Modularity and Complexity in Global Trauma System Development

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Trauma is emerging as the new global pandemic. Around 10% of all deaths that occur worldwide, approximately 5 million people each year, are due to trauma, with 90% of these injury-related deaths occurring in low- and middle- income countries (LMICs). To tackle this problem, many High Income Countries (HICs) have implemented their own trauma systems, however the design of these are often non-transferable to the LMIC setting, where the need is even greater. Trauma systems should be viewed as highly integrated, interdependent, and complex systems, therefore improvement to a single component of the system is unlikely to be reflected in demonstrably improved clinical outcomes, if other areas of the system remain sub-optimal or failing. Trauma care can be viewed as the pinnacle of a systems problem, as it comprises complex and heterogenous patient groups and disease presentations, and requires co-ordinated macro-healthcare and micro-clinical systems, with multiple and variable outcome measures involved. This project aims to answer how trauma systems can best be designed, developed, and maintained in LMICs through a systems engineering approach. Using mixed methods we will first understand the current landscape and key stakeholders in trauma provision in LMICs, before assessing opportunity-costs and risks involved in focussing on each aspect of the trauma care components. By the end of the project, we aim to develop a new methodological approach through which a trauma system can be implemented and optimised within a resource- limited setting.