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Omondi MP, Mwangi JC, Sitati FC, Onga’ngo H. Patterns of facility and patient related factors to the orthopedic and trauma admissions at the Kenyatta National Hospital: A qualitative assessment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002323. [PMID: 38271345 PMCID: PMC10810445 DOI: 10.1371/journal.pgph.0002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024]
Abstract
Inappropriate utilization of higher-level health facilities and ineffective management of the referral processes in resource-limited settings is increasingly becoming a concern in health care management in developing countries. This is characterized by self-referrals and frequent bypassing of nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. This situation compromises the ability and capacity of Kenyatta National Hospital (KNH) to function as a tertiary referral health facility as envisioned by Kenya Health Sector Referral Implementation Guidelines of 2014, Kenya 201 constitution and KNH legal statue of 1987. The study objective was to assess the patterns of facility and patient related factors to the orthopaedic and trauma admissions at the KNH. This was a descriptive qualitative study design. The study was conducted amongst the orthopaedic and trauma admission caseload for 2021. Data collection was done through a) data abstraction from 905 patients charts admitted during February to December 2021 and b) 10 (ten) semi-structured interviews with 10 major health facilities that refer to KNH to understand the reasons for referral to KNH. Quantitative data was analysed using Statistical Package for Social Science version 21.0 to calculate the frequency distribution. Qualitative data from the data abstraction and transcripts from the KIIs were analysed using NVivo version 12. The major facility and patient related factors to the orthopaedic and trauma admissions at KNH were inadequate human resource capacity and availability (42.7%), financial constraints (23.3%), inadequate Orthopaedic equipment's and implants availability (20.0%) and inadequate health facility infrastructure (6.3%) while the major patient related factor was patient's preference (23.4%). In conclusion, to decongest KNH requires that the lower-level health facilities need to be better equipped and resourced to handle essential orthopaedic and trauma care.
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Affiliation(s)
- Maxwell Philip Omondi
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Joseph Chege Mwangi
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Fred Chuma Sitati
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Herbert Onga’ngo
- Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya
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Koranda NW, Knettel BA, Mabula P, Joshi R, Kisigo G, Klein C, Bunting A, Lauritsen M, O'Tool J, Dunlop SJ. Evaluating the impact of a training program in prehospital trauma care and mental health for traffic police in Arusha, Tanzania. Int Emerg Nurs 2023; 70:101346. [PMID: 37708788 DOI: 10.1016/j.ienj.2023.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Tanzania does not have a formalized prehospital Emergency Medical Services (EMS) response. As a result, traffic police play an integral role in the emergency response system. This study examines the potential impact of a brief training program in prehospital trauma care and mental health to improve knowledge, self-efficacy, and practice intentions related to trauma care among police officers. METHOD A cohort of 45 police officers were enrolled to participate in the training and accompanying evaluation. The training was 12 h long, held over 3 days, and included education on how to manage traumatic injuries in a prehospital environment. The course included classroom instruction, hands on skills practice, and a training simulation. Officers received instruction on conducting a primary survey, managing common airway, spinal cord, and bleeding emergencies, as well as coping strategies for their own mental health. Before and after the course, a 26-item assessment was administered to measure knowledge, self-efficacy, and practice intentions specific to the training. The study used paired-samples t-tests to compare scores in each of the three domains before and after the training. RESULTS Participants demonstrated significantly improved knowledge (M = 0.30, SD = 0.27; t(34) = 6.67, p <.001), greater self-efficacy (M = 0.44, SD = 0.53; t(34) = 4.97, p <.001), and more evidence-informed practice intentions (M = 0.12, SD = 0.28; t(34) = 2.55, p <.05) at the conclusion of the course. CONCLUSION Police officers who received the 12-hour training focused on trauma management were better prepared to respond to emergencies and demonstrated a greater understanding of prehospital trauma care. Further studies are required to assess real world impact of the training and to determine how to increase support for traffic police as emergency medical responders in low-resource settings.
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Affiliation(s)
- Nathan W Koranda
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States; PrairieCare, United States.
| | - Brandon A Knettel
- Duke University, School of Nursing, United States; Duke Global Health Institute, United States
| | - Peter Mabula
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States; Same Qualities Foundation, United Republic of Tanzania
| | - Rupa Joshi
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States
| | - Godfrey Kisigo
- The London School of Hygiene & Tropical Medicine, United Kingdom
| | - Christine Klein
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States; PrairieCare, United States
| | - Alec Bunting
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States; Hennepin Healthcare, United States
| | | | | | - Stephen J Dunlop
- Koranda O'Tool Paramedics Incorporated (KOPI Medical), United States; Hennepin Healthcare, United States
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Hosaka L, Tupetz A, Sakita FM, Shayo F, Staton C, Mmbaga BT, Joiner AP. A qualitative assessment of stakeholder perspectives on barriers and facilitators to emergency care delays in Northern Tanzania through the Three Delays. Afr J Emerg Med 2023; 13:191-198. [PMID: 37456586 PMCID: PMC10344688 DOI: 10.1016/j.afjem.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Emergency conditions cause a significant burden of death and disability, particularly in developing countries. Prehospital and Emergency Medical Services (EMS) are largely nonexistent throughout Tanzania and little is known about the community's barriers to accessing emergency care. The objective of this study was to better understand local community stakeholder perspectives on barriers, facilitators, and potential solutions surrounding emergency care in the Kilimanjaro region through the Three Delays Model framework. Methods A qualitative assessment of local stakeholders was conducted through semi-structured focus group discussions (FGDs) from February to June 2021 with five separate groups: hospital administrators, emergency hospital workers, police personnel, fire brigade personnel, and community health workers. FGDs were conducted in Kiswahili, audio recorded, and translated to English verbatim. Two research analysts separately coded the first two FGDs using both inductive and deductive thematic analysis. A final codebook was then created to analyze the remaining FGDs. Results A total of 24 participants were interviewed. Thematic analysis revealed that participants identified significant barriers within the Three Delays Model as well as identified an additional delay centered on community members and first aid provision. Perceived delays in the decision to seek care, the first delay, were financial constraints and the lack of community education on emergency conditions. Limited infrastructure and reduced transportation access were thought to contribute to the second delay. Potential barriers to receiving timely appropriate care, the third delay, included upfront payments required by hospitals and emergency department intake delays. Suggested solutions focused on increasing education and improving communication and infrastructure. Conclusion The findings outline barriers to accessing emergency care from a stakeholder perspective. These themes can support recommendations for further strengthening of the prehospital and emergency care system. Due to logistical constraints, emergency care workers interviewed were all from one hospital and patients were not included.
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Affiliation(s)
- Leah Hosaka
- University of Hawaii at Manoa School of Nursing, Honolulu, HI, United States
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Francis M. Sakita
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Frida Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Anjni Patel Joiner
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Durham, NC, United States
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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Mwenda V, Yellman MA, Oyugi E, Mwachaka P, Gathecha G, Gura Z. Piloting a hospital-based road traffic injury surveillance system in Nairobi County, Kenya, 2018-2019. Injury 2023; 54:S0020-1383(23)00182-1. [PMID: 36925372 PMCID: PMC10599333 DOI: 10.1016/j.injury.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/14/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Kenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. METHODS We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018-April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. RESULTS Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1-89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. CONCLUSION We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.
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Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya; Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya.
| | - Merissa A Yellman
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elvis Oyugi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | | | - Gladwell Gathecha
- Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
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Tzenetidis N, Kourlaba G, Triantafyllou C, Tzenetidis V, Koulouvaris P, Myrianthefs P. Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey. Work 2023:WOR220150. [PMID: 36683479 DOI: 10.3233/wor-220150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. OBJECTIVE Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. METHODS An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. RESULTS A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. CONCLUSION There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.
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Affiliation(s)
- Nikolaos Tzenetidis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kourlaba
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli Greece
| | - Christos Triantafyllou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Koulouvaris
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Liu C. Exploration of the police response time to motor-vehicle crashes in Pennsylvania, USA. JOURNAL OF SAFETY RESEARCH 2022; 80:243-253. [PMID: 35249604 DOI: 10.1016/j.jsr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION After roadway crashes occur, the quick emergency response is essential for minimizing tolls and economic losses. Many studies have analyzed the post-crash emergency medical services response time, but few ones have explored the post-crash police response time. However, the presence of police is the precondition for other agencies to perform their duties safely and smoothly. METHOD With Pennsylvania crash data from 2008 to 2017, this study gives an assessment of the post-crash police response time in Pennsylvania. RESULTS First, we demonstrate that police response time is highly correlated to crash consequences: the longer police response time is positively associated with more fatalities at both individual level and county level. Then, for fatal crashes, a negative binomial model with the police agency-level random effects is built to identify the significant factors influencing the police response time. The results indicate that day of week, illumination, weather, area, roadway type, and roadway location could significantly affect the police response time. Police respond much slower to fatal crashes occurring in rural areas, mid-blocks, turnpikes, adverse weather, on weekends, and at nighttime without streetlights. Police response time shows a decreasing trend since 2016 and varies a lot by police agencies. It is found that many police agencies affiliated to the Pennsylvania State Police, which oversees statewide law enforcement on all interstate and state highways, respond slower than other police agencies. Practical Applications: These findings are expected to provide some new insights for Pennsylvania police agencies to improve their response mechanisms to roadway crashes.
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Affiliation(s)
- Chenhui Liu
- College of Civil Engineering, Hunan University, Changsha, Hunan 410082 China.
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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Smith AM, Sawe HR, Matthay MA, Murray BL, Reynolds T, Kortz TB. Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania. Front Pediatr 2021; 9:764163. [PMID: 34917561 PMCID: PMC8669816 DOI: 10.3389/fped.2021.764163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited. Methods: A secondary analysis was performed on data from 1,803 patients (28 days-14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (>48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals. Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17-3.00). Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.
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Affiliation(s)
- Audrey Marilyn Smith
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Brittany Lee Murray
- Department of Pediatrics and Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Teresa Bleakly Kortz
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States.,Division of Critical Care, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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Police Transportation Following Vehicular Trauma and Risk of Mortality in a Resource-Limited Setting. World J Surg 2020; 45:662-667. [PMID: 33164113 DOI: 10.1007/s00268-020-05853-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In resource-limited settings, prehospital trauma care and transportation from the scene to a hospital is not well developed. Critically injured patients present to the hospital via privately owned vehicles (PV), public transportation, or the police. We aimed to determine the mortality following road traffic injury based on the mode of transportation to our trauma center. METHODS We performed a retrospective analysis of the Kamuzu Central Hospital (KCH) Trauma Registry from January 2011 to May 2018. Patients with road traffic injuries, presenting from the scene, were included. Those brought in dead or discharged from casualty were excluded. Bivariate analysis was performed over mortality. A Poisson multivariate regression determined the relative risk of mortality by prehospital transportation. RESULTS 2853 patients were included; 7.8% (n = 223) died. Patients were transported by PV (n = 1963, 68.8%), minibus (n = 497, 17.4%), and police (268, 9.4%). No patients were transported by ambulance. Patients transported by police (1 h, IQR 0-2) and PV (1 h, IQR 0-2), arrived earlier than those transported by minibus (2 h, IQR 0-27), p < 0.001. There was no difference in injury severity between the transportation cohorts. Compared to PV, patients transported by police (RR 1.56, 95% CI 1.13-2.17, p = 0.008) have an increased risk of mortality after controlling for injury severity. There was no difference in mortality in patients presenting by minibus (RR 0.83, 95% CI 0.55-1.24, p = 0.4). CONCLUSION Patients transported to KCH via police have a higher risk of mortality than those transported via private vehicle after controlling for injury severity. Training police in basic life support may be an initial target of intervention in reducing trauma mortality. Overall, the creation of a functional prehospital ambulance system with a cadre of paramedics is necessary for both trauma and non-trauma patients alike. This can only be achieved by training all stakeholders, the police, public transport drivers, and the public at large.
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Khalique N, Urfi, Ahmad A, Ahmad S. Post-crash emergency care: Availability and utilization pattern of existing facilities in Aligarh, Uttar Pradesh. J Family Med Prim Care 2020; 9:2313-2318. [PMID: 32754494 PMCID: PMC7380813 DOI: 10.4103/jfmpc.jfmpc_1251_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/06/2020] [Accepted: 04/03/2020] [Indexed: 12/05/2022] Open
Abstract
Context: Road traffic injuries is estimated to be the ninth leading cause of death across all age groups globally. People in need of trauma care, after a road crash, are most likely to survive if they receive definitive care within the first hour (Golden hour) after the crash. Essential prehospital care includes prompt communication, treatment, and transport of injured people to formal healthcare facilities. Aims: To assess the availability and utilization pattern of existing facilities for post-crash emergency care in Aligarh. Settings and Design: The present study was undertaken on two National highways- NH-91 and NH-93 and the connecting bypass roads of Aligarh district of Uttar Pradesh. Subjects and Methods: All the individuals who met road traffic accident (RTA) between the earmarked areas from 1st October, 2018 to 30th September, 2019 and reported for treatment (either on their own or brought by relatives, passersby, ambulance or police) to the selected hospitals were included in the study. Statistical Analysis Used: Data presented in the form of frequency tables and percentages. Results: Out of 665 patients interviewed during the study period, 556 (83.61%) patients were males and 109 (16.39%) were females with M: F ratio been 5.10:1. Among the first responders, 448 (67.36%) were lay persons and 42 (6.31%) were police personnel. 261 (39.25%) of patients received help within 10–30 min of RTA. Use of toll-free no. was limited to 265 (39.84%) patients. Ambulance was the mode of transport in 155 (23.30%) of RTA cases. 589 (88.58%) of patients reported to Government hospitals. Conclusions: Post-crash emergency care is in nascent stage in Aligarh district of Uttar Pradesh. Toll free numbers and ambulances are available but proper utilization and quality of care is lacking. Lay person is the most important personnel in improving the post-crash care.
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