Laypeople roles at road traffic crash scenes: a systematic review

Prehospital Emergency Care: A Cross-Sectional Survey of First-Aid Preparedness Among Layperson First Responders in Northern Uganda

Background

Uganda has a high incidence of road traffic accidents and high mortality rates, yet lacks a mature prehospital emergency care system. Our study addresses this gap by assessing the experiences, training, and confidence in providing first aid (FA) among diverse layperson first responders in Northern Uganda, expanding beyond previous research, which was limited to Central Uganda and specific occupational groups.

Methods

We conducted a cross-sectional survey among layperson first responders of various occupations in Gulu City, Acholi sub-region, Uganda. Data on socio-demographics, training, experiences, knowledge, and confidence in FA were collected.

Results

We included 396 participants, of whom 81.6% (n=323) were male, 47.0.6% (n=186) were aged 21-30 years, 59.3% (n=235) had obtained a secondary level of education, 23.7% (n=94) were commercial motorcyclists, and 45.7% (n=181) had work experience of >5 years. The majority (85.4%, n=338) had witnessed acute illness/trauma. Accidents/bleeding were the most commonly witnessed cases (68.6%, n=232), followed by burn injuries (10.1%, n=34). Most participants (52.3%, n=207) had attended FA training. Only 20.5% (n=81) had obtained an above-average score (≥70%). The majority (67.9%, n=269) were confident in providing FA. Lack of knowledge and skills (61.4%, n=78), fear of taking health risks (18.9%, n=24), and legal implications (7.1%, n=9) were the major reasons for not being willing to confidently give FA. Factors associated with above-average knowledge were tertiary education and being confident in providing FA, while training in FA and prior experience in giving FA were associated with confidence in giving FA.

Conclusion

In this study, laypeople in Northern Uganda exhibited a high level of FA training. However, low confidence in providing FA is attributed to inadequate knowledge, fear of health risks, and legal concerns. Therefore, future efforts should focus on assessing FA practices in diverse regions and promoting formal FA training.

Fears and Concerns of Bystanders to Help People Injured in Traffic Accidents: A Qualitative Descriptive Study

In most traffic accidents, bystanders arrive at the scene before the rescuers. If they provide the right help, they can play an important and effective role in reducing the number of deaths and complications caused by these accidents. However, in many cases, fears and concerns prevent bystanders from providing assistance. This study aims to investigate and understand the fears and concerns of bystanders when they decide to help in traffic accidents. In 2022, this study was carried out in Iran using a qualitative content analysis approach. The data was collected through semistructured interviews. Participants were 15 males and females who had experience providing assistance in traffic accidents. Interviews, after digital recording, were transcribed verbatim. A purposeful and theoretical sampling method was performed. Data analysis and the determination of codes, categories, and subcategories were done using qualitative analysis software. O'Brien's qualitative research reporting standard was used. The results of the study include a category of fears and concerns and five subcategories. The subcategories include fear and concern caused by lack of information, fear of legal troubles, stress caused by previous experience, fear and anxiety caused by anticipation, and anxiety of unknown origin. The results of this study showed that some of the fears and concerns of the bystanders were related to a lack of information about providing assistance. By increasing bystanders' information about assistance, such as first aid training, fear and anxiety caused by a lack of information can be reduced. Another part of the fear and concern of bystanders is due to legal issues. Passing and implementing laws that protect bystanders can help reduce this fear and concern. Bystanders should be trained to provide assistance according to the rules of assistance so that they do not get into legal problems. A part of the bystander's fear and concern stems from their previous experiences providing assistance in traffic accidents. These experiences can also affect the fear and anxiety caused by anticipation. It is necessary to conduct more studies on the role of bystanders' experiences in creating fear and anxiety in them, as well as their effect on anticipatory fear.

Effectiveness of first-aid education in road traffic crashes on non-healthcare professionals' knowledge, attitude, and skills: a systematic review

This review aimed to evaluate and synthesize information on the effects of first-aid education in road traffic crashes on knowledge, attitudes, and skills among non-healthcare professionals. A qualitative study was designed according to the Prepared Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards to evaluate three outcomes, knowledge, skills, and attitude. The search strategy was performed in five databases (Science Direct, Scopus, CINAHL Plus, PubMed, and Google Scholar) to retrieve primary studies published between January 2011 and December 2021. In addition, the full texts of randomized controlled trials conducted on adults were included. Among the 2,399 articles retrieved from the databases, 2,388 were discarded, and only five studies met the inclusion criteria and were used in the final analysis and synthesis. Three of the five studies suggested that knowledge and skills are crucial in differentiating outcome factors between intervention and control groups regarding the effectiveness of first aid education. However, two studies on attitude and behaviour toward first-aid found no discernible change between the intervention and the control group. Therefore, our review revealed that only a well-structured first aid education is crucial to leverage the knowledge and skills of non-healthcare professionals before first aid provision, not attitude or behaviours.

Understanding people's experiences of extrication while being trapped in motor vehicles: a qualitative interview study

OBJECTIVE

To explore patient's experience of entrapment and subsequent extrication following a motor vehicle collision and identify their priorities in optimising this experience.

DESIGN

Semistructured interviews exploring the experience of entrapment and extrication conducted at least 6 weeks following the event. Thematic analysis of interviews.

SETTING

Single air ambulance and spinal cord injury charity in the UK.

PARTICIPANTS

10 patients were recruited and consented; six air ambulance patients and two spinal cord injury charity patients attended the interview. 2 air ambulance patients declined to participate following consent due to the perceived potential for psychological sequelae.

RESULTS

The main theme across all participants was that of the importance of communication; successful communication to the trapped patient resulted in a sense of well-being and where communication failures occurred this led to distress. The data generated three key subthemes: 'on-scene communication', 'physical needs' and 'emotional needs'. Specific practices were identified that were of use to patients during entrapment and extrication.

CONCLUSIONS

Extrication experience was improved by positive communication, companionship, explanations and planned postincident follow-up. Extrication experience was negatively affected by failures in communication, loss of autonomy, unmanaged pain, delayed communication with remote family and onlooker use of social media. Recommendations which will support a positive patient-centred extrication experience are the presence of an 'extrication buddy', the use of clear and accessible language, appropriate reassurance in relation to co-occupants, a supportive approach to communication with family and friends, the minimisation of onlooker photo/videography and the provision of planned (non-clinical) follow-up.

Is safety in the eye of the beholder? Discrepancies between self-reported and proxied data on road safety behaviors—A systematic review

Recent studies have problematized on the lack of agreement between self-reported and proxied data in the field of road safety-related behaviors. Overall, and although these studies are still scarce, most of them suggest that the way we perceive our own road behavior is systematically different from the perspective from which we perceive others' behavior, and vice versa. The aim of this review paper was to target the number and type of studies that have researched the behavioral perceptions of different groups of road users, contrasting self-reported behavioral data with those reported by other users (proxied), and their outcomes. This systematic review followed the PRISMA methodology, which allows for the identification of relevant articles based on the research term. A total number of 222 indexed articles were filtered, and a final selection of 19 articles directly addressing the issue was obtained. Search strategies were developed and conducted in MEDLINE, WOS, Scopus and APA databases. It is remarkable how road users perceive themselves as behaviorally “safer” than the rest of road users in what concerns the knowledge of traffic norms and their on-road performance. In addition, and regardless of the type of user used as a source, self-reported data suggest their perceived likelihood to suffer a traffic crash is lesser if compared to any other user. On the other hand, proxied reports tend to undervalue third users' performance, and to perceive riskier behaviors and crash-related risks among them. The outputs of this systematic review support the idea that the perception of road users' behavior and its related risks substantially differ according to the source. It is also necessary to increase the number, coverage and rigor of studies on this matter, perhaps through complementary and mixed measures, in order to properly understand and face the bias on road users' risk-related behaviors.

Environmentally friendly, but behaviorally complex? A systematic review of e-scooter riders' psychosocial risk features

Introduction

E-scooters have made a place for themselves on urban roads as an affordable, easy-to-use and environmentally friendly method of transportation. However, and partly because of their road behaviors and safety outcomes, e-scooter users have started to represent a focus of attention for transport planners and policymakers.

Aim

The present systematic review aims to target and analyze the existing studies investigating the psychosocial characteristics of e-scooter riders, focusing on their behavioral and risk-related features.

Methods

For this systematic review, the PRISMA methodology was used, which allows for the selection of suitable papers based on the study topic, in accordance with a set of pre-defined criteria and a search algorithm. A total of 417 indexed articles were filtered, resulting in only 32 eligible original articles directly addressing the issue. WOS, Scopus, NCBI, Google Scholar, and APA databases were used to create and test search techniques.

Results

At the literature level, most of the existing studies are distributed in a few regions of the globe. At the user’s level, results show how e-scooters are most commonly used by young, highly educated, urban-dwelling males, usually for short trips. In regard to road behavior, individuals with the lowest degrees of risk perception remain more prone to engaging in risky road behaviors likely to increase their crash involvement. This might be worsened by the lack of normative e-scooter regulations (and their enforcement) in many countries, plus the marked absence of road training processes. As common limitations, it can be mentioned that 87.5% of these studies used self-report methods, while 59.4% had local coverage.

Conclusions

The findings of this systematic review endorse the growing need to develop and enforce traffic laws and training processes for e-scooter users. In addition, road safety education and training programs are highlighted by existing studies as potentially pertinent alternatives to increase risk perception, and reduce risky behaviors, road conflicts and crash likelihood among e-scooter riders.

Perception of Law Enforcement Officers on Preventing Road Traffic Injury in Vanuatu: A Qualitative Study

Background: Road Traffic Injuries (RTIs) cause approximately 1. 35 million deaths annually, and is the leading cause of death among people between ages 5 and 29. Law Enforcement Officers (LEOs) deal with Road Traffic Collisions (RTCs) and have contact with RTI victims at a daily basis, they possess an excellent perspective on preventing RTI. This study aimed to explore LEOs perceptions on risk factors and preventive measures of RTI in Vanuatu. Methods: This study employed qualitative methods that used Focus Group Discussions (FGDs) to gather data from 25 LEOs between October 14th and November 30th, 2020. Self-identified Ni-Vanuatu LEOs who have been serving for over 6 months and residing at the study setting were included in this study. Purposive sampling was used to recruit study participants from three municipalities in Vanuatu. A semi-structured open ended questionnaire was designed to guide the FGDs. Data obtained were sorted out using thematic analysis processed with some preconceived themes based on theory, and also allowing the data to determine new themes. Results: Data saturation was reached from conducting 5 FGDs with 25 LEOs who were traffic officers and municipal wardens. Five main themes and sixteen subthemes were generated from the study. The main themes include driving and alcohol, the challenges to effective enforcement, barriers to effective care and support for RTI victims, measures for road traffic control and promoting road traffic safety. The respondents perceived that addressing resources issues and the legislations on road traffic control act and vehicle regulation act will enhance prevention of RTI. Conclusion: This study explored the risk factors of RTI and the barriers to effectively prevent RTI in Vanuatu. The study also generated suggestions of a combination of road traffic control measures that could be implemented to prevent RTI. Future research should look at effective strategies of preventing RTIs in resource deficit settings.

A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services

Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.

Comparison of pre-hospital emergency services time intervals in patients with heart attack in Arak, Iran

Background:

After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables.

Methods:

This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13.

Results:

The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April.

Conclusions:

The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

BACKGROUND

Africa accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa.

METHODS

A scoping review of published studies and grey literature was conducted. The search strategy utilized electronic databases comprising of Medline, Google Scholar, Pub-Med, Hinari and Cochrane Library. Screening and extraction of eligible studies was done independently and in duplicate.

RESULTS

A total of 782 study titles and or abstracts were screened. Of these, 32 underwent full text review. Out of the 32, 17 met the inclusion criteria for final review. The majority of studies were literature reviews (24%) and retrospective studies (23%). Retrospective and qualitative studies comprised 6% of the included studies, systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%), systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%). Reported post-trauma mortality ranged from 13% in Ghana to 40% in Nigeria. Reported preventable mortality is as high as 70% in South Africa, 60% in Ghana and 40% in Nigeria. Transport mode is the most studied health system factor (reported in 76% of the papers). Only two studies (12%) included access to pre-hospital care interventions aspects, nine studies (53%) included care providers aspects and three studies (18%) included aspects of referral pathways. The types of transport mode and referral pathway are the only factors significantly associated with post-trauma mortality, though the findings were mixed. None of the included studies reported significant associations between pre-hospital care interventions, care providers and post-trauma mortality.

DISCUSSION

Although research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.

Emotional Interaction in Road Traffic Injury: A Qualitative Study On People With Spinal Cord Injury

The injury management in the acute phase of spinal cord injury starts at the accident scene and focuses on preventing and reducing secondary damages. The road traffic injured patients are mostly transferred by relatives, untrained laypeople, and the drivers of heavy vehicles. The current study explored the experience of people with spinal cord injury in the accident scene. This was a qualitative content analysis study using the semi-structured interviewing method with an interview guide for data collection. Purposive sampling method was performed within ten months until data saturation. We used the constant comparative approach recommended by Corbin and Strauss (2015). In total, 15 people with spinal cord injury and bystanders participated in this study. The central theme extracted in this study was "emotional interaction" that referred to the emotional reactions in managing road traffic victims. Two main categories of "emotional intervention" with "emotional atmosphere," "desperation," "rescue efforts," subcategories and "scene shock" with "unplanned intervention," "emotional behavior," "emotional decisions," and "emotional involvement," subcategories were classified. The emotional atmosphere of the scene and stress level of the victim and the relatives, and the insistence of the victim to escape from the harsh condition have caused those lacking medical knowledge and expertise to transfer the patient unsafely. This resulted in secondary damages, like aggravated spinal cord injury or even caused the spinal cord injury.

Environmental Related Risk Factors to Road Traffic Accidents in Ilam, Iran

Introduction:

Road traffic injuries (RTIs) are the most serious health issue in the world and the main cause of death after the first year of birth. Environmental factors are among the most important and effective aspects of RTIs occurrences and their human consequences.

Aim:

This study aimed to identify the environmental factors associated with road traffic accidents (RTAs) in Ilam province.

Methods:

All crash data in Ilam province in 2012 were investigated. RTI’s data was collected using COM 114 form which included some human, environmental and vehicle related factors. Through Chi-Square test and logistic regression model, the association between environmental factors and RTIs was examined. For all statistical analyses we used the package Stata 13.1.

Results:

A total of 2314 traffic accidents were investigated. The highest 1659 (72.3%) and lowest 19 (0.83%) frequency of RTAs occurred during day and sunrise respectively. The majority of RTAs took place in July and September. The maximum number of RTAs was when the day was clear (91.7%) 2103 and the minimum when it was cloudy (3.5%) 81. A significant relationship was found between fatal RTAs and factors such as; the sort of the road, the hindered visibility, the location of the accident, the accidents’ place, the climate, and lighting of the day (P<0.05). The adjusted chance of traffic accidents causing death or injuries in main streets was 9.7 times more than in highways; in sidetracks it was 3.54 times more. And when it was cloudy, the chance was 2.60 times more than when was clear (P<0.05).

Conclusion:

Regarding the standards of road construction, development of the roads, and educating drivers how to adjust their driving behavior to the environment and road conditions could have a great role in decreasing RTAs causing death or injury.

Traffic police officers' experience of post-crash care to road traffic injury victims: a qualitative study in Tanzania"

BACKGROUND

Recently, road traffic injuries (RTIs) have become a major health problem affecting health systems in many low- and middle-income countries. Regardless of whether an ambulance is available for evacuation, police officers have been shown to arrive at the crash scene first, becoming, in effect, the first responders to RTI victims. Therefore, the study aimed to explore the experiences of traffic police officers in regard to the provision of care to RTI victims in the prehospital environment, including the role of traffic police upon arriving at the crash scene, the challenges they face, and their opinions about how to improve care to RTI victims.

METHOD

The study used a qualitative approach in which data were obtained from 10 individual interviews and three focus group discussions. There were 41 participants, 27 of them were male and 14 were female. About half (48.7%) of the study participants were aged between 30 to 39 years. Qualitative content analysis was used to analyse all the materials.

RESULTS

Three themes emerged from the analysis. The theme "Maintain safety while saving injured victims' lives and facilitating access to a health facility" was comprised of safety, sorting, initial help, and assisting access to hospital care. "Overwhelmed working with limited resources and support" included limited care and transport resources, police fatigue, and little or no support. "Improving supportive system and empowering frontline personnel" included the need for an emergency care system, availability of resources and an emergency medical support system, and training for police and drivers regarding victims' first-aid care, and road safety.

CONCLUSION

The study findings characterize an environment in which the police first responders have no knowledge or skills and no equipment and supplies to provide care to RTI victims at the scene before rushing them to definitive care. The results suggest a favorable climate for training and equipping officers so that they can deliver competent postcrash care at the scene while emergency medical services are yet to be established. However, more research will be needed to determine the efficacy of such training and its acceptability in the Tanzanian context.