Abstract
BackgroundPre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).MethodsA cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA.ResultsFrom 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities.ConclusionsThough some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.
Highlights
Pre-hospital emergency care is a vital and integral component of health systems in the resource constrained countries like Uganda
Study setting This study was conducted in the Greater Kampala Metropolitan Area (GKMA), which covers a radius of 40 Km2 (1000 Km2 total area) from Kampala capital city to the nearby cities of Entebbe, Kira, Mpigi, Mukono, Nansana and Wakiso–which is at times referred to as the Kampala Metropolitan Extra region (KMA) [12,13,14]
Available data indicates that roughly half of total road traffic incidents (RTIs); 12,152 (54%); 12,136 (54%) and 9651 (53%) occurred in the GKMA of the total crashes registered in Uganda; 22,461, 22,272 and 18,368 in 2010, 2011 and 2013 respectively in Uganda as a whole [5,6,7]
Summary
Design A cross-sectional study was conducted to identify the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the GKMA. Study participants and context Two groups of RTI victims and EMS specialists (first emergency responders, paramedics, nurses and ambulance crew); 459 and 23 respectively were involved in the study for a period of 2 months–May and June, 2016 The former were recruited from three major hospitals: Mulago National Referral Hospital (MNRH), ChinaUganda Friendship Hospital Naguru (CUFH-N) and Kibuli Muslim Hospital (KMH). The contribution of 9 and 15 variables related to the weaknesses and capacities respectively affecting the prehospital emergency care were weighed against the construction of the principal components (PCs) through the PCA pairwise correlation tests. This involved detecting the most predominant variable(s) among others which influence the PC score and vice versa. This can tell us whether there is some variable that contributes significantly to that dimension with respect to the others
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