Introduction Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality trauma care within the 21 countries in the region. Methods OVID Medline, Embase, EBM reviews and Global Health databases were systematically searched in October 2020. Records were screened by two independent researchers. Data were extracted according to a predetermined proforma. Studies of any type, published in the preceding decade were included, excluding grey literature and non-English records. Trauma was defined as blunt or penetrating injury from an external force. Studies were individually critically appraised and assessed for bias using the RTI item bank. Results 57 records met the inclusion criteria. 20 countries were covered at least once. Nine key barriers were identified: training (37/57), resources and equipment (33/57), protocols (29/57), staffing (17/57), transport and logistics (16/57), finance (15/57), socio-cultural (13/57), capacity (9/57), public education (4/57). Conclusion Nine key barriers negatively impact on the provision of high-quality trauma care and highlight potential areas for improving care in Central & South America. Many countries in the region, along with rural areas, are under-represented by the current literature and future research is urgently required to assess barriers to trauma management in these countries. No funding was received. Clinical Trial Registration: PROSPERO CRD42020220380.

Painting vivid, exquisitely detailed pictures, this book delivers poignant lessons through human stories and personal memoir told with self-deprecating humour and humility. An emphatic, thoughtful work, Head First takes the reader to hidden crevices and open canyonschallenging our thoughts on medicine and exploring the far-reaching consequences of separating 'mental' from 'physical'. In 'Stigma' for example, we meet sisters Pearl and Sadie, whose isolation shows us the deep consequences of self-stigmatisation. Simon, who we meet in 'Melancholia', experiences the fraught loneliness of depression, and Gary's frequent and baffling presentations to hospital in 'Medical mysteries' teach us that the answer is not always revealed by ever more medical tests. The patient stories are contextualised with wide-ranging and erudite discussion on subjects as diverse as autonomy, personality and the meaning of an evidence base in medicine.Dr Santhouse reflects on his years at medical school and his utter bewilderment at the question 'is medicine an art or a science?', believing then that it could be nothing but a science. His striking memoir, however, is a powerful argument for medicine as both. To look beyond the obvious, to understand each patient in their own messy realities, in tears, pain and joy, is a privilege of medicine that the author so perfectly enunciates.This book recaptures an often neglected understanding of the person as a whole, while being rooted firmly in a contemporary understanding of integrated psychological medicine. It is accessible to the non-clinical (or clinical novice) reader, but for more experienced or even expert readers it offers a richer understanding of the mind-body interface and an invitation to step back and take a fresh look at medicine.