Organisation of hospital responses for the trauma epidemic

The caseload of the Department of Surgery (Baragwanath Hospital, Johannesburg, South Africa) is characterised by a singularly heavy trauma component. Penetrating injuries account for the majority of cases. The management of penetrating trauma is not as demanding as that of blunt trauma, yet the sheer number of cases, over the past four decades, has imposed a clinical burden that has never been met by commensurate resources. The organisation of the hospital and departmental responses has manifested itself on two different levels. The first one is the structural and functional deployment of insufficient staff, facilities and equipment to cope as flexibly as possible with the trauma epidemic. The second one is the gradual adaptation of the clinical management philosophy to ensure that the best possible quality of care is provided to the majority of trauma victims, with the full knowledge that better resources would sometimes have elicited a different clinical approach.