ASJ Anniversary

14 THE GLEANER | SUNDAY, MARCH 3, 2019 T RAUMA IS a major cause of morbidity and mortality in both the developed and developing world. It is perhaps the disease which has themost negative impact onhealthcare systems and so- cieties today. Injuries are the leading cause of deathunder the age of 40 in theUSAand the fourth-leadingcause of death for all Americans. It results in greater loss of potential years of life than cancer and cardiovascular diseases combined. In the develop- ingworld, injuries inmales in the age group 15-44 years resulted in 55 mil- lion disability-adjusted life years lost. Presently, injuries account for one in sevenhealthy lifeyears lostworldwide, and the World Health Organization predicts that this will increase to one in five by 2020, with low- and mid- dle-income countries accounting for themajority of the increase. Jamaica, with a murder rate of 36 per 100,000, is one of the highest in the world, while the death rate from motor vehicle accidents (MVA) is 18 per 100,000, compared to10and10.2 for the Caribbean region and Britain, respectively. Trauma and injuries, therefore, have held the attention of surgeons and public health workers in Jamaica for a very long time. The main trauma hospital in Jamaica is theKingstonRegional Hospital (KPH). It should not be a surprise then that on the first day of my internship, two injured patients were brought to the ward, onewithagunshotwoundand the other was a young man found in a ditch with multiple stab wounds. I started with the gunshot wound, as I thought that was the more serious injury. A nurse, however, pointed out tome that the youngpatientwith the stabwounds was bleeding profusely from his wounds and was quite rest- less. After setting up an intravenous line, Iwent about suturinghiswounds. However, after some time, I noticed that hewas no longer restless but had become quite still. The nurse and I attempted to check his blood pres- sure, and thenwe realised that hewas pulseless. Attempts at resuscitation failed.That incidentwas tohaveapro- found influenceonmy career and led tomy interest in trauma and injuries. It is because of this interest in trauma that I accepted the academic post at theUniversityof theWest Indies (UWI) when thiswas offered tome.Myman- date was to transform the Casualty Department into amodernAccident and Emergency Department. I accepted because of my interest in traumaand injuries, which I still regard as a surgical disease. In theearly years, the first Accident and Emergency Department in Jamaica was estab- lished at the University Hospital of the West Indies (commissioned in 1993) and later, theDM inEmergency Medicine Residency Programme and training in emergency nursing were established. The need to define the epidemiol- ogyofinjuriesinJamaicawasclear.This was necessary for thedevelopment of preventative measures to control this epidemic. In the late 1980s and 1990s, I attempted togather this information on injured patients. With no research assistants,noaccesstoelectronicdata- bases, I attempted to collect this infor- mation from the dockets of admitted patients and visits to the Emergency Department. After collecting a lot of information, my first attempt at data analysis revealed to me the folly of my actions, as it was impossible to retrieve and analyse the data with- out coding. I therefore explored the possibility of establishing a Trauma Registry. My research led me to Professor Lenworth Jacobs, a UWI alumnus, who was one of the lead- ing trauma specialists in theUSA. He was significantly in the development and international promulgation of the Advanced Trauma Life Support Programme in the USA. Professor Jacobs assisted with the acquisi- tion of the software for the Trauma Registry at no cost to the UWI and the Department of Surgery. The importance of trauma and its impact on the health dollar led to the development of two projects, the Jamaica Injury Surveillance Survey (JISS) and theTrauma Registry at the UniversityHospital of theWest Indies (UHWI). The JISS was developed by colleagues from the Ministry of Health and the KPH, with me as a collaborator from the UWI. The JISS collects data on all injuries present- ing to the Accident and Emergency Departments at the government hospitals across the island and is ad- ministered by theMinistry of Health. Information is collected on demo- graphics, mechanism of injury, loca- tion and circumstanceswhich caused the injury, victim-perpetrator relation- ship, and disposition of the patient. These two databases enabled us to fairly define the epidemiology of in- juries in Jamaica. For the period 2000-2009, infor- mation from JISS revealed that 11 per cent of all accident and emer- gency visits were due to injuries. Road traffic accidents account for 17 per cent, unintentional injuries account for 45 per cent, and inten- tional injuries account for 38 per cent of injuries. Patients less than 19 years old accounted for 57 per cent of unintentional injuries, while 62 per cent of these injuries took place in the home. Relationship between the victim and the perpetrator in intentional injuries found 47 per cent being injured by an acquaint- ance. Thirty per cent of injuries in women were inflicted by an inti- mate partner. The Trauma Registry at the UHWI was started in 1998 and it documents detailed information on all trauma admissions using the software programmeTrauma! devel- oped by Cales and Associates and nowmanaged by Digital Innovation Inc. Analysis of data from 11,733 trauma admissions during the 10- year period, January 1, 2001 to December 31, 2010, revealed that 20 per cent of all admissions to the sur- gical wards were injury-related. The epidemiological data is similar to that of the JISS. The peak incidence was in the second and third decades with a male to female ratio of 2.5:1. Unintentional injuries accounted for 57 per cent of injury-related admissions, of which falls and MVA were the major contributors in this category. The majority of intentional injuries were as a result of penetrat- ing trauma occurring in the home or on a nearby street. Knives, machetes and firearms were the weapons of choice. Overall, the mortality for the period was five per cent and, as expected, MVA and assaults by firearms accounted for the majority of deaths. The estimated cost of hospital care for the treatment of injuries in Trauma care in Jamaica since the 1980s PLEASE SEE TRAUMA, 16 ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FE TURE: T E SUNDAY GLEANER MAGAZINE | MARCH 3, 2019