Trauma cases continue to be a pressing issue for healthcare facilities in the Western Cape. This is now causing significant delays in scheduled surgeries, extended waiting periods and a financial burden on the healthcare system.

During a summit last week, professors from Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS) discussed the province’s inability to satisfy basic healthcare. Areas affected by preventable trauma cases include care for chronic diseases and maternal and child health.

The meeting included key stakeholders in trauma care, public health, community safety, and provincial healthcare leaders. The summit acknowledged that alcohol plays a role in many trauma cases.

Head of the Western Cape Health Department, Dr Keith Cloete, revealed that from 2021 until June this year the province’s 27 sentinel emergency centre (ECs) sites treated almost 80 000 trauma patients. 

Trauma cases contribute to surgery backlogs

“Of the 79 058 cases, almost half (35 108) trauma injury patients presented due to interpersonal violence. These patients are young adults, often between 20-40″.  Cloete said the weekend and end-of-month saw considerable spikes in cases compared to midweek or mid-month.

Due to pre-COVID-19 surgery lists, the COVID pandemic, and the high number of trauma cases, the province currently has a surgery backlog of 77 139 cases, he revealed. The department has set aside an additional R20 million towards catching up on surgeries and other theatre slots for this financial year.

“While the department tries to reduce this backlog, it is very difficult for the health system to make significant inroads if there is a consistent flow of trauma cases that must be prioritised over other conditions. This is the reality that many of our clients, especially the vulnerable and older people, must endure – meaning they must wait longer to undergo elective surgery, which will improve their quality of life”, he said.

Most trauma cases preventable

Dr Hendrick Lategan, a lead author on a study of trauma patients, said most trauma cases are preventable.

According to Stellenbosch University, the study – a multi-site cross-sectional study of major trauma patients that began in September 2019 in sites located in the Cape Town metro and Cape Winelands areas – provided data and logistical support for the review of 138 trauma-related deaths. 

The ongoing study collects data from the time of injury until the patient is discharged from the hospital. This includes in-ambulance care and pathology records as applicable.

Dr Lategan elaborated further on the impact of preventable trauma cases.

“Preventable trauma cases include interpersonal violence, particularly those fuelled by alcohol abuse, gang-related violence which we see daily in the trauma unit, non-adherence to road regulations and speeding, gender/child-based violence”, he said.  

Resolve root causes

According to Lategan, the causative factors of these cases are multiple. Addressing the root factors is the only way the numbers will drop.

“Social factors include unemployment, alcohol abuse, gang dominance in certain areas, GBV violence engrained in certain communities and violence toward children. Disregarding authority and rules, particularly on our public roads, lead to a high number of motor-vehicle and pedestrian-vehicle accidents, “said Lategan.

Lategan said trauma cases consumed funding and resources needed elsewhere, like the medical and nursing staff. The cost of treating the significant number of trauma cases was extraordinarily high.

Booze ban lowered number of cases.

According to Lategan, the EPiC research team uses a 3-fold system in their trauma unit besides the hospital-based data system. HECTIS is a patient tracking tool. VULA is a patient referral system. And the EPiC study further dissects trauma cases within a specific subset of areas and patients.  

“We have strong data to show these unacceptably high numbers. During the Covid 19 lockdown, trauma cases dropped dramatically because there were no alcohol sales and road restrictions. Unfortunately, GBV and child-related violence increased due to the population being homebound”, he said.

Lategan said all facilities are affected, from CHC level to Tertiary Trauma Units. “No one is spared in our ongoing trauma pandemic”.

According to Cloete, addressing issues which fuel trauma incidents requires a whole-of-society, whole-of-government approach. 

“The Western Cape recently launched a safety dashboard, one initiative that will support this approach. Using data from 34 health facilities, this safety dashboard will further support the establishment of the Provincial Government’s Violence Prevention Unit (VPU) and allow for the identification of admissions patterns into these ECs.  – Health-e News