Chinese expert consensus on the prehospital management of major trauma.

India needs shift in thinking to improve road safety

Injury remains a major cause of death and disability worldwide, and places an enormous burden on countries with limited resources. The optimal way to reduce life-threatening injuries is through primary prevention efforts that decrease the incidence and severity of injuries. When prevention fails, however, it is often possible to minimize the consequences of injury through effective prehospital and hospital-based trauma care. Unfortunately, much of the world's population does not have access to prehospital trauma care, particularly in low income countries. In many parts of the world, few victims receive treatment at the scene and fewer still receive safe transport to the hospital in an ambulance. Transport, when available, is usually provided by relatives, untrained bystanders, commercial drivers (minibus, taxi or truck drivers), or by public safety officers (police and firefighters). Many high-income countries have developed technically complex and costly prehospital trauma care systems to provide care for acutely ill or injured patients. While these systems are impressive and they undoubtedly benefit some patients, there is little evidence that they are inherently superior to less costly systems that provide a more basic level of prehospital care. The start-up and maintenance costs of advanced life support systems place them out of the reach of all but a few countries, effectively eliminating them as a practical, sustainable option in many parts of the world. Expensive systems are not necessarily the best. With few exceptions, most advanced prehospital interventions have not been scientifically proven to be effective because the necessary randomized trials have not been conducted. In fact, most of the benefits of prehospital trauma care can be readily realized if basic, vital interventions are quickly and consistently applied, utilizing a country's existing resources and health-care infrastructure. Considerable good may be accomplished by ensuring that victims receive life-sustaining care within a few minutes of injury. Even in countries with limited resources, many lives may be saved and disabilities prevented by teaching individuals what to do at the scene of an injury. The foundations of an effective prehospital system can be laid by recruiting carefully selected volunteers and non-medical professionals, and providing them with training as well as the basic supplies and equipment they need to provide effective prehospital care. Most severely injured patients who die in the first few hours after injury succumb to airway compromise, respiratory failure or uncontrolled haemorrhage. All of these conditions can be treated using basic first aid measures. The challenge, however, is to promote sustainable and affordable prehospital trauma care systems that provide services to everyone. To do this, each system must be defined by local needs and capacity and must be developed with due regard for local culture and health-care capacity. …

Appropriate care for injured people can reduce mortality and long-term disability. Care for victims of injury is an issue upon which member states frequently turn to the World Health Organization...

Dr. Michael DeBakey's Contributions to Emergency Medicine and Trauma Care

Road traffic injuries (RTIs) and attendant fatalities on Nigerian roads have been on an increasing trend over the past three decades. Mortality from RTIs in Nigeria is estimated to be 162 deaths/100,000 population. This study aims to compare and identify best prehospital trauma care practices in Nigeria and some other African countries where prehospital services operate. A review of secondary data, grey literature, and pertinent published articles using a conceptual framework to assess: (1) policies; (2) structures; (3) first responders; (4) communication facilities; (5) transport and ambulance facilities, and (6) roadside emergency trauma units. There is no national prehospital trauma care system (PTCS) in Nigeria. The lack of a national emergency health policy is a factor in this absence. The Nigerian Federal Road Safety Corps (FRSC) mainly has been responsible for prehospital services. South Africa, Zambia, Kenya, and Ghana have improved prehospital services in Africa. Commercial drivers, laypersons, military, police, a centrally controlled communication network, and government ambulance services are feasible delivery models that can be incorporated into the Nigerian prehospital system. Prehospital trauma services have been useful in reducing morbidities and mortalities from traffic injuries, and appropriate implementation of this study's recommendations may reduce this burden in Nigeria.

Traumatic injuries are a major cause of morbidity and mortality worldwide, with disproportionate burden in low-and-middle income countries. Nepal is no exception. Achham, a rural district in Nepal, suffers from a high prevalence of traumatic injuries primarily due to falls and road traffic incidents. Female Community Health Volunteers (FCHVs) might serve as essential frontline health providers to mitigate delay in care in rural regions. This study explores the feasibility of integrating FCHVs into the pre-hospital trauma care system in Achham, Nepal. A qualitative approach using phone-based key informant interviews with 20 randomly selected FCHVs and five purposively selected health coordinators from different municipalities across the Achham district was conducted. Data analysis involved thematic coding using NVivo software to identify key themes related to FCHVs' interest, availability, authority, potential barriers and opportunity in their participation in pre-hospital trauma care. RESULTS: FCHVs demonstrated high availability (flexible schedules, willingness to respond to emergencies) and motivation. However, a significant knowledge gap exists (90% unfamiliar with first response in trauma) and existing first-response training was limited (25%). Health authorities from all represented municipalities showed support for FCHV training and mobilization efforts in pre-hospital trauma care. CONCLUSIONS: FCHVs possess the potential to contribute to pre-hospital trauma care, but require thoughtful program development that includes training and supervision. This study highlights the initial feasibility, motivation from participants and leaders for FCHVs integration in rural trauma care, paving the way for improved trauma care access in rural Nepal.

This study evaluated the impact of the prehospital trauma care system on the mortality from motor vehicle crashes and on the temporal distribution between the crash and related death. Autopsies performed by the Forensic Medical Institute on all deaths caused by motor vehicle crashes 1 year before and 1 year after the beginning of the prehospital trauma care system were evaluated. In the first period, 128 deaths occurred, 53.9% of them in the first hour after the crash, 36.7% between the first hour and the seventh day, and 9.4% after 1 week. In the second period, 115 deaths occurred, 40.8% of them in the first hour, 52.2% between the first hour and the seventh day, and 7% after 1 week. Central nervous system injury was the most frequent cause of death in both periods. Mortality was greatest among young people as well as male victims in both periods. After starting the prehospital trauma care system in our city, there was a decrease in the deaths occurring before hospital admission, a change in temporal distribution of deaths, and a reduction in the motor vehicle crash mortality rate.

BackgroundRoad traffic crashes are a major cause of death and injury, especially in low and middle-income countries (LMICs). Improvements in prehospital trauma care can help minimise mortality and morbidity from...

Emergency Medical Service (EMS) systems in developed and developing countries

International comparison of prehospital trauma care systems

ObjectiveTo understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines.MethodsWe conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines – Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes – were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines’ implementation.FindingsWe identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries – 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions.ConclusionAlthough WHO’s trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.

Background The prehospital care system in Nepal is poorly developed, with multiple providers, limited co-ordination of services and no national coverage. There is little published evidence reporting the prehospital care of patients with trauma, data which are important to inform the development of the prehospital care system. Objectives In order to understand the challenges of providing prehospital care to trauma patients, the study aimed to explore the burden of trauma presenting to prehospital care providers and the experience of providing care to these patients. Design We used a mixed-method study that included secondary data analysis and qualitative semistructured interviews. Setting Nepal (Kathmandu Valley, Chitwan, Pokhara and Butwal). Participants Staff employed by the Nepal Ambulance Service including ambulance drivers, emergency medical technicians, dispatch officers and service managers. Data sources Data describing callouts by the Nepal Ambulance Service over 1 year. Callout data were anonymised and analysed descriptively. Semistructured interviews were audio-recorded, transcribed, translated and analysed using inductive thematic analysis. Results Of 1408 trauma calls received, 48.4% (n = 682) resulted in prehospital care being provided. The most common mechanism of injury was falls (35.8%), followed by road traffic crashes (19.1%) and the commonest types of injuries were fractures (33.1%) and spinal injuries (10.1%). Mean time from call to arrival at hospital was 48 minutes (range 20 minutes–6 hours). Seventeen staff described factors facilitating effective prehospital care, including having adequate resources, systems and training. Barriers to delivering prehospital care included the expectations and behaviour of patients’ relatives and bystanders, a lack of public awareness of the role and provision of prehospital care, and poor road and traffic conditions. Limitations For some data fields, data were missing, limiting the ability to precisely determine patient needs and response times. The qualitative data may have been subject to responder bias if participants felt uncomfortable reporting something that may have reflected badly on their employer. Conclusions Trauma is a major reason for requesting prehospital care, which can be delivered in less than an hour from receiving a call to arrival at the hospital. Multiple factors impede the effective delivery of care which could be addressed through further development across the prehospital care system. Future work Qualitative research to explore the perceptions and experiences of trauma victims, road users, emergency department staff, police officers, members of organisations involved in prehospital care, firefighters, and policy-makers would complement the findings from this study. Specific issues raised, such as the difficulties experienced when handing over patients between prehospital and hospital care providers, warrant further exploration. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.

:Background:In countries with evolving prehospital trauma care systems, it is recommended that volunteers es-pecially youth can be trained to perform as first responders to render basic emergency care until care by formally trained health-care personnel’s is available. Based on the theory of planned behavior (TBP), the present study aims to predict intention to help road accident victim among young adults in a fast-urbanizing Indian city.Methods:A cross sectional survey was conducted among 695 college students of Jodhpur, Rajasthan by self-administered questionnaire based on theory of planned behavior (TPB). Predictor of behavioral intention to help an accident victim was assessed through partial least square structural equation model (PLS-SEM).Results:Theory of planned behavior provided a reliable and valid framework for predicting intention of college students towards helping an accident victim. Perceived confidence (β = 0.344, p less than 0.001); attitude (β = 0.323, p less than 0.001) and social norm (β = 0.251, p less than 0.001), all emerged as the significant direct predictor of intention. Perceived confi-dence also significantly predicted social norm (β = 0.370, p less than 0.001) and attitude (β = 0.281, p less than 0.001). Further, attitude towards helping an accident victim was also influenced by social norm (β = 0.366, p less than 0.001). Conclusions:Based on framework of TPB, role of perceived confidence, social norm and attitude is found to significantly predict intention among college youth towards helping an accident victim. Public health interventions designed towards engaging and training youth as first responders in countries with fragmented pre-hospital trauma care systems need to encompass these aspects by establish-ing community based training programs for potential first responders and recognition of good Samaritans.

BackgroundThe majority of trauma deaths occur in pre-hospital settings. Pre-hospital trauma care system built on first responders' network (such as village health workers, police, bystanders, volunteers, and others) with 3000...

Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status. We compared India and Germany in terms of (1) vehicular infrastructure and causes of road traffic accident-related trauma, (2) burden of trauma, and (3) current trauma care and prevention, and (4) based on these observations, we suggested how India and other countries can enhance trauma care and prevention. Data for Germany were obtained from federal statistical databases, German Automobile Club, and German Trauma Registry. Data from India were available from the Ministry of Road Transport and Highways. We also performed a standardized literature search of PubMed for India and Germany using the following key words: "road traffic accidents", "prevention", "prehospital trauma care", "trauma system", "trauma registry", "trauma centers", and "development of vehicles." The total number of registered motor vehicles increased 473-fold in India and 100-fold in Germany from 1951 to 2011. The number of road traffic deaths increased in both countries until 1970, but thereafter decreased in Germany (3606 in 2012) while continuing to increase in India (142,485 in 2011). The differences between Germany and India relate to the relative sizes and populations of the countries (1:9 and 1:15, respectively), and differences in prevention and prehospital care (nationwide versus big cities) and hospital trauma systems (nationwide versus exceptional). Improvement requires attention to three major issues: (1) prevention through infrastructure, traffic laws, mandatory licensing; (2) establishment of a prehospital care system; and (3) establishment of regional trauma centers and a trauma registry.