Enhancing Trauma Care in Tertiary Hospitals: Addressing Gaps and Pathways to Improvement.

Abstract

Background: Trauma is a major cause of morbidity and mortality globally, with road traffic accidents projected to be the leading cause of death by 2030. In developing countries like Pakistan, trauma patients face significant challenges in receiving timely and effective care. This study aimed to evaluate trauma centers in tertiary care hospitals in the twin cities of Pakistan to highlight gaps and pitfalls in trauma patient management. Methods: A descriptive cross-sectional study was conducted using the World Health Organization's Hospital Emergency Unit Assessment Tool (HEAT) at five major public sector hospitals in Islamabad and Rawalpindi. Data collection involved collaboration between the Violence, Injury Prevention and Disability Unit and key informants, including Emergency Room in-charges and Heads of Departments. Information on trauma protocols and guidelines was gathered. Results: All hospitals provided 24/7 emergency services with access to operating rooms and laboratories. However, significant disparities were found in equipment availability, particularly portable X-rays (40% availability) and RDT/HIV testing (20% availability). Protocol adherence varied, with 80% of hospitals having clinical management protocols but only 20% having specific protocols for conditions like asthma exacerbation and maternal hemorrhage. This study identifies infrastructural deficiencies and highlights systemic barriers that contribute to inadequate trauma care delivery, underscoring the need for targeted reforms. Conclusion: The study highlights significant gaps in trauma care management in Pakistani tertiary care hospitals, including shortages of personnel, infrastructure deficiencies, and lack of standardized protocols. These findings underscore the urgent need for systemic improvements in trauma care delivery. Recommendations include increased investment in medical infrastructure, addressing staffing and training deficiencies, and standardizing clinical management protocols to enhance trauma care outcomes and reduce morbidity and mortality rates in Pakistan. This research contributes novel insights into the specific barriers faced by trauma care systems in Pakistan, which have not been previously addressed in existing literature.