OPENING SPEECH BY DR JANIL PUTHUCHEARY, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH & MINISTRY OF COMMUNICATIONS AND INFORMATION, AT THE OPENING OF THE SINGAPORE TRAUMA AND ACUTE CARE CONFERENCE ON 5 OCTOBER 2023 AT SUNTEC CITY CONVENTION CENTRE

Distinguished Guests

Ladies and Gentlemen

    Good morning. It is my pleasure to join everyone at the opening of the Singapore Trauma and Acute Care conference (STACC) today.

2    Trauma is the leading cause of mortality worldwide, with more than five million deaths per year. In Singapore, trauma is among the top 10 leading causes of death from 2020 to 2022, accounting for about 2% of all deaths in Singapore.

Improving Trauma Care Delivery in Singapore

3    What can the Ministry of Health (MOH) from a policy and regulatory perspective do about it? From the public perception, trauma is something focused on Emergency Department (ED) care, pre-hospital and emergency medical services, the heroic efforts in the operating theatre. Of course, the real hard of the critical care faculty afterwards. But there is a role for policy, and there is a role for how we have organised our system.

4   I have two key messages today. First, how we organise our system is important. Second, we can go upstream and look at the population to see how we might prevent some proportion of the burden of disease or trauma. Trauma spans a spectrum of complexity and severity, and involves many specialties and a multi-disciplinary approach to the chain of care. In organising our system around this challenge, it requires an optimisation of resources and accessibility. We have the National Trauma Committee here in Singapore, established by the MOH in 2008. We have been regularly reviews the organisation and delivery of trauma services by our public acute hospitals.

5   We have organised the hospitals into regional trauma groups across the nation and collectively ensure that each region then has sufficient trauma coverage. Each trauma group has an anchor hospital with a comprehensive range of specialties and subspecialties under one roof to manage most of the trauma cases, and support the partner hospitals in the region. This allows us to work closely with our Emergency Medical Services (EMS) colleagues in the Singapore Civil Defence Force (SCDF) to have a national approach towards a pre-hospital trauma diversion protocol, where major trauma cases can be preferentially diverted to the anchor hospitals for definitive care. Decisions will then be made early in the chain of care.

6   This regionalisation approach in our dense city state has several advantages. I think for our audience, you appreciate the advantage in terms of the volume of cases and the relationship with the experience and expertise being developed. But it is not only about the patient load and clinical care outcomes. It allows the sharing of resources, clinical capabilities, training opportunities, and the administrative approach. How do you ensure a common quality assurance framework? And of course the issue of concentrating the workload, building up that volume so that you have the competencies amongst all the multiple specialties involved, to achieve better treatment outcomes. That is the starting position, but it is not the be-all and end-all. There are other benefits of having this type of approach.

7   It also allows MOH to think through standards for acute care of trauma for public acute hospitals. By laying out the capabilities that our hospitals must have before they can be receiving these types of patients, they have to have these capabilities and competencies in place, then they can effectively manage common acute trauma cases. This addresses issues of the services, but also the infrastructure that they need to put in place. So that’s some of the things we have to do at the level of the Ministry in terms of thinking about the organisation of our system to deal with trauma.

Injury Prevention Efforts

8   The other aspect is then going upstream. What can we do on a preventive basis, on the population basis to prevent the injuries and the burden of disease? It is overlooked in the common perception or chain of survival. But prevention is important. Based on data from the National Trauma Registry, elderly persons made up more than two-thirds of the moderate to severe trauma cases, with same-level falls being the major cause of trauma injuries among the elderly. With ageing society in Singapore, fall-prevention among seniors is an important area of focus in injury prevention.

9   The Health Promotion Board’s (HPB) engages and educates seniors on fall prevention awareness through interactive health workshops, helping them learn about the causes and consequences of falls, how to prevent falls, and how to encourage them and their peers to engage in strength and balance exercises, having an appropriate diet rich in calcium, going for regular check-ups for your vision, wearing the right types of shoes and keeping the home environment safe and clutter-free. These are vital and essential for the population approach to reduce the burden of disease that trauma can potentially present.

10   As an extension of its efforts on falls and frailty prevention, HPB also collaborates with the allied health team from Tan Tock Seng Hospital (TTSH) on Steady Lah!, a programme targeted at seniors identified as being at risk or showing early signs of frailty. Since August this year, HPB has rolled out Steady Lah! programme in the community. The programme features progressive strength and balance exercises to improve muscle function, mobility and interactive activities to address the issues of diet. Seniors also have the opportunity to learn about fall recovery techniques, to minimise injuries and call for help and recover, should an incident occur.

11   These are two areas at the Ministry level, where we can play a part in addressing some of the issues to do with trauma. We can try to organise our system correctly so that we can respond correctly, provide the right type of resource optimisation and capability and competency development across our entire system. We can then intervene once something occurs. Secondly, moving upstream on a population basis, think through how we can reduce the burden of disease through appropriate preventive strategies involving coordination, strength, mobility, diet as well as a holistic approach to population health. That helps seniors cope with ageing, better reduce the risk of serious injury and trauma. I think these are two important points that we at the Ministry can continue to play our part.

Closing

12   I would like to end by congratulating the organising committee for organising STACC, as this is the first time the conference is being held again after a four-year hiatus in-person. I am very happy to see so many of you coming together in person. I especially welcome those of you who came from overseas to contribute and share your experience and participate in this conference. In Singapore, we benefit very much from the learning. It is heartening to see professionals, both local and international, gathered here to learn from one another and improve trauma care for the benefit of patients. In Singapore, we benefit very much from the learning, sharing and collaborative approach that we have with colleagues from around the world to help us improve the care that we deliver for our patients, to learn from each other and to develop that a fellowship, which I think is very important in our various specialties focused on solving these types of problems such as trauma. I wish everyone a fruitful time over the next few days. Thank you very much for inviting me to join you. And once again, congratulations to the organizing committee. Thank you.