S. Lombardo1,2, B. Unurbileg4, J. Gerelmaa4, L. Bayarbaatar4, E. Sarnai4, R. Price2,3 1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 2University Of Utah,Center For Global Surgery,Salt Lake City, UT, USA 3Intermountain Medical Center,Department Of Surgery,Salt Lake City, UT, USA 4Mongolia National University Of Medical Sciences,Department Of Surgery,Ulaanbaatar, UB, Mongolia
Introduction: Injury is the third leading cause of death in Mongolia. Mongolians have enjoyed two decades of economic growth, resulting in greater availability of medical care and increased motorization. This same period saw a 29% increase in motor vehicle fatalities. More than half the population lives outside the urbanized capital of Ulaanbaatar, where access to care may be limited by inefficient organization and/or inadequate local resources. This study evaluates and describes the trauma system in Mongolia, and makes recommendations for improvements.
Methods: A survey instrument was created to collect hospital-level data to calculate an International Assessment of Capacity for Trauma (INTACT) score (0-10). INTACT is a validated measure for objective evaluation of trauma capacity of facilities in developing countries based on resource availability; a score of 10 reflects ideal staffing and equipment to provide advanced trauma care. The survey was administered to key staff members (surgeons, emergency and critical care physicians, nurses, statisticians) at 10 hospitals in February and March 2016. Following on-site interviews, researchers visually confirmed hospital resources. An INTACT score was calculated for each hospital and compared to expected INTACT scores based on the World Health Organization (WHO) Guidelines for Essential Trauma Care (ETC) recommendations.
Results: Trauma care in Ulaanbaatar includes a centralized prehospital transportation service and two tertiary hospitals adequately resourced to care for the injured patient (Table 1). Outside of the capital city there are limited tertiary facilities with similar capabilities. Secondary-level hospitals are staffed and resourced at levels consistent with WHO guidelines. Most primary care centers, however, fall below these recommended standards. In all but two instances, INTACT scores were within the expected range by WHO guidelines for facility level (Table 1). Outside of Ulaanbaatar, prehospital transport is hospital-based. There are no national standards for the prehospital care provider, and no universally accepted criteria to guide patient triage or transfer. There are no public outpatient rehabilitation facilities within Mongolia.
Conclusion: The Mongolian trauma system utilizes regionalized care to provide emergency services to its diverse population. Among surveyed hospitals, all except the most basic facilities have resources that meet the WHO recommendations for essential trauma care. Areas for improvement include better resourcing of primary facilities, development of a cohesive prehospital system outside of Ulaanbaatar, adoption of universal policies and standards for patient triage, management, and transfer, and creation of post-acute rehabilitation facilities.
