Report from Dominican Republic Establishing Injury Surveillance: No Need to Reinvent the Wheel

Editor’s note: We all know the statistics on global road traffic injuries - over 1.2 million deaths, 500 billion dollars per year, and third on the list of global burden of disease by 2020. Unfortunately reliable data is not available in many of the countries most severely affected. That’s one reason to establish injury surveillance system. In 2007, Pediatric Resident David Kessler spent part of his residency training in the Dominican Republic, studying injuries and helping set up an injury surveillance system.

Here are excerpts from his report:

From the scant data that is available in the Dominican Republic (DR) road traffic injuries are the number one cause of mortality among working age (14-44 years old) men. A majority of these fatalities involve motorcycles. In February and March, 2007, I worked with colleagues from NYPH/Columbia University, a consortium of the major trauma centres and the Dominican Republic’s Ministry of health in the DR, to help set up a hospital-based injury surveillance system.

Before we did anything, I spent five days meeting with my colleagues, identifying local stakeholders, and performing an initial needs assessment. With the help of medical students, we also conducted a pilot survey. Our first draft of the surveillance questionnaire was cumbersome and included too many needless questions. Using the WHO Injury Surveillance Guidelines we modified the questionnaire and developed a core set of variables. Eventually our form was streamlined from six to two pages. The next step was refining the surveillance form to reflect nuances of the local language and medical parlance. One added benefit of this step was that we were able to get other physicians, medical residents and nurses involved in the project - a key to sustainability. Now the injury surveillance form is being used at one of the major trauma centers and we’re planning to implement its use at other centers over the next few months.

Rather than reinvent the wheel, we used material in the WHO Helmet Manual [LINK ] to guide us in conducting an observational study of motorcycle helmet use. Data from that survey provided key information to the Minister of Health about traffic injury. We believe that the data will be used by the Minister to establish new policies on helmet use. We’re currently working to organize several activities for the upcoming United Nations Global Road Safety Awareness Week to promote public awareness. Some of our activities include:

• Implementing a community-based project in the DR to teach basic first-aid to local leaders.
• Conducting a trauma course as part of an ongoing “Train-the-Trainers” program for building capacity in Emergency Medicine, Trauma Care and Disaster Management in DR.
• Holding a press conference to announce the national injury surveillance database and facilitate continued research directed at decreasing morbidity and mortality secondary to trauma at the community, pre-hospital and hospital level.
• Encouraging policy makers to make a public commitment to improve motorcycle helmet compliance.

David Kessler is a third year resident in pediatrics with distinction in global health at Mount Sinai Hospital in New York. In July, he will be starting fellowship in Pediatric Emergency Medicine at NYU.

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