Strengthening trauma care in low- and middle-income countries through guideline adaptation and scalable system reforms

Table 3 Practical proposed actions for strengthening trauma care in low- and middle-income countries

Domain	Key actions
Workforce & training	Expand ATLS, PTC, CME
	Integrate trauma modules in curricula
	Strengthen trauma workforce training & continuous professional development
Rapid diagnostics	Train GPs & EM physicians in eFAST
	Perform eFAST promptly in unstable trauma patients
	Apply the principle of “image to decide, not to delay”, integrating diagnostics with clinical judgment
Hemostatic resuscitation	Administer TXA early
	Activate MTP with 1:1:1 ratio (PRBC:Plasma:Platelets)
	Ensure timely delivery of blood products
Surgical & infrastructure	Maintain 24/7 emergency operating theater
	Ensure local blood bank availability
	Upgrade district/provincial hospitals with essential trauma equipment
Prehospital care	Strengthen ambulance & referral systems
	Train first responders and paramedics in trauma stabilization
	Enhance prehospital assessment and triage
Clinical pathways & data	Implement standardized trauma protocols adapted to LMICs
	Establish national trauma registry
	Ensure completeness of core data for quality improvement

ATLS: Advanced trauma life support; PTC: Primary trauma care; CME: Continuing medical education; GPs: General practitioners; EM: Emergency medicine; eFAST: Extended focused assessment with sonography for trauma; TXA: Tranexamic acid; PRBC: Packed red blood cells; MTP: Massive transfusion protocol; LMICs: Low- and middle-income countries.