ITACCS: A Worldwide Eye on Preparedness

Given recent conflicts and the threat of terrorism, it is not surprising that interest in trauma anesthesia and critical care is intense. The International Trauma Anesthesia and Critical Care Society (ITACCS) has been active on many fronts and has recently been involved in several important international projects.

The 2003 ITACCS meeting was held in Dallas, Texas, on May 23-25, and despite a war, threats of terrorism and an epidemic of a new viral severe acute respiratory syndrome (SARS), it was a success. Clinicians involved in the management of trauma patients from many nations met to discuss and hear of advances in the management of trauma victims. The educational benefit from these interactions is enormous and translates to a potential benefit for patients.

Members of ITACCS from the United States, United Kingdom, Australia and France recently participated with two important initiatives in India. Last September, the 16th National Trauma Management Course (NTMC) was jointly organized by the International Association for Surgery of Trauma and Surgical Intensive Care (IATSIC), the Academy of Traumatology (India), the Indian Society of Critical Care Medicine and the Kanpur Orthopaedic Club and was held in Kanpur, India. A group of 100 delegates took part in a two-day advanced trauma life support-type program that is designed for the Indian environment.

The second initiative was Trauma Criticare 2003, the Seventh Conference of the International Trauma Anaesthesia and Critical Care Society (Indian Chapter), which was held in New Delhi, India, September 26-28, 2003, with 900 delegates attending. The inauguration of the conference featured the Minister of Labor who made some interesting promises regarding the provision of trauma resuscitation services. The need for a system approach in India has been long recognized, and it is encouraging to see the rapidity with which improvements in trauma care are evolving in this part of India. According to World Health Organization (WHO) figures for 2000, India has a disproportionately high road traffic injury mortality, at 29 per 100,000, more than twice the rate of developed nations. This translates to an Indian trauma death every few minutes. According to Global Burden of Disease study data, this problem is set to worsen with trauma becoming the second most important health problem in developing nations by the year 2020. ITACCS recognizes that it has much to contribute through international educational initiatives.

Since 1997, on the occasion of the 10th World Congress on Emergency and Disaster Medicine in Mainz, Germany, ITACCS has been organizing the “International Chief Emergency Physician (ICEP) Course.” The course is based on the national German CEP curriculum as well as experiences gained in previous courses run in Mainz. The basic curriculum has been adapted continuously to meet the requirements of the participants and to adapt to changes in emergency medicine and disaster management. Throughout the ICEP course, participants are trained to function as leaders within a local command structure to manage all medical aspects of mass casualty incidents and disasters. Participants learn how to define medical priorities, analyze and organize key problems such as triage of victims, medical care and its limitations, field treatment and means of transportation at mass casualties and disasters. The most recent ICEP course was held in Graz, Austria, at the end of September 2003, and future courses are being planned.

ITACCS recently provided significant input for the “Essential Trauma Care Course,” which is a project of IATSIC and WHO. The course will provide details of services that are “essential” to prevent death and disability in injured patients that might be considered as the “rights of the injured patient.” These will be categorized into three broad sets of rights:

1. Life-threatening injuries are appropriately treated, according to appropriate priorities and in a timely fashion, to maximize the likelihood of survival.

2. Potentially disabling injuries are treated appropriately so as to minimize functional impairment and to maximize return to independent and participating community life.

3. Pain and psychological suffering are minimized.

The precise procedures that can optimally achieve these goals, as well as human and physical resources, will vary across the spectrum of economic resources of the world’s nations and the geographic location of the facilities concerned. These goals should, however, be achievable for most injured patients in most locations.

ITACCS continues to run a large number of smaller, largely U.S.-based continuing medical education programs in conjunction with Northwest Anesthesia Seminars. The U.S. and international faculty that contribute to these trauma team seminars bring a great depth of experience that results in a successful program.

Finally plans for TraumaCare 2004 in Sydney, Australia, are well under way. The Sydney meeting will realize many innovations for ITACCS that are currently in preparation, and details can be found at <www.traumacare2004.com> and via the recently updated ITACCS Web site at <www.itaccs.com>.

These are particularly interesting times to be involved in trauma care; increased collaboration, improved electronic communication and the continued dedication of clinicians continue to foster real progress in this area.

Michael J.A. Parr, M.D., is Senior Staff Specialist in Intensive Care, Liverpool Hospital, and Lecturer in Intensive Care, Anaesthesia and Emergency Medicine, University of New South Wales, Sydney, Australia.