Guidelines for essential trauma care: from recommendation to implementation across all countries of varied income levels
Authors: Timothy C Hardcastle, Charles Mock, Christine Gaarder
Published: 2026

The recent publication of the updated Guidelines for essential trauma care in the World Journal of Surgery is an important first step in strengthening worldwide trauma care across all income levels.1 The updated guidelines address changes and progress from the original 2004 document from the WHO and the International Association for Trauma Surgery and Intensive Care (available online, https://www.who.int/publications/i/item/guidelines-for-essential-trauma-care). That document formed the basis of many countries’ development of trauma care, often where none existed, with demonstrated improved trauma outcomes.1 From the trauma system perspective, they are read in conjunction with the prehospital care guidelines and quality improvement guidelines documents.2 3

The guideline outlines the various structural, consumable, and process (administrative) aspects of a trauma system, along with some guidance on quality assurance and quality improvement processes. Integration with other WHO policies and publications is listed. There is introductory text for each subsection and accompanying tables that place the recommendations into ‘facility’ context, allowing lower- and middle-income regions to select the interventions and equipment with the greatest potential impact and apply these as standards at their various levels of care, and encouraging higher-income regions to improve care at lower levels. Items are marked as either core (essential) or extended (optional), and where relevant at the lowest levels of care, ‘not applicable’.

Having recommendations is great, but for global implementation, there must be wide dissemination and adoption by ministries or departments of health in governments across all income levels. The guideline is structured so application can be performed irrespective of the health gross domestic product of individual countries.

Application is encouraged with the addition of standardized guidance on clinical trauma care addressed in the recent ‘ERATIC’ papers, which address the day-to-day best evidence trauma care at the bedside.4,6 Combining effective management, along with ensuring minimal facility, equipment, consumables, and education, will enable early definitive trauma care for the most vulnerable of society.

For this to be effective and cost-efficient, political will must exist, whereas clinician buy-in, via professional organizations, can direct policy change. Continuing education will improve decision-making, and governance-directed audit, after implementation, can lead to further quality improvement. Incorporating all sectors, including prevention and rehabilitation strategies, can lead to a system that gets the right patient to the correct level of care in a timely fashion, ensuring rehabilitation in conflict zones and low- and middle-income countries to really impact the entire globe.7

Footnotes

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

Patient consent for publication: Not applicable.

Ethics approval: Not applicable.

Provenance and peer review: Commissioned; internally peer reviewed.

References