Identifying the Need for Better Emergency and Out-of-Hospital Care in the Developing World: A Case Study in Chennai, India

Abstract

Study objectives: Increasing urbanization and urban-related health problems are affecting developing countries. This epidemiologic transition has resulted in increasing deaths from trauma and cardiovascular changes, which necessitates the development of out-of-hospital care and emergency care delivery systems better adapted to the changing environment. This study is done to assess the effectiveness of the emergency care and out-of-hospital services for the present health needs of the population in Chennai, India, as it passes through the epidemiologic transition and to allow for future recommendations to meet the growing need for organized emergency services in the community. Methods: Statistics describing the health status and demographic and socioeconomic profiles of the community were obtained from a published community survey. Information about availability of resources for management of trauma and cardiovascular emergencies were obtained from the results of an unpublished survey of the local emergency departments (EDs) provided by the hospital. Retrospective data were obtained from trauma and ambulance registry about trauma-related admissions or death and out-of-hospital assistance. The participating hospital is Sundaram Medical Foundation. It is a 130-bed, community hospital, nonprofit organization in the town of Annanagar, with a growing interest in the establishment of a formal emergency care delivery system. Results: Data analysis revealed changing patterns in the causes of mortality, with increase in mortality from trauma and cardiovascular etiologies. Hospital statistics showed that 30% of the annual hospitalizations were from trauma and acute coronary syndromes. Thirty-six percent of the trauma was from road traffic accidents. Mean age of the trauma victims was 30 years. Of the trauma victims who made it to the hospital, 50% of them were brought in by family with no out-of-hospital assessment or intervention. Ambulances were primarily used as transport vehicles and not as response vehicles. It was found that the standard of care in the EDs varied considerably, with less than half of them carrying defibrillators, thrombolytics, cervical spine collars, or backboards and only a third of them carrying intubation equipment. Conclusion: As developing countries begin to urbanize and grow, so do their health care needs. In Chennai, India, the antiquated out-of-hospital and hospital system does not address the current trends of increased mortality from trauma and cardiovascular disease. Project recommendations will be made for strengthening these services, including adapting the current role of the ambulance response system, offering training to EDs, and providing continued evaluation to further develop an emergency response system that meets the evolving health needs of this community in transition.