2026 Donald Trunkey Lecture: strengthening care for the injured globally: successes, challenges, opportunities

Trauma is a major health problem, killing 4.5 million people each year. Most (84%) of these deaths are in low- and middle-income countries (LMICs), where resources for trauma care are constrained, often severely. These resource constraints lead to discrepancies in outcomes, with higher case-fatality rates for similar injuries in LMICs compared with high-income countries. Over one million trauma deaths could be averted each year if case-fatality rates in LMICs could be brought down to high-income country levels. There have been many local examples of affordable and sustainable improvements in trauma care and trauma outcomes in LMICs. The WHO and professional societies have worked to make more sustained progress globally. These efforts have resulted in moderate improvements in the availability of resources for trauma care, as assessed by consensus panels over the past 20 years. During this time, mortality for trauma has declined by 24% in the richer half of the world (high-income and upper middle-income countries) and by 15% in the poorer half (low-income and lower middle-income countries). To make further progress, there are several priorities (long-term efforts that probably require significant investment and new technology) and opportunities (which are immediately actionable). Priorities include increased availability of blood; improved care for traumatic brain injury; and improved prehospital care. Several opportunities are calling out for immediate action: increased use of trauma short courses and quality improvement programs; development of an international trauma registry for benchmarking; and use of the newly updated edition of the International Association for Trauma Surgery and Intensive Care's Guidelines for Essential Trauma Care for needs assessments of trauma care resources, with advocacy to fill identified gaps.