PROBLEMS AND PROSPECTS OF TRAUMA CARE ORGANISATION AT THE PRESENT STAGE. Analytical review
Authors:   Russian Research Institute of Health, Ministry of Health of the Russian Federation, Moscow, Russia, Rugol Liudmila , Boryak Andrey ,   Republican Trauma Centre of the Ministry of Health of the Donetsk People's Republic, Donetsk, Donetsk People's Republic
Published: August 2024

Significance. A high share of injury as a death cause in the mortality structure, its significant impact on life expectancy, high incidence of conditions under chapter “Injury, poisoning and certain other consequences of external causes”, road accident rates characterized by high severity injury and unresolved problems of road safety exacerbate the issues of providing high-quality orthopaedic and trauma care especially in rural areas and small towns. The purpose of the study was to identify current problems in the system of orthopaedical and trauma care delivery to patients with injury in the Russian Federation and to map out prospects for its development. Material and methods. The authors have conducted a systematic review of scientific publications (2002-2023), current regulatory legal documents and methodological recommendations and guidelines on trauma care organization in the Russian Federation, and selected 52 sources that met the purpose of the study, Results. Trauma care on an outpatient basis in mainly provided in trauma care offices and first-aid stations, while residents of villages, townships and small towns still experience significant difficulties in receiving it. Trauma care beds are irrationally used, there are problems in organizing rehabilitation of injury patients, hospital-replacing technologies and mobile forms of work organization in the process of care delivery to victims are not widely used, there are shortcomings in the organization of the work of first-aid stations, preventive work and follow-up of patients with injury-related consequences, and injury registration. The principles of phasing and continuity of trauma care are being violated. Peculiar features of current regulatory legal documents and methodological recommendations on trauma care organization have been analyzed. Some contradictions regarding staffing and the structure of units providing trauma care have been identified. A number of issues related to health care organization of medical care were not reflected in the analyzed documents. Discussion. It is necessary to provide measures to intensify activities of 24-hour hospitals, with due regards to stages of trauma care delivery, organize high-quality rehabilitation and medical follow-up of patients with injury and its consequences, and to take measures to increase availability and quality of trauma care to rural population. Competent territorial planning is important when organizing emergency and urgent trauma care. A condition for ensuring effective organization of care delivery to injury patients is improvement of the regulatory, legal and methodological support for organizing trauma care delivery. Conclusion. The issue of improving organization of trauma care delivery remains relevant. A number of issues of trauma care organization are not regulated by normative legal documents. In the context of intensive digitalization of the industry, and relevancy of introduction of new forms of specialized care organization, there is a need for new methodological approaches to calculating number of medical staff of units of medical facilities providing trauma and orthopaedical care, normative and legal regulation of the issues related to a prompt delivery of medical personnel and portable medical equipment to the injured, and their emergency medical evacuation to specialized centers with a possibility of organizing a multi-type care in full volumes with rehabilitation activities at each stage of care delivery and intensification of prevention.