308 Trauma as the Neglected Emergency After Emergency Medical Services Systems Introduction: Lessons Learned From Rural Uganda

Abstract

The World Health Organization estimates that injury accounts for over 5 millions deaths annually and 138 million disability adjusted life years, 90% of which occur in low and middle income countries. Growing evidence that time-sensitive injuries contribute significantly to mortality in poor countries. However, the burden to access emergency services is often placed solely on community members and local health workers; however, low and middle income countries have typically focused community health worker curriculum and public awareness campaigns on topics such as infectious diseases and obstetric emergencies. Ruhiira, Uganda has a newly implemented emergency medical services system, in which the frontline community health workers refer to local clinics and hospitals. The first objective of this study was to understand community health worker knowledge, attitudes, behavior and practice related to emergent conditions, specifically the care of injured patient. A second objective was to explore the community perceptions of emergent conditions which required activations of the emergency medical services system in Ruhiira, Uganda. In depth interviews were held with all community health care workers. Focus groups were held with community and village leaders. QSR NVIVO 8.0 software was used to code all data by 2 separate coders, themes were identified, and a theoretical framework was developed. In total, 53 in-depth interviews were conducted and 119 community members participated in focus groups. In-depth interviews with health care workers and community health care workers revealed that injury was not perceived as an emergent issue. Moreover, no community health worker interviewed felt that they were prepared to assess an injured patient, and many believed they did not have the skills to assess the need for simple interventions, such as applying pressure to a bleeding wound. Conversely, 100% of community health workers interviewed were comfortable assessing and referring obstetric and pediatric emergencies. Themes from the community members included the belief that the emergency medical services system was “for women and children only” and that it was of little use for trauma patients. Community members also felt ill-prepared to care for an injured patient and said they would seek the help of a community health worker in this case. Trauma accounts for a disproportionately large portion of the burden of disease in low and middle income countries; despite this, community health workers feel ill-prepared to deal with the injured patient and community members believe that the emergency medical services system does not provide services for trauma patients. As we introduce emergency medical services systems in rural Africa, it is important that we also provide concomitant educational curriculum and social marketing campaigns for all time sensitive illnesses, such as trauma, if we are to allow these systems to be utilized to their full potential.