Trauma Care in Mongolia: INTACT Evaluation and Recommendations for Improvement

• Published in: World journal of surgery Vol. 42; no. 8; pp. 2285 - 2292
• Main Authors: Lombardo, S., Unurbileg, B., Gerelmaa, J., Bayarbaatar, L., Sarnai, E., Price, R.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Developing countries; Emergency Medical Services; Emergency vehicles; General Surgery; Health Resources; Hospitals; Humans; LDCs; Mathematical analysis; Medicine; Medicine & Public Health; Mongolia; Motor vehicles; Original Scientific Report; Rehabilitation; Resource availability; Surgery; Thoracic Surgery; Transportation services; Trauma; Trauma care; Trauma centers; Vascular Surgery; Wounds and Injuries - therapy; Mongolia
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4462-8

Introduction Injury is the third leading cause of death in Mongolia, with a 29% increase in motor vehicle fatalities over the past decade. Half of the population lives outside the urbanized capital of Ulaanbaatar, where access to care is limited. This study evaluates and describes the Mongolian trauma system and makes recommendations for improvements. Methods Hospital-level data were collected, and an International Assessment of Capacity for Trauma (INTACT) score (0–10) was calculated. INTACT is a validated measure for evaluating trauma capacity in developing countries based on resource availability; a score of 10 reflects ideal staffing and equipment. The survey was administered to key staff members at 10 rural and urban hospitals in spring 2016. INTACT scores were calculated for each hospital and compared to expected INTACT scores based on the World Health Organization Guidelines for Essential Trauma Care (GETC). Results Ulaanbaatar enjoys a centralized prehospital transportation service and two appropriately resourced tertiary hospitals. Rural Mongolians rely upon regionally located tertiary facilities with similar capabilities. INTACT scores for secondary-level hospitals ( n  = 2) failed to meet expected GETC minimums, as did 2 of 4 primary facilities. There are no national standards guiding prehospital care, triage, or transfer. No outpatient rehabilitation facilities exist within Mongolia. Conclusion The Mongolian trauma system utilizes regionalized care to provide emergency services. Among surveyed hospitals, 60% met GETC standards. Areas for improvement include increased resourcing of primary and secondary facilities, development of rural prehospital systems, adoption of universal standards for patient care, and creation of post-acute rehabilitation facilities.