Reconfiguration of surgical, emergency, and trauma services
http://www.100md.com
《英国医生杂志》
EDITOR—The editorial by Black on reconfiguration of emergency services in the United Kingdom is also important for the developing world.1 Emergency services and acute care constitute a major gap in the focus of the health sector in the developing world, and several issues need to be considered to promote a global dialogue on how best to configure (rather than reconfigure) such services.
Traditional investments in the health sector in the developing world have been biased towards urban areas, large tertiary facilities, and specialty services to the detriment of primary and acute care. This bias needs to be addressed by ministries of health and finance.
The use of non-doctor personnel is critical for the developing world. Shortages of skilled staff, lack of training, and poorly defined career structures plague human resources in the health sector. It is time to assess the potential contributions of other health professionals for emergency care, analogous to the community health workers of primary health care.
Building infrastructure is important for hospitals, clinics, and district facilities. Defining essential equipment and functions seems like an appropriate task for agencies such as the World Health Organization.
Capacity development for responding to emergency is crucial. Training individual doctors is not enough; emergency care systems will need to be built to make a quantum change in responding to the needs of people.
It is time to recognise the great need for acute care in the developing world and call for more investment and efforts in building appropriate systems. Maternal mortality, cardiac deaths, and trauma should all be manageable in the developing word, as in the United Kingdom, by an appropriate emergency medical system.
Adnan A Hyder, assistant professor
Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E-8132, Baltimore, MD 21205, USA ahyder@jhsph.edu
Competing interests: None declared.
References
Black A. Reconfiguration of surgical, emergency, and trauma services in the United Kingdom. BMJ 2004;328: 178-9. (24 January.)
Traditional investments in the health sector in the developing world have been biased towards urban areas, large tertiary facilities, and specialty services to the detriment of primary and acute care. This bias needs to be addressed by ministries of health and finance.
The use of non-doctor personnel is critical for the developing world. Shortages of skilled staff, lack of training, and poorly defined career structures plague human resources in the health sector. It is time to assess the potential contributions of other health professionals for emergency care, analogous to the community health workers of primary health care.
Building infrastructure is important for hospitals, clinics, and district facilities. Defining essential equipment and functions seems like an appropriate task for agencies such as the World Health Organization.
Capacity development for responding to emergency is crucial. Training individual doctors is not enough; emergency care systems will need to be built to make a quantum change in responding to the needs of people.
It is time to recognise the great need for acute care in the developing world and call for more investment and efforts in building appropriate systems. Maternal mortality, cardiac deaths, and trauma should all be manageable in the developing word, as in the United Kingdom, by an appropriate emergency medical system.
Adnan A Hyder, assistant professor
Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E-8132, Baltimore, MD 21205, USA ahyder@jhsph.edu
Competing interests: None declared.
References
Black A. Reconfiguration of surgical, emergency, and trauma services in the United Kingdom. BMJ 2004;328: 178-9. (24 January.)