Objective: Current global surgery initiatives focus on developing a surgical workforce to address road traffic deaths (RTDs). However, it is unclear whether this approach would be helpful in all countries, as patients in low... [ view full abstract ]
Objective: Current global surgery initiatives focus on developing a surgical workforce to address road traffic deaths (RTDs). However, it is unclear whether this approach would be helpful in all countries, as patients in low resource countries may not be able to reach hospitals in a timely enough fashion to receive life-saving trauma care.
Methods: Estimated RTDs were obtained from the Global Status Report on Road Safety 2013 (GSRRS 2013) which estimated the RTD rate in 2010 (RTD 2010). The classification of Emergency Medical Services (EMS) was defined by GSRRS 2009. The density of surgeons, obstetricians and anesthesiologists (SAO density) and 2010 income classification were accessed from the World Bank. Multivariable regression analysis was performed adjusting for different trauma system characteristics in different countries and income levels. Sensitivity analysis was performed using the RTD 2013 or the all-cause injury mortality rate as dependent variables.
Results: On adjusted analysis, SAO density was not associated with changes in the RTD 2010 rate in countries without EMS (p=0.50). However, for countries with EMS, each increase in SAO density per 100,000 population decreased road traffic death rates by 0.079 per 100,000 population (p <0.001). Income was the only factor resulting in reduced mortality rates. Similar results were found in the sensitivity analysis.
Conclusions: Increases in surgical workforce reduces RTDs only when EMS exist. In countries without EMS, investment in prehospital systems and training non-clinical personnel should be prioritized. Global surgical initiatives should also focus on bringing a non-physician workforce to developing countries.
