A group of surgeons, nurses, medical students and staff seek to improve pre-hospital and trauma care in South America’s most impoverished nation
CHICAGO–(ENEWSPF)–March 5, 2013. North Yungas Road is the main passageway connecting Bolivia’s capital city of La Paz to the country’s Amazon rainforest region in the north. The 35 mile stretch of road winds through mountains and rainforest and in most spots is so narrow that only one-way traffic can pass through. The roadway’s steep cliffs, sharp curves and unpredictable weather has resulted in an incredibly high number of fatal traffic incidents. With 200 to 300 fatalities each year, it has become known as “Death Road” and was given the dubious distinction of being the most dangerous roadway in the world. Faced with the enormous burden of caring for the countless injured motorists, the hospitals in La Paz are ill-equipped to handle critically wounded patients. As the poorest country in South America, Bolivia lacks a trauma system and most hospitals are inadequately prepared to handle the serious injuries that result from automobile accidents and other traumas. A Northwestern Medicine® team is seeking to change this by traveling to La Paz with a goal of creating long-term partnerships between Bolivian and American hospitals to improve the pre-hospital and hospital trauma care throughout the country.
“If you’re injured in a car accident in Chicago, you can count on an ambulance to quickly arrive and bring you to the nearest hospital, or even a level 1 trauma center like Northwestern, if you’re critically injured,” said Mamta Swaroop, MD, a trauma surgeon at Northwestern Memorial Hospital and assistant professor at Northwestern University Feinberg School of Medicine. “Unfortunately, this standard of care isn’t a reality in other parts of the world, including Bolivia. La Paz sees a high volume of traumas, but the region has no formal pre-hospital care system and the local hospitals lack triage systems to effectively prioritize its patients, leading to ineffective care.”
The Northwestern Medicine team will travel to La Paz from March 8 to 22 as part of the Northwestern Trauma Initiative (NTI), which plans to facilitate the development of a comprehensive trauma care system in Bolivia. Participating along with Swaroop are Steven Schuetz, a graduating medical student at the Feinberg School, Jennifer Mullen, RN, trauma coordinator at Northwestern Memorial, and Inge LeBlanc, RN, surgical ICU staff nurse at Northwestern Memorial. The initiative is the brainchild of Schuetz who previously spent seven months in Bolivia and experienced the inadequate trauma system firsthand.
“The vast majority of hospitals in Bolivia are understaffed and poorly equipped, making the care of severely injured patients very difficult,” explained Schuetz, who has been in La Paz since early February. “Physicians receive no formal training in trauma care and those who staff the emergency departments are simply general physicians with no training in emergency medicine.”
The NTI will work with Hospital Arco Iris (HAI), one of two tertiary care centers in La Paz. Given its proximity to “Death Road,” HAI treats a large volume of patients injured in traffic accidents. With mass transit as one of the primary modes of transportation in the city, mass casualties are frequent and often result in 30 to 40 injured patients arriving simultaneously from a single accident.
“Just a few weeks ago, a bus carrying 56 passengers fell 250 meters off a cliff and into a river, killing 28 passengers and injuring 28 others; sadly this is not a unique incident,” said Schuetz. “The pre-hospital care system in La Paz is severely underdeveloped with most trauma patients arriving at the hospital by private vehicle, taxis or volunteer firefighters. These first responders lack 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 in time.”
The patients who do make it to the hospital are faced with a disorganized system that leads to ineffective care. “The hospitals have no triage system that would allow identification and prioritization of treatment for the most critically injured patients,” explained Swaroop. “This lack of a triage system combined with lack of training in trauma care means that the staff is simply doing what they can to keep patients alive.”
The Northwestern team is hoping to implement a trauma model at HAI that could be replicated at other hospitals throughout La Paz and the rest of Bolivia. With a focus on improving both pre-hospital care and in-hospital trauma infrastructure, the team will implement an emergency triage system and develop a neuro intensive care unit (ICU) at HAI. Staff at the hospital and the local taxi drivers and firemen will be trained a Trauma First Responders Course that is based on the principles of advanced trauma and life support (ATLS). This will help standardize the assessment and treatment of trauma patients. The team also seeks to formulate an academic partnership with the hospital and local medical school to offer continuing training.
“We’re working to develop a community initiative to build backboards that will be provided to vehicles that respond to accidents and transport patients to the hospital,” said Swaroop. “Our hope is that by enlisting community groups to help build the backboards, we’ll raise awareness for our initiative and get the public involved with changing the trauma and emergency medical services system in their community.”
The team has already begun implementation of a comprehensive trauma registry at HAI to measure outcomes and assess needs. The registry will provide data to help advance trauma care in areas such as epidemiology, injury control, acute care, quality improvement, resource allocation and be used to develop a trauma system unique to Bolivia.
“The vast numbers of mass casualties that occur in Bolivia would be unacceptable in any developed country, yet they are an accepted risk of daily travel there,” said Schuetz. “Many of these deaths could be preventable if not for a lack of capacity to care for trauma victims. While these issues are deeply engrained in the current infrastructure, it is our hope that our projects will begin a movement of change in the care of Bolivia’s trauma victims.”
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