Abstract
BackgroundTraffic injuries place a significant burden on mortality, morbidity and health services worldwide. Qualitative factors are important determinants of health but they are often ignored in the study of injury and corresponding development of prehospital Emergency Medical Services (EMS), especially in developing country settings. Here we report our research on sociocultural factors shaping pathways to hospital care for those injured on the roads and streets of Vietnam.MethodsQualitative fieldwork on pathways to emergency care of traffic injury was carried out from March to August 2016 in four hospitals in Vietnam, two in Ho Chi Minh City and two in Hanoi. Forty-eight traffic injured patients and their families were interviewed at length using a semi-structured topic guide regarding their journey to the hospital, help received, personal beliefs and other matters that they thought important. Transcribed interviews were analysed thematically guided by the three-delay model of emergency care.ResultsSeeking care was the first delay and reflected concerns over money and possessions. The family was central for transporting and caring for the patient but their late arrival prolonged time spent at the scene. Reaching care was the second delay and detours to inappropriate primary care services had postponed the eventual trip to the hospital. Ambulance services were misunderstood and believed to be suboptimal, making taxis the preferred form of transport. Receiving care at the hospital was the third delay and both patients and families distrusted service quality. Request to transfer to other hospitals often created more conflict. Overall, sociocultural beliefs of groups of people were very influential.ConclusionsAnalysis using the three-delay model for road traffic injury in Vietnam has revealed important barriers to emergency care. Hospital care needs to improve to enhance patient experiences and trust. Socioculture affects each of the three delays and needs to inform thinking of future developments of the EMS system, especially for countries with limited resources.
Highlights
Traffic injuries place a significant burden on mortality, morbidity and health services worldwide
For each of the three delays, we described socio-cultural and system factors that contributed to delays
Our study found that attaining prehospital care for traffic injured patients was a roundabout where patients circulate between the crash site, several hospitals and home
Summary
Traffic injuries place a significant burden on mortality, morbidity and health services worldwide. Qualitative factors are important determinants of health but they are often ignored in the study of injury and corresponding development of prehospital Emergency Medical Services (EMS), especially in developing country settings. Transition from war to peace involves many societal transformations including the conversion of emergency health services from a military to a civilian format. Following World War II, Western countries developed emergency health services (EHS) using two principal models, generally characterised today as a doctor-centred ‘stay and play’ (Franco-German) or a paramedic ‘scoop and run’ (Anglo-American) [1]. Every high income country (HIC) has fine-tuned its own system and has succeeded in stabilising and transporting most people needing emergency care to health services in remarkably short time. Resuscitative support during the transfer with helicopter ambulances and mobile surgeons are widespread
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