Maleficent is a character from the television series "Once Upon a Time" and she is also known as the Witch of the West. She is a powerful sorceress with a dark past and her story has been explored in both the show and the famous Disney movie "Sleeping Beauty." Maleficent is characterized as a complex and misunderstood villain, which adds depth to her character. Her transformation from a fairy with good intentions to a vengeful witch is a key element of her story. In "Once Upon a Time," Maleficent is portrayed as a powerful and feared character. She is one of the original villains from the Enchanted Forest and is known for her association with dragons.
Unlike the early studies done on the significance of the “golden hour,” this study in Germany showed no correlation between increased prehospital transport times and patient mortality. The study even goes as far as to suggest other factors such as on scene stabilization that may be just as important or even more important than the actual transport time. It is suggested that taking extra scene time to stabilize a patient could be more beneficial than simply prioritizing fast transport.
Even with further blood loss halted, the patient may decompensate before arrival at the hospital increasing patient mortality if transport is delayed Pollak et al. In recognition of the contributions of health workers to the COVID-19 response, 2021 has been declared by the World Health Organization, as the Year of the Health and Care Worker.
She is one of the original villains from the Enchanted Forest and is known for her association with dragons. Maleficent is shown to have a strong connection to nature and possesses the ability to transform into a dragon herself. Her path to villainy is revealed through flashbacks, which showcase her tragic past.
The Golden Hour: The Critical Time Between Life and Death
In the early 1980s, R. Adam Cowley, a U.S. military surgeon popularized the term "golden hour," words often used in trauma and emergency medicine settings. The term's origins lie in photography and reference the first hour of light after the sun rises and the last hour of light before sunset. That concept of a critical window of perfect sunlight was co-opted by emergency medical providers to refer to the crucial period of time immediately after an injury when appropriate life-saving medical or surgical intervention can offer the highest chance of survival for a traumatically injured patient.
There is a crucial period immediately after an injury when life-saving medical or surgical intervention can offer the highest chance of survival
Although there is little scientific basis for this traditional one-hour rule, as many trauma care providers note, trauma care is time-dependent and a prompt response can be a matter of life and death. The "golden hour" is now more scientifically referred to as the "resuscitative hour."
In much of the world, road traffic accident victims and others suffering life-threatening injuries are not able to receive essential surgical care—including trauma, surgery, and anesthesia care—within an hour, or even many hours, following an accident. The window of opportunity for a chance at survival is narrow for a severely injured patient. Road traffic and other injuries kill more people every year than HIV-AIDS, tuberculosis, and malaria combined. Though injury-related deaths occur everywhere, the overwhelming majority happen in low- and middle-income countries (LMICs), where emergency communication systems and health care are often limited. Specialized and timely trauma care in LMICs is critical, though, to reducing permanent, long-term disability and deaths.
COVID-19 Lockdowns and Traffic Accidents
During the COVID pandemic, the world initially witnessed a dip in the volume of injuries presenting to emergency departments—a phenomenon linked to restricted travel. A global review indicated that there was a worldwide reduction of between 20.3 percent and 84.6 percent in trauma patients [treated in health-care facilities] compared to a pre-COVID control period. The reduction in traumatic injuries did not, however, translate to reductions in the severity and kinds of injuries seen. In turn, the need for both acute trauma care and for longer term rehabilitation services did not decrease, and it has remained critical throughout the COVID-19 pandemic.
Parents hold a photo of their son, who lost his life in a car accident, at their home in Sulaimaniya, Iraq, on December 18, 2018. REUTERS/Ako Rasheed
Although the overall trauma case volume—especially due to road traffic accidents—decreased during lockdowns, injuries due to road traffic accidents may, in some instances, have been of higher severity. In the United States, the pandemic significantly reduced traffic volume, but the rate of traffic fatalities per miles driven jumped by 18 percent in 2020, according to the National Highway Traffic Safety Administration. Safety experts have blamed speeding on emptier roads for the increase in traffic fatalities. Japan reported a similar narrative.
In some LMICs, where the "informal economy" is critical to day-to-day survival for much of the population (those most at risk of traumatic injury), authorities had difficulty enforcing lockdowns effectively. India, for example, did not experience a decrease in the severity of road traffic accidents.
Unmet Need
Even before the pandemic, the delivery of timely, high-quality trauma care was often an unmet need in LMICs. Unlike health systems in high-income countries (HICs) that could, for the most part, continue to maintain functional emergency departments despite pressures of treating COVID-19 patients, and sometimes divert trauma cases to "COVID-free" hospitals, fragile health systems in LMICs often crumbled under the weight of the pandemic.
Middle-income countries, including Mexico and Costa Rica, have reported an ongoing shortage of hospital and intensive care unit (ICU) beds since the start of the pandemic. In Costa Rica, in May 2021, there was a 121 percent excess in occupancy of ICU beds due to COVID-19 patients, leaving critically ill patient—including those suffering from traumatic, life-threatening injuries—without care. Two months later, Mexico faced a similar problem. According to the Mexican Institute of Social Security (IMSS) 52 percent of 7,017 existing beds with oxygen were occupied by COVID-19 patients. Both countries are among those with some of the highest burden of road traffic injuries.
The entrance to the intensive care unit, where patients suffering from COVID-19 are treated, at Hospital Juarez de Mexico, in Mexico City, Mexico, on October 29, 2020. REUTERS/Carlos Jasso
Global Impact of Road Traffic Accidents
Approximately 1.35 million people die each year as a result of road traffic accidents. Between 20 and 50 million additional victims suffer non-fatal injuries, and more than 93 percent of road traffic fatalities occur in LMICs. The health systems are now tasked with the challenges of prolonged delays in the delivery of trauma care, and consequently, higher trauma-related morbidity and mortality rates. The redistribution and task shifting of workforce and resources required to care for COVID cases is a heavy burden with a grave cost—preventable trauma deaths.
The reduction of trauma-related preventable deaths is a UN target. The UN Sustainable Development Goal 3.6 aims to halve all road-related deaths by 2030. Building safer roads and incentivizing safer driving, and creating access to definitive care, are critical to achieving this target.
One HalfThe UN Sustainable Development Goal 3.6 aims to halve all road-related deaths by 2030
Initiatives to reduce trauma-related injuries must target younger people. Among 5- to 29-year-olds, trauma-related injuries are the leading cause of death. As the recently released documentary Trauma Healers vividly shows, more than half of all road traffic deaths are among pedestrians, cyclists, and motorcyclists—not automobile drivers.
By investing in injury prevention and quality trauma care, countries can mitigate the significant negative economic impact of trauma injuries. An estimated 3 percent of gross domestic product globally is lost due to trauma, including an estimated 1 to 2 percent in HICs and up to 30 percent in LMICs. The rehabilitation of injured patients and their ability to return to work is critical to countries' economies. No country is immune. Countries that have effective trauma care systems, such as the U.K. and Australia, suffer less economic burden due to trauma.
Trauma systems must also be strengthened to avoid the consequential delays in delivering trauma care in the midst of required surge capacity, which COVID continues to make painstakingly clear. Our starting point must be to overcome the barriers to trauma care, including a lack of infrastructure to deliver safe, affordable, and timely care; health workforce shortages; lack of information and communication networks; and improvement of roads and other infrastructures that facilitate geographic access to care.
The site of a road accident during the Songkran festival in Bangkokm, Thailand, on April 13, 2013. REUTERS/Damir Sagolj
Reducing Preventable Deaths—a Call to Action
Reducing preventable deaths due to road traffic accidents and providing timely, safe trauma care requires a comprehensive approach that tackles both injury prevention and trauma care delivery. The world has made systematic progress, but there are still significant barriers.
Countries should develop, budget for, and implement national surgical system strengthening plans that are integrated into national health systems strengthening strategies. Strengthening the surgical and anesthesia care systems needed for trauma care can build a country's health system resilience and capacity to respond to pandemics and other health crises. Countries, including LMICs, and donor agencies need to uphold their global commitments to invest in the health sector in general—and in surgical systems in particular. In 2021, for example, the U.S. Congress mandated USAID to invest in strengthening surgical systems, and discussions are underway to attach a funding commitment to this language.
Governments, civil society, and the private sector need to work together to provide safer roads and quality trauma care
Until recently, there was no coordinated research or funding strategy to support the development of surgical care in LMICs such as that which exists with Global Alliance for Vaccines and Immunizations (GAVI) and the Global Fund for HIV, Malaria and Tuberculosis. In early 2020, the Global Surgery Foundation (the GSF), embedded within the UN system, was created as a common platform to pool resources, following the model of other multinational initiatives. The GSF is working to engage with the private sector and multilateral agencies and national governments.
In recognition of the contributions of health workers to the COVID-19 response, 2021 has been declared by the World Health Organization, as the Year of the Health and Care Worker. Even prior to the COVID-19 pandemic, many countries faced pre-existing health workforce challenges, including shortages estimated at 18 million globally, mostly in LMICs, and maldistribution and misalignment of needs and skills. The pandemic has further affected the availability and capacity of health workers to preserve continuity of essential services, including trauma care. More highly skilled health workers are urgently needed, especially in poorer countries, to offer emergency medicine and other trauma-related care, as well as COVID-19 care and other primary health care services.
Civil society organizations and other stakeholders need to continue to support investments in preventing injuries, including road traffic accidents. Without attention to prevention—including safer roads and motor vehicles, along with incentivizing safer driving—national health systems and the world cannot meet the continuing growing need for timely, high-quality, and affordable trauma care. Coalitions such as the Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (The G4 Alliance) and the Global Alliance of NGOs for Road Safety play important roles in raising public awareness and advocating to policy makers for evidence-based policies and resources.
Governments, civil society, and the private sector need to work together to provide safer roads and quality trauma care. Reducing preventable disability and death due to road traffic accidents, and ensuring that emergency and longer-term trauma care and rehabilitation are available and affordable, requires a comprehensive approach that tackles both injury prevention and trauma care delivery capacity.
People observe a collapsed overpass in Mexico City, Mexico, on May 11, 2021. REUTERS/Carlos JassoLaura Hoemeke is a global health consultant and adjunct professor, University of North Carolina (UNC) Gillings School of Global Public Health.
Nigel Rossiter is a trauma consultant and orthopedic surgeon, and chair of the Primary Trauma Care Foundation, United Kingdom.
Sylvio Augustin is an attending general surgeon and adjunct secretary of the Haitian Surgical Association, Haiti.
Alejandra Cortés-Rodríguez is a doctor and a public health fellow at Anahuac Institute of Public Health, Costa Rica.
Michelle Joseph is a trauma and orthopedic surgeon and instructor at Harvard Medical School, United States.
- Trauma Care
- Traffic Crashes
- Emergency Reponses
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The “golden hour” is the term often used in trauma or emergency care to suggest that an injured or sick person must receive definitive treatment within the first 60 minutes from the time of injury or appearance of symptoms. It was believed that once this time has lapsed, the risk of death or long-term complications will significantly increase.
Maleficent was once a fairy with a kind heart, but after losing her child, she becomes consumed by revenge. This loss changes her perspective on the world and fuels her desire for power and darkness. Throughout the series, Maleficent's relationship with other characters is explored. She forms alliances with other villains, such as Regina, the Evil Queen, and Ursula, the Sea Witch, as they all share a common desire for revenge and power. However, Maleficent also displays moments of vulnerability and remorse, showing that there is more to her character than just being a wicked witch. Maleficent's redemption story is an important aspect of her character arc. In "Once Upon a Time," she is given the opportunity to redeem herself and find true happiness. This highlights the idea that even villains have the potential for change and growth. Overall, Maleficent is a fascinating character in "Once Upon a Time." Her transformation from a fairy to a vengeful witch, her complex relationships with other characters, and her journey towards redemption make her a captivating and multi-dimensional character in the show..
Reviews for "The Dark Side of Magic: The Maleficent Witch of the West's Storyline in Once Upon a Time"
1. John - 2 out of 5 stars
I was really disappointed with "Maleficent witch of the west once upon a time." The storyline was confusing and poorly developed. It lacked depth and failed to provide a clear understanding of the characters' motives. The pacing was also off, with several scenes feeling rushed or unnecessary. Additionally, the special effects were underwhelming, making the magical elements of the movie feel lackluster. Overall, I had high hopes for this film, but it fell flat and left me feeling unsatisfied.
2. Sarah - 1 out of 5 stars
I regret spending money on "Maleficent witch of the west once upon a time." The acting was subpar and lacked passion. The dialogue seemed forced and unnatural, making it hard to connect with any of the characters. The plot was predictable and unoriginal, offering nothing new to the fantasy genre. The movie also dragged on for what seemed like an eternity, leaving me bored and uninterested. I had hoped for a captivating and exciting experience, but unfortunately, this film delivered none of that.
3. Mark - 2 out of 5 stars
"Maleficent witch of the west once upon a time" failed to live up to its expectations. The storytelling felt disjointed and convoluted, making it difficult to follow the plot. The pace was too slow, and the movie lacked suspense or any sense of urgency. The CGI was decent, but it couldn't save the film from its flat characters and bland script. I had hoped for a thrilling and imaginative fantasy film, but this wasn't it. I wouldn't recommend it to anyone seeking an engaging cinematic experience.