Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP]).

Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

The fiction of health Services / La ficción de los servicios de salud

What we know today as Health Services is a fiction, perhaps shaped involuntarily, but with deep health repercussions, more negative than positive. About 24 centuries ago, Asclepius god of medicine and Hygeia goddess of hygiene and health, generated a dichotomy between disease and health that remains until today. The confusing substitution of Health Services with Medical Services began by the end of the XIX century. But it was in 1948 when the so called English National Health Service became a landmark in the world and its model was adopted by many countries, having distorted the true meaning of Health Services. The consequences of this fiction have been ominous. It is necessary to call things by its name not to deceive society and to correct the serious imbalance between Medical Services and Health Services. Hygeia and Asclepius must become a brotherhood

The fiction of health Services.

What we know today as Health Services is a fiction, perhaps shaped involuntarily, but with deep health repercussions, more negative than positive. About 24 centuries ago, Asclepius, god of medicine, and Hygeia, goddess of hygiene and health, generated a dichotomy between disease and health that remains with us until today. The confusing substitution of Health Services with Medical Services began toward the end of the XIX century. But it was in 1948 when the so called English National Health Service became a landmark in the world with its model being adopted by many countries with resulting distortion of the true meaning of Health Services. The consequences of this fiction have been ominous. It is necessary to call things by their names and not deceive society. To correct the serious imbalance between Medical Services and Health Services, Hygeia and Asclepius must become a brother and sisterhood.

Lo que hoy conocemos como servicios de salud es una ficción creada, talvez involuntariamente, con hondas repercusiones, más negativas que positivas para la salud. Hace unos 24 siglos, Esculapio dios de la medicina e Hygeia diosa de la higiene y la salud generaron una dicotomía entre enfermedad y salud que se mantiene hasta hoy. La substitución de los servicios de salud con servicios médicos comenzó confusamente a fines del siglo XIX. Pero fue en 1948 cuando el llamado Servicio Nacional de Salud inglés marcó un hito en el mundo y su modelo fue adoptado por muchos países, tergiversando el sentido de los verdaderos servicios de salud. Las consecuencias de esta ficción han sido nefastas. Es necesario llamar las cosas por su nombre para no engañar a la sociedad y corregir el grave desequilibrio entre los servicios de salud y los servicios médicos. Hygeia y Esculapio deben hermanarse.