title: Development of a novel Global Trauma System Evaluation Tool and initial results of implementation in the Republic of South Sudan.
abstract: BACKGROUND
  Trauma remains a leading cause of death and disability in the world, and trauma systems decrease mortality from trauma. We developed the Global Trauma System Evaluation Tool (G-TSET) specifically for use in low- and middle-income countries (LMICs). The Sudan People's Liberation Army (SPLA) in the Republic of South Sudan (RSS) desires a military trauma system (MTS) which allowed us to pilot the G-TSET.
  
  
  METHODS
  The G-TSET was developed by modifying key components of a trauma system applicable to LMICs. We partnered with the SPLA Medical Corps using clinical collaboration, direct observation, and discussion groups. Benchmarks and indicators were scored with 5 indicating "full capability" and 1 meaning "not present" and were used to develop a SPLA MTS plan.
  
  
  RESULTS
  The overall MTS score was 1.15 indicating an urgent need for system development. The assessment highlighted the need for SPLA Command support. Battlefield care, transport to a trauma facility, and inter-facility communication were identified for improvement. After essential battlefield care, consisting primarily of bandaging and splinting, transport times for injured SPLA soldiers were 12h to 3 days by truck. Based on our findings, we collaborated with SPLA medical leadership to develop a plan to develop a formal MTS.
  
  
  CONCLUSIONS
  We piloted a novel trauma system assessment tool for the MTS in the RSS. Qualitatively, we identified gaps in the MTS and provided the medical leadership with a plan for improvement. We anticipate a short-term follow-up to quantify improvement, and we seek to validate this tool for use in other countries.
authors.affiliation: Trauma and Acute Care Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, United States; Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: kyleremickmd@yahoo.com.
authors.forename: Kyle N
authors.initials: KN
authors.lastname: Remick
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States. Electronic address: evan.wong@mail.mcgill.ca.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: SPLA Medical Corps, SPLA Military Hospital, Juba, South Sudan. Electronic address: chepchuot@yahoo.com.
authors.forename: Chep
authors.initials: C
authors.lastname: Chuot Chep
authors.affiliation: 212th Combat Support Hospital, Miesau, Germany. Electronic address: armytraumanurse@yahoo.com.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Morton
authors.affiliation: SPLA Medical Corps, SPLA Military Hospital, Juba, South Sudan. Electronic address: amelnayer2013@gmail.com.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Monsour
authors.affiliation: Uniformed Services University of the Health Sciences School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: dane.fisher@usuhs.edu.
authors.forename: Dane
authors.initials: D
authors.lastname: Fisher
authors.affiliation: Trauma and Acute Care Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, United States; Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: john.s.oh.mil@health.mil.
authors.forename: John S
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: ramey.wilson@usuhs.edu.
authors.forename: Ramey
authors.initials: R
authors.lastname: Wilson
authors.affiliation: Trauma and Acute Care Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, United States; Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: debra.l.malone.mil@health.mil.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Malone
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States. Electronic address: cbranas@upenn.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: Branas
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States. Electronic address: eric.elster@usuhs.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Elster
authors.affiliation: Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass Ste B, JBSA Ft Sam Houston, TX 78234, United States. Electronic address: Kirby.r.gross.mil@mail.mil.
authors.forename: Kirby R
authors.initials: KR
authors.lastname: Gross
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Surgeons OverSeas (SOS), 504 E. 5th Street, Suite 3E, New York, NY 10009, United States; Columbia University, Department of Surgery, New York, NY, United States. Electronic address: adamkushner@yahoo.com.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D019985:Benchmarking; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D013397:Sudan / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology / Q000458:organization & administration* / Q000592:standards; D014218:Triage / Q000458:organization & administration; D014857:Warfare; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology
keywords: Global injury; Global surgery; Injury care; International surgery; Trauma systems