A call for action to declare trauma as a disease

Every year injuries kill more than 5 million − in other words they cause the deaths of around 1 out of every 10 people. They have been considered the number one killer and crippler of children and youngsters for more than 20 years, yet in most countries acute injuries (also known as trauma) are still considered ‘accidents’. As such they do not enjoy an integrated and comprehensive approach in national healthcare systems, even if some countries such as Canada, Germany and the USA have significantly reduced deaths and disability by focusing on acute injury as an integral, inclusive and undivided entity.

Therefore, member academies of IAP Health today issued the statement ‘A call for action to declare trauma as a disease’. Drawing attention to the need for a strong paradigm shift, it encourages countries not only to control but also to prevent trauma by considering it as a disease with an integrated comprehensive approach in their health agenda. This statement has been endorsed by more than half the member academies of the network and was released during the 7^th World Health Summit Regional Meeting.

What is trauma? Trauma is the physical damage that results when a human body is exposed to levels of energy (kinetic, thermal, chemical, electrical or radiant) in amounts that exceed the threshold of mechanical/physiological tolerance and/or the impairment of normal function resulting from a lack of oxygen (drowning, smoke inhalation or strangulation) or heat resulting in hypothermia (trench foot, environmental hypothermia, freezing...).

Why a disease framework is suitable for trauma. A disease framework consists in a series of steps: identify the problem, measure the consequences, find the causative agent, develop treatment strategies, and implement a prevention plan all within a measurement and analysis continuum.

“Vehicle crash, homicide, fall, drowning: when reported, trauma is still described by category. In contrast, while there are many types of cancer, healthcare systems have unified their prevention and control strategies – and rightly so, as this has been proven very effective. It is time for all countries to make a similar transition and declare trauma as a disease,” says Professor Jorge Neira of the Academia Nacional de Medicina (Argentina) who co-chaired the working group responsible for reviewing the statement.

“Far for being ‘accidents’ − unforeseen events attributable to chance factors – injuries are the consequence of a causal chain of facts and circumstances. As such, health authorities can elaborate and test strategies that will not only reduce the events themselves, but also the precursor events when they do occur,” explains Professor Depei Liu, IAP President and IAP Health Co-chair.

“Once the causes and consequences of this disease have been identified, health authorities must receive the appropriate support to develop an injury prevention and control plan to reduce trauma mortality, as well as improve treatment and rehabilitation. There is a clear need to consider the diverse categories of trauma not as different entities, but as particular aspects of the same disease model,” says Professor Detlev Ganten, Founding President of the World Health Summit.

“Injury distribution disparities across countries are key to understanding the devastating impact of trauma. It is crucial to implement strategic interventions to develop a trauma system methodology especially in low/middle-income countries because 90% of road traffic deaths occur here, even though these countries account for only 53% of the world’s registered vehicles,” adds Dr. Peggy Hamburg, IAP Health Co-chair.

The statement also emphasizes the need of for more research on trauma, develop trauma registries regarding to all its facets and curricula where it is framed as a disease, and reduce well-known risk factors for motor vehicle crashes by lowering speed limits, introducing drink-driving laws and the compulsory use of helmets, seat-belts and child restraints, banning the use of cell phones while driving, and promoting violence prevention using the information obtained from trauma registries.

The cost of trauma. Worldwide, fatal and non-fatal trauma is associated with an annual economic cost of approximately US$670 billion in medical care expenses and lost productivity. In the specific case of car crashes, while figures vary between regions, globally 1.2 million people die annually and an additional 20-50 million survive but have mild to serious disabilities (the overall cost of car crashes has been estimated at more than US$160 billion annual).

Working group
Profs Jorge Neira and Ezequiel Monteverde, Argentina
(Co-chairs)
Prof. Dario Birolini, Brazil
Prof. Ariana Vorko Jovicˇ, Croatia
Prof. Alan Ivkovic, Croatia
Prof. Karl Zilles, Germany
Prof. Shuvra Dasgupta, Jamaica
Prof. Tatsuhiro Yamanaka, Japan
Prof. Ashok Ratna Bajracharya, Nepal
Prof. Loek Leenen, Netherlands
Prof. Raul Nelson Morales Soto, Peru
Prof. Edward Wang, Philippines
Prof. Dan Mircea Enescu, Romania
Prof. Soraya Seedat, South Africa
Dr. Achala Upendra Jayatilleke, Sri Lanka
Prof. Feza Korkusuz, Turkey
Prof. Stephen W. Hargarten, USA

This statement is the final academic review of a original manuscript produced by the Argentine Academy of Medicine (Acad. Jorge Neira; Acad. Vicente Gutierrez), Fundación Trauma Argentina (Jorge Neira, MD, FCCM; Ezequiel Monteverde, MD; Laura Bosque, PhD) and endorsed by the Argentine Ministry of Health.