Evaluating Trauma Care Capacity and Capability in Low-Resource Conflict Settings: Pilot Implementation of the International Assessment of Capacity for Trauma-Blast Tool at Regional Health Facilities in Burkina Faso

Abstract

Background: Existing tools to evaluate surgical care and trauma systems in low-resource settings contain a large number of variables that may limit feasibility of their use in low-resource conflict settings (LRCS). Further, such tools do not emphasize damage control capabilities, which are particularly relevant for explosive ordnance casualties. To address these needs, we developed a revised version of the existing International Assessment of Capacity for Trauma (INTACT) tool, INTACT-Blast (INTACT-B). We then piloted this tool at regional health facilities in an LRCS in the Sahel.

Methods: INTACT-B was developed by synthesizing expert opinion with a narrative review of existing LMIC trauma and surgical capacity assessment tools as well as U.S. Department of Defense Joint Trauma System Clinical Practice Guidelines. This instrument was then piloted across regional and district hospitals in Burkina Faso with functional surgical services.

Results: Thirty-six regional and district health facilities in Burkina Faso were included in the INTACT-B pilot, with required less than 15 min for data entry. Both material (e.g., equipment and infrastructure) and training needs were identified. Only 30.6% of facilities reported the ability to perform damage control laparotomy, with differences between regional and district facilities (70.0% vs. 15.4%, respectively). Although 75.0% had blood banks, only 44.4% had access to tranexamic acid and 33.3% to tourniquets and hemostatic dressings. Imaging equipment was limited (38.5% of district facilities had a functioning X-ray machine). Fewer than half of facilities were capable of performing essential war surgery interventions, such as chest tube placement and amputation (both 47.2%) or fasciotomy (33.3%), with the most significant gaps at district facilities. No facilities either at the regional or district level reporting vascular repair capabilities including intravascular shunt.

Conclusion: The INTACT-B tool provides a feasible instrument for evaluating trauma care capacity and capability in LRCS. Significant needs both with respect to material resources, infrastructure, and training were identified in the study setting. Information generated through use of the INTACT-B tool may help guide efforts to strengthen regional and district health facilities closer to point-of-injury, which holds potential to reduce preventable death among local casualties in LRCS.

Keywords: casualty care; conflict‐related injury; low‐resource settings; trauma care.