TY - JOUR
T1 - Applying trauma systems concepts to humanitarian battlefield care
T2 - A qualitative analysis of the Mosul trauma pathway
AU - Garber, Kent
AU - Kushner, Adam L.
AU - Wren, Sherry M.
AU - Wise, Paul H.
AU - Spiegel, Paul B.
N1 - Funding Information:
The Mosul trauma pathway encompassed a variety of actors, including NGOs, UN agencies, local civilian agencies, military forces, and one private medical company. Actors participated in one or sometimes multiple echelons of care, reflecting their respective capacities, interest, and experience. Some were present for the entire response, whereas others participated for only a portion of it. Several groups, including NYC Medics, Samaritan’s Purse, and Aspen, were supported materially by WHO, which in turn received funding from the U.S. government (OFDA), the European Union (ECHO), and the UN Central Emergency Response (CERF) Fund. Others were supported by separate donors (e.g. IOM was supported by the UK’s Department for International Development (DFID) or independent contributions (e.g. MSF). A list of the key trauma actors, with their designation and associated role in the trauma response, is provided in Table 2.
Funding Information:
Funding for this study was provided through an independent, unrestricted grant from the United States Agency for International Development (USAID). The findings do not necessarily represent the views of USAID or the U.S. government.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/2/4
Y1 - 2020/2/4
N2 - Background: Trauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016-July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts. Methodology: A qualitative study design was used to examine the Mosul civilian trauma response. From August-December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified. Results: The Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system. Conclusions: The Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.
AB - Background: Trauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016-July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts. Methodology: A qualitative study design was used to examine the Mosul civilian trauma response. From August-December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified. Results: The Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system. Conclusions: The Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.
KW - Armed conflict
KW - Humanitarian responses
KW - Trauma and surgical care
KW - Trauma systems
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U2 - 10.1186/s13031-019-0249-2
DO - 10.1186/s13031-019-0249-2
M3 - Article
C2 - 32042308
AN - SCOPUS:85079638553
SN - 1752-1505
VL - 14
JO - Conflict and Health
JF - Conflict and Health
IS - 1
M1 - 5
ER -