Improvement of the Trauma Prevention System in a Major Industrial Center

The dissertation is devoted to the improvement of the trauma prevention system in a major industrial center — the city of Yekaterinburg and its administrative-territorial entities. The study analyzes the prevalence of traumatic injuries for the period 1997–2004 based on data from emergency medical assistance, trauma centers, and inpatient facilities, as well as the characteristics of mortality and disability resulting from injuries. The study identifies and ranks manageable risk factors based on a sociological survey, develops an organizational-functional model of the trauma service, and forms a comprehensive system for trauma prevention based on an interdepartmental approach involving the efforts of internal and external structures.

Relevance of the Problem.

At the present time, one of the most urgent socio-medical problems is trauma, which reflects the socio-economic status of society. Traumatic injuries constitute, according to Brongel L. (2003), the most serious epidemic of the twentieth century and an international problem, driven by the growth of terrorism and natural disasters (Zamarripa VG., 2003).

Given the number of victims and the costs associated with the treatment of patients of a trauma profile, trauma has been called the longest war of the modern world. Throughout the 1990s in Russia, the relevance of this problem increased, which was associated with the criminogenic nature and urbanization of society against the backdrop of economic instability of the state. Injuries claim the lives of people of the most youthful working age. Thus, in the age group from 1 to 45 years, mortality from injuries ranks first in the overall structure, accounting for 52% (Babenko A.I., 2003).

Disability resulting from injuries occupies third place in Russia, with an annual increase of 10% noted, and persons under 45 years of age constitute 50% (V.I. Starodubrov, 2004).

Under the prevailing economic conditions of sectoral financing, the development of primary trauma prevention will make it possible to avert the economic damage associated with expenditures on diagnosis, treatment, and rehabilitation of patients of a trauma profile (Kuznetsova, 2000).

The level of trauma is higher in economically developed regions with a predominance of enterprises in the mining, metallurgical, forestry, and wood-processing industries (A.B. Blokhin, 1999). In connection with this, in major administrative centers, considerable interest is attached to the creation of a trauma prevention system that accounts for the specific features of individual administrative-territorial entities and involves the leadership of districts in its implementation.

At present, in the Russian Federation, comprehensive programs are insufficiently developed, and in those that exist, the emphasis is placed on the study of trauma prevalence, while questions of its prevention are inadequately addressed from the standpoint of a systemic approach.

A promising direction should be considered the improvement of primary trauma prevention and its consequences, based on an intersectoral foundation and the development of effective mechanisms of influence on identified manageable risk factors.

Objective of the Study: Improvement of the trauma prevention system based on the identification of manageable risk factors and the substantiation of an interdepartmental approach in the conditions of a major industrial center.

Tasks of the Study:

1. To examine the prevalence of trauma in Yekaterinburg and its administrative-territorial entities for the period 1997–2004.

2. To identify manageable risk factors of trauma and conduct their ranking.

3. To evaluate the efficiency of the organizational structure of the trauma service and the quality of medical care provided for injuries in a major industrial center.

4. To develop a comprehensive, scientifically grounded system for the prevention of the causes and consequences of trauma based on an interdepartmental approach and to evaluate its efficiency.

Scientific Novelty:

An analysis of trauma prevalence in Yekaterinburg and its administrative-territorial entities for the period 1997–2004 is presented.

Manageable risk factors have been identified and ranked based on the determination of their proportional contributions to the development of various types of trauma in a major industrial center.

An organizational-functional model of the trauma service of Yekaterinburg has been developed and its medical-social and economic efficiency has been evaluated.

A system for the prevention of the causes and consequences of trauma has been developed based on an interdepartmental approach (Intellectual Property Certificate No. 73200400210 dated 03.12.2004), which made it possible to stabilize its level and improve the quality of trauma care provided.

Results Obtained:

The results obtained made it possible to scientifically substantiate and improve the system of trauma prevention among the population in a major industrial center, based on the determination of the proportional contribution of the principal risk factors and the use of an interdepartmental approach. The efforts of intramural structures (pre-hospital, ambulatory, inpatient, and rehabilitation stages) as well as extramural structures — the Ministry of Internal Affairs, the State Traffic Safety Inspectorate, municipal services, industrial enterprises, preschool and school educational institutions, sports organizations, and the Ministry of Social Protection of the Population of the Sverdlovsk Region — were consolidated. This contributed to the stabilization of the level of trauma prevalence, the reduction of mortality and disability from injuries, the improvement of the quality of trauma care provided, and the reduction of economic expenditures on the treatment of the injured and the rehabilitation of persons disabled by injuries.

Potential Area of Application:

The proposed trauma prevention system may be used not only in relation to trauma but also adapted for other socially significant diseases.

Validation, Publications, and Implementation:

The principal provisions of the research were reported and discussed at: the City Trauma Scientific-Practical Conference (Yekaterinburg, 1999); the Association of Healthcare Organizers of the Ural Region (Tyumen, 2000); the Jubilee International Scientific-Practical Conference of Trauma Orthopedists (Moscow, September 2001); the Association of Healthcare Organizers of the Ural Region (Chelyabinsk, 2002); the Interregional Scientific-Practical Conference "Gerontology, Geriatrics, and Medical Care for Veterans of Wars" (Yekaterinburg, 2002); the Scientific-Practical Conference "Medicine of the Future" (Krasnodar, 2002); the VII Congress of Trauma Orthopedists of Russia (Novosibirsk, 2002); the International Conference "10 Years of Social Work in Russia" (Yekaterinburg, 2002); the Russian Scientific-Practical Conference "Continuity in the Provision of Emergency Medical Care at the Pre-Hospital Stages" (Yekaterinburg, 2002); the International Conference "Treatment of Combined Injuries and Diseases of the Extremities" (Moscow, 2003); the Scientific-Practical Conference of City Clinical Hospital No. 23 (Yekaterinburg, July 2003); the International Forum "Emergency Medicine in a Megacity" (Moscow, 2004); the Church-Public Forum "The Spiritual-Moral Foundation of Demographic Development of Russia. The Ural Region" (Yekaterinburg, 2004); and the First Congress of Trauma Orthopedists of the Ural Federal District "High Technologies in Traumatology and Orthopedics: Organization, Diagnosis, Treatment, Rehabilitation, Education" (Yekaterinburg, 2005).

Based on the materials of the study, the following normative documents were prepared and issued:

- City Target Complex Program "Traumatology" dated 05.01.2000;

- Decree of the Head of the Administration of the Ordzhonikidzevsky District No. 498 dated 25.05.2001 "On the Implementation of the Target Program 'Prevention of Trauma in the Ordzhonikidzevsky District'";

- Resolution of the Collegium of the Administration of the Ordzhonikidzevsky District dated 04.07.2002 "On the Implementation of the Trauma Prevention Program in the Ordzhonikidzevsky District";

- Regional Target Program "Prevention of Trauma and Organization of Trauma Care for the Population of the Sverdlovsk Region."

Based on the dissertation, 40 publications have been issued.

Propositions to be Defended:

1. The prevalence of traumatic injuries and the identification of manageable risk factors based on their proportional contributions to the development of various types of trauma in the conditions of a major industrial center.

2. The organizational-functional model of the trauma service of Yekaterinburg and the evaluation of its efficiency.

3. The improvement of the trauma prevention system in a major industrial center based on an interdepartmental approach and the evaluation of its efficiency.