services Agency. San Luis Obispo County Trauma System Plan 2010. Available from: URL:http://www.sloemsa.org/files/TraumaSystemsPlanRevis ion2010.pdf [cited on May 15, 2011]

Masmejean EH, Faye A, Alnot JY, Mignon AF. Trauma care systems in France. Injury 2003;34(9):669-73.

Cheng CH, Graham CA, Gabbe BJ, Yeung JH, Kossmann T, Judson RT, Rainer TH, Cameron PA. Trauma care systems: a comparison of trauma care in Victoria, Australia, and Hong Kong, China. Ann Surg 2008;247(2):335-42.

Evans DC. From trauma care to injury control: a people's history of the evolution of trauma systems in Canada. Can J Surg 2007;50(5):364-9.

Hameed SM, Schuurman N, Razek T, Boone D, Van HR, Taulu T, Lakha NRN, Evans DC, Brown DR, Kirkpatrick AW, Stelfox HT, Dyer DBN, van Wijngaarden-Stephens M, et al. Access to trauma systems in Canada. J Trauma 2010;69(6):1350-61.

Sturms LM, Hoogeveen JM, Le CS, Schenck PE, Pahlplatz PV, Hogervorst M, Jukema GN. Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry. Langenbecks Arch Surg 2006;391(4):343-9.

Civil ID. Focus on trauma systems/centres: an Australasian perspective. Trauma 1999;1(3):193-7.

Trauma Association of Canada. Trauma System Accreditation Guidelines. 2007. Available from:

URL:http://sp.ontariotrauma.ca/Accreditation%20Documents/Accreditation_Guidelines_Jun_07.pdf [cited on May 15, 2011]

Albert J, Phillips H. Trauma care systems in the United Kingdom. Injury 2003;34(9):728-34.

The NHS Confederation. Implementing trauma systems: key issues for the NHS. 2010. Available from: URL:http://www.nhsconfed.org/publications/Documents/Imp lementing_trauma_systems_report.pdf [cited on May 15, 2011]

American College of Surgeons. Regional Trauma Systems: Optimal Elements,Integration, and Assessment Systems Consultation Guide. 2008. Available from: URL:http://www.facs.org/trauma/tsepc/pdfs/regionaltraumas ystems.pdf [cited on May 15, 2011]

Kiening K, Unterberg A. Trauma care in Germany: a European perspective. Clin Neurosurg 2007;54:206-8.

Cameron P, Dziukas L, Hadj A, Clark P, Hooper S. Major trauma in Australia: a regional analysis. J Trauma 1995;39(3):545-52.

Croser JL. Trauma care systems in Australia. Injury 2003;34(9):649-51.

Kortbeek JB, Buckley R. Trauma-care systems in Canada. Injury 2003;34(9):658-63.

Eastman AB. Wherever the dart lands: toward the ideal trauma system. J Am Coll Surg 2010;211(2):153-68.

Delprado AM. Trauma systems in Australia. J Trauma Nurs 2007;14(2):93-7.

Lowe DK. Trauma system development: the critical need for regional needs assessments. J Trauma 1999;47(3 Suppl):S106-S107.

US Department of Health and Human Services. Model Trauma Care System Plan. Washington, DC: Bureau of Health Resources Development; 1992. Available from: URL:http://www.sdemsc.org/model.pdf [cited on May 15, 2011]

The Royal College of Surgeons of England. Regional trauma systems interim guidance for commissioners. 2009. Available from: URL:http://www.rcseng.ac.uk/Service_delivery/documents/R egional_trauma_systems%202009.pdf [cited on May 15, 2011]

Michigan State Government. Michigan Statewide Trauma System: A Guide to Development and Operation of Regional Trauma Networks. 2009. Available from: URL:http://www.mgh.org/trauma/stateWide_traumasystems. pdf [cited on May 15, 2011]

Liberman M, Mulder DS, Lavoie A, Sampalis JS. Implementation of a trauma care system: evolution through evaluation. J Trauma 2004;56(6):1330-5.

Files
IssueVol 50, No 1 (2012) QRcode
SectionArticles
Keywords
Injuries Trauma Trauma System Lead Agency Trauma Regionalization Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Tarighi P, Tabibi SJ, Motevalian SA, Tofighi S, Maleki MR, elgoshaei B, Panahi F, Masoomi GR. Designing a Model for Trauma System Management Using Public Health Approach: The Case of Iran. Acta Med Iran. 1;50(1):9-17.