Stellenbosch University: High trauma caseload impedes delivery of healthcare services

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​The relentless burden of trauma cases – physical injuries which need immediate medical attention – is “squeezing out” the healthcare system’s ability to keep up with basic healthcare needs, including care for chronic diseases, maternal and child health.

So said Professor Heike Geduld, head of the Division of Emergency Medicine in the Faculty of Medicine and Health Sciences (FMHS), in an interview following a high-level summit on preventable trauma deaths in the Western Cape.

The meeting, hosted jointly by Professor Elmin Steyn from the FMHS’ Department of Surgery, Dr Janette Verster from the Division of Forensic Pathology, and the Division of Emergency Medicine, comprised key stakeholders in trauma care, public health, community safety as well as provincial health-care leaders.

In April, a multi-disciplinary panel conducted a comprehensive review of trauma-related mortalities across the region with the goal of determining which deaths were preventable, potentially preventable, or non-preventable; identifying common factors that may have contributed to both in-hospital and out-of-hospital deaths; and identifying potential interventions to avert preventable deaths.

Geduld said the review was exceptionally helpful and important. “The resources we have to put towards trauma care in this country are seriously impeding general healthcare service delivery,” she said.

Geduld added that while there is a strong need to prioritise a co-ordinated trauma system across the province in terms of clinical care, the health sector plays a key role in “advocating for and supporting trauma-prevention strategies including road traffic incidents, gender-based violence (GBV) and community justice. A whole-of society approach is needed of which health – which feels the burden of care – is a critical part.”

Geduld said healthcare workers at the coalface of trauma cases had, for a long time, witnessed the burden of these cases on the system, “but we have never really had the data to drive our advocacy message,” she said. “We haven’t had the opportunity to do extensive research before.”

The EpiC study (Epidemiology and Outcomes of Prolonged Trauma Care: A Prospective Multi-centre study of trauma in the Western Cape), had provided the first opportunity to do extensive research and to assess what happens along the trauma care pathway in the Western Cape, she added.

The study – a multi-site cross-sectional study of major trauma patients, that began in September 2019 in sites located in the Cape Town metro and Cape Winelands areas – provided data and logistical support for the review of 138 trauma-related deaths. The study, which is ongoing, collects data beginning at the time of injury, until the patient is discharged from hospital, including in-ambulance care and pathology records as applicable.

The summit acknowledged that alcohol plays a role in many trauma cases.

It also described trauma as a “predictable epidemic”. “We know there are surges over weekends, and times associated with pay cycles – so there is a need to map our activities and resources to match.”

A further key finding was that the under-reporting of incidents results in fewer safety and security resources being allocated to those under-reported areas.

Emergency worker burnout and compassion fatigue were also highlighted as notable challenges: “Healthcare workers, police, social workers, and everyone working in the system are repeatedly traumatized by their work experiences. This affects their functioning and therefore the quality of care they give. There is a high turnover rate of staff working in this area which affects the capacity to deliver service.”

A further takeaway from the summit was that Covid-19 had proven that players across the multi-disciplinary spectrum were able to work well together as a team, highlighting the need for continuing with a team approach and good interdisciplinary communication.

Participants felt a strong need to acknowledge the inherent difference in resources and access to care for the rural population in the province and to prioritise pathways to care.

“The Western Cape Department of the Premier has prioritised the multidisciplinary approach to violence prevention, and health has an important role to play in this. Health can highlight the burden of violence and injury through generating data. It is reassuring to know that there are programs and initiatives within the community and across government aimed at reducing the burden of injury in this province. This includes violence prevention, GBV and road-injury prevention,” Geduld said.

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