Collectively Rewriting the Rules of Global Trauma Care in Colombia & beyond

The Social Innovation

Magnitude of the Problem, and its Root Causes

Traumatic injury is the leading cause of death in Colombia's economically active population between 15 and 45 years old. According to data from the Colombian Institute of Legal Medicine and Forensic Sciences, approximately 25,000 people die from trauma annually in Colombia- from violence, work related accidents, road accidents, and conflict. Studies from Meditech's own published research found that up to 20% of trauma deaths are "preventable", meaning they result from failures in the management process, not from the severity of the injury itself.

Globally, 90% of TBI cases and traumatic spinal cord injuries occur in LMICs, which simultaneously bear the greatest burden of trauma and have the least access to neurosurgical care. Some of these regions has associated mortality of 50% to 70% In these types of injuries.  

During Meditech's participation in the Globalizer, co-created by Philips Foundation and Ashoka in 2018, the team highlighted key factors that contribute to the magnitude of the problem:

• Siloed care pathways: Emergency professionals, surgeons, and ICU teams operated by separate guidelines, developed independently, with no connection between phases of the patient's journey.
• Guidelines built for wealthy contexts: International protocols from entities like the Brain Trauma Foundation and other bodies were developed in high-income settings and were simply not implementable in rural or low-resource environments.
• Fragmentation among medical associations: In every country, specialty associations — neurosurgeons, emergency physicians, critical care teams — developed their own protocols in isolation, even when their patients overlapped completely.
• Absence of local science: Research and guideline development from LMICs was systematically undervalued by the global medical community, creating a self-reinforcing exclusion.

Based on their systems analysis, Meditech made it a mission to create a shared vision among the actors in the trauma care systems and drive systems change, redesigning how emergency trauma care guidelines are built from the ground up, with and for the people who deliver care in low-resource settings, and scaling this new methodology across Latin America and globally.

"The most important thing was to have the systemic thinking. Globalizer emphasized systemic thinking and how to collaborate with the different actors. In healthcare, this is very well understood at a directional level in major hospitals — but now we are applying it at the specific pathway-of-care level for specific diseases. That's part of what we learned during the process."   

Strategy to Catalyze a Network of Changemakers towards the Targeted Mission

The field building strategy centres on a multi-stakeholder co-creation process to strengthen the emergency care field in different contexts: bringing together medical associations, emergency professionals, surgeons, community-level health workers, and government-linked actors to collectively build guidelines that reflect local infrastructure.

1) Co-Creating the Resource-Stratified Protocols Model with a Changemaker Network (Breaking the Silos)

The cornerstone of Meditech's approach is a structured consensus-building exercise that brings together, for the first time, professionals from all phases of the trauma care pathway including prehospital responders, emergency department staff, surgeons, and ICU teams, into a single room to build shared protocols.

"In the past, people of surgery didn't know what the guidelines for emergency care recommend, and people of prehospital care didn't know what the guidelines for critical care said. Now, because it's a whole pathway, everyone knows what everybody does in their own area and they participate in the development of everybody’s protocols."

This is a deliberate inversion of the dominant practice. Global guideline exercises typically invite only those working in the most advanced environments. Meditech intentionally invites those working in the least resourced environments, from the Amazonian region, the Caribbean coast, the border areas with Ecuador, and treats their knowledge as foundational, not supplementary.

The output is a tiered guideline that asks: "What trauma system resources are available at this phase?"

The full Colombia brain injury protocol, published as BOOTStraP in the Journal of Neurosciences in Rural Practice (2020), was developed in collaboration with key partners including the Colombian Association of Neurosurgery (ACNCx), the Colombian Association of Emergency Medicine Specialists (ACEM), the Colombian Association of Intensive Medicine and Critical Care (AMCI), the Colombian Association of Prehospital Care University Programs (ASUNAPH), and the Latin American Federation of Neurosurgical Societies (FLANC). International research support came from the Global Health Research Group for Neurotrauma (GHRG-Neurotrauma) of the National Institute of Health Research (NIHR), United Kingdom.

It has been cited internationally as a landmark in resource-stratified clinical guidance and recognised by several international entities like the World Federation of Neurosurgical Societies (WFNS), the American College of Surgeons Committee on Trauma (ACS-COT) and the Coalition for National Trauma Research of North America (CNTR) as a model for equitable guideline development.

A 2014 study published in the Academic journal “Injury” by Meditech´s scientists (Kesinger et al.) already demonstrated a 20% decrease in in-hospital mortality of severe TBI patients following an early-stage protocol implementation at a teaching hospital in Colombia- proof that the methodology saves lives. The BOOTStraP exercise in Colombia brought together 5 medical associations across 8 specialties.

Once proven in Colombia, this process has become a replicable, adaptable model, now being exported across Latin America and into Asia and Africa.

As of 2026, the BOOTStraP methodology has expanded beyond traumatic brain injury to cover spinal trauma and spinal cord injury (BOOTStraP-SCI), developed through the same multi-stakeholder consensus process with healthcare providers across LMICs and high-income countries alike. The spinal injury project involves for first time international participants across prehospital care, emergency medicine, intensive care and neurosurgery from countries like Spain, Scotland, Unites States, Guatemala, Colombia, Portugal, Nigeria, Italy, Brazil and Bolivia.  

2) Co-creating a Research Collaboration Network for Building Scientific Credibility and Overcoming the LMIC Bias on their Changemaker Network Methodology

One of the most significant and unexpected obstacles Meditech faced in scaling its methodology was not logistical, but ideological. When Andrés and his team began presenting BOOTStraP as a model for global adoption, they encountered a structural bias embedded in how the global scientific community receives knowledge- guidelines and protocols developed in high-income countries are accepted as default standards, while science generated from LMICs is met with skepticism.

"When you generate science from LMICs it is not well received. When you develop guidelines from high-income settings, they are more easily accepted worldwide. But when we said this started in Colombia, Latin America, they started generating a lot of possible explanations of why it didn't work, because it was created in an environment that does not have a lot of resources."

Meditech's response was to double down on scientific rigour, pursuing peer-reviewed publication in leading journals, building partnerships with globally recognised research centres, and letting adoption speak louder than origin. The publication record reflects this deliberate strategy:

• Journal of Neurosciences in Rural Practice (2020)- included the "Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury", the foundational BOOTStraP position paper and has since accumulated 84 citations with a Field Citation Ratio of 17, placing it significantly above the average for its field. The paper immediately drew editorial responses from leading neurosurgical institutions across Asia like the All India Institute of Medical Sciences (AIIMS), National Institute of Mental Health and Neurosciences (NIMHANS India), Northwest General Hospital (Pakistan) and MGM Medical College (India). Each independently recognized the BOOTStraP framework as a model for their own LMIC contexts.  
• Trauma Surgery & Acute Care Open Journal by the British Medical Journal Group (2024)- included a piece Rubiano co-authored alongside Johns Hopkins, University of Maryland, and University of Washington, proposing 11 recommendations for equitable global trauma guideline development. Meditech's methodology is now being proposed as the new standard.
• By 2025, The Brain and Spine Journal, and World Neurosurgery Journal- two of the field's most internationally recognized journals from scientific associations like the European Association of Neurosurgical Societies and the World Federation of Neurosurgical Societies, included the methodology, which had been expanded to cover spinal trauma and spinal cord injury. The research collaboration network built around these publication records includes 26 institutional partners from 3 continents.

The turning point in credibility, however, came not from endorsement from above, but from adoption on the ground. "When they (the high-income countries) start using it, they realise the importance of that, and they accept it."

Perhaps the clearest signal of this shift: a coalition of North American trauma care practitioners began following Meditech's process, and funded Andrés' travel to their region to learn from him. The methodology developed in Colombia, for Colombia, was now being imported by the very ecosystem that had initially questioned it.

As of 2026,

• For first time in their history, the Brain Trauma Foundation from North America, considered the Top Global entity on the development of Evidence Based Guidelines in Traumatic Brain Injury, has considered to include a “resource-based stratification” for their 5th edition of international guideline development based on Meditech´s BootStrap approach.
• Colombia has been selected to be the host of the International Neuro-Trauma Society Congress, the most important global academic meeting in this field, and where Rubiano will be elected society president for the 2026-2028 period.  For first time in history, this meeting will be hosted out of North America, Australasia and Europe and where Meditech´s BootStrap project will be highlighted as one of the promising interventions for decreasing mortality and decreasing disability associated to traumatic brain and spinal cord injuries at a global level.  

This tactic holds a broader lesson for social innovators working from the Global South- scientific credibility is not granted. It is built through rigorous documentation, strategic partnerships, and the patience to let results speak louder than origin.

3) Collaborating with Peers in the Trauma Care Systems around the world to Involve Stakeholders to Co-create Protocols using their Changemaker Network Methodology

Having validated the methodology in Colombia, Meditech began replicating the exercise in other Latin American countries- not by importing the Colombian protocols, but by facilitating the same co-creation process locally, respecting each country's own regulatory framework and care infrastructure.

"When we developed the exercise in Colombia, emergency care services are divided in three categories. When we did it in Peru, they are divided in five categories. So, they developed their own protocols based on their own system — but using a template we generated in our early exercises."

Exercises have been completed in Ecuador, Peru, Paraguay, and Brazil, with Argentina and Bolivia planned for 2026, and exercises in India, Indonesia, and the Philippines in active planning. A critical feature of this replication is the identification of local champions- medical associations already recognised and trusted within their country's health system, some of which have direct connections to government.

"We identify the same type of associations in each country, and regularly one or two of those are very attached at government level. So, it's the process to take the final document to that level moving from academics to public health policy."

For the first time in many of these countries, specialty associations that had previously worked as isolated silos were brought together around a single process, because the patient's pathway does not respect the jurisdictional boundaries of medical societies. 

As of 2026, Meditech has engaged 200 professionals across 27 organizations in 15 countries in the methodology, producing 5 national-level and 2 international-level consensus protocol documents.

4) Leveraging AI to Accelerate Evidence Synthesis to Inform and Influence their Exercises

A persistent bottleneck in guideline development has been the systematic review of existing literature- combing through global research to establish the evidence base before a consensus exercise can begin. For Meditech, this process previously took approximately six months per exercise.

With the integration of AI tools into their workflow, Meditech has reduced this phase to approximately one week- a dramatic compression that makes more frequent, more country-specific exercises financially and logistically viable.

This acceleration is not just an efficiency gain; it is a scaling enabler. With exercises planned across India, Indonesia, and the Philippines for 2026, the ability to rapidly synthesize country-specific literature is now foundational to their strategy.  

5) Influencing and Involving Allies working on Other Healthcare Conditions by Opening their Methodology  

Perhaps the most significant signal of the strategy's maturity is this- what began as a trauma-specific methodology is now being requested for stroke, cardiovascular disease, and acute general surgery conditions (including appendicitis) across multiple countries.

"The ecosystem has opened doors for using the same strategies in other topics. We are in conversations with different actors interested in using the same methodology for other healthcare conditions — stroke, cardiovascular diseases, general surgery."

This is the hallmark of a methodology that has achieved legitimacy and transferability beyond its original domain. Meditech is no longer solely a trauma care organisation. Iit is increasingly becoming the steward of a new field: community- and resource-responsive clinical guideline development for LMICs. Five organisations have approached Meditech in this year to apply the methodology to at least 5 new health conditions.