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Autor: Michel B. Aboutanos, MD, MPH

Michel B. Aboutanos, MD, MPH

Virginia Commonwealth University Medical Center / Divisions of Trauma / Critical

Care & General Surgery, Department of Surgery, Richmond Virginia 23298

Telephone: (804) 827-1207 Fax: (804) 8270285

E-mail: mbaboutanos@vcu.ed

Richmond Virginia, USA




Trauma is a global epidemic accounting for 90% of the fatalities in low- and middle-income countries. This is attributed to recent increase in armed conflicts, rapid urbanization especially in the Latin American Region, improved national registration, and improved epidemiological interest and efforts by various  international organization  (the Panamerican Health Organization, the Inter-American Development Bank,etc).  In some countries like Ecuador, the fatality rate for “aggressions” and for “automobile accidents” is 16.3 and 15.7 per 100,000 inhabitants, respectively.   With a combined rate of 32.0 per 100,000 inhabitants, trauma is the leading cause of mortality (Instituto nacional de estadisticas y censos del Ecuador- 2001) .


In the past 40 years, lessons learned in the Korean conflict and the Vietnam War in terms of rapid patient transport from site of injury to definitive centers, were adapted to civilian trauma care in the North American countries, and lead to the formation of organized national systems of trauma care. Such systems are based on injury prevention programs, optimal prehospital and hospital care, mandated training, and quality certification. Cost effective regionalized trauma systems were based on formal categorization of trauma care facilities. The achievement of measurable reduction in morbidity and mortality is directed attributed to such trauma care system development. (Nathens JAMA 200, 283:1990-94).


In the Latin American region, the logistics of trauma care is much more complex than in the European and North American Region. One reason is the variability of the incidence of trauma not only between the various Latin American countries, but also within the individual countries. For example, in 2002, the external causes of death for Chile were 48.5/100.000 inhabitants (10.9% due to Homicide, 27.6% Motor-Vehicle Crashes, 20.6% Suicide ) compared to death rate of 132.4/100.000 inhabitants in Colombia with 63.9% due to homicide, 15.7%  to Motor-Vehicle Crashes and 5,1%  to Suicide. (2001-2005 Organización Panamericana de la Salud).


Another reason is the variation in health care spending between the different Latin countries as well as variation in the public/private mix within the individual countries. As a share of GDP, health spending in the Latin American region is less than 10%  of the government budgets with public spending as low as 1.5% in Guatemala and the Dominican republic to as high as 5% in Argentina and Costa Rica. Countries with lower per capita incomes such as Haiti, Bolivia and Guatemala have considerably higher proportion of private expenditures. (PAHO, and public health expenditures 2000). Such variabilities place a significant economic stress upon the development of organized trauma systems in the Latin region.


Recently the world health organization (WHO) and the International Association for Trauma and surgical Intensive Care (IATSIC)  has undertaken  efforts to address the growing injury problem in developing countries, with deviation from the robust trauma care systems that exist in developing nations such the United States, Canada, The United Kingdom of Great Britain, and Australia. WHO Emphasis was rather directed toward inexpensive improvement in prehospital and facility based trauma care.  Specific guidelines are advocated to establish achievable and affordable standard for the care of the injured patient worldwide (Guidelines foe essential trauma Care, WHO, 2004.). So far the WHO/IATSIC guidelines were  used in one Latin American country (Mexico).  Unfortunately, there remains a paucity of data to support or validate the various advocated interventions, especially in the Latin American region.


In the past, most if not all presentation at the Pan American Trauma Society Congress, focused on individualized experience from  hospitals or health centers from various  Latin American countries. No true national presentation in terms of trauma improvement and outcome was feasible. This is expected in light of the absence of a regionalized trauma systems, and of absent or inaccurate national trauma statistics.  


 In a recent field evaluation undertaken in the southeastern region of Ecuador by the Division of Trauma & Critical Care of the Virginia Commonwealth University, a  trauma system evaluation model was used for the progression of  care of the injured patient from rudimentary health post in the jungles, to rural hospital, and finally to an urban referral center. Deficiencies were present at  all levels including continuing medical education, injury control and prevention, prehospital care, definitive care, leadership, legislation, local statistics and system development. Various projects at the prehospital and hospital levels were undertaken including the implementation of a trauma registry and an electronic referral system in the region. The challenges encountered and the lessons learned could serve as a model for facilitating the development of an organized trauma care system in the Latin American Region.


Dirección: Cañar 607 y Coronel, Segundo Piso. Guayaquil - Ecuador


Teléfonos: (593-4) 2344259 - 2447551 - 2292725 Celular:  09-9757784 Fax: 2290408