BackgroundAfrica accounts for one sixth of global road traffic deaths—most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined.MethodsThis is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes.ResultsOver half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16–4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86–2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49–1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity.ConclusionsDespite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0158-5) contains supplementary material, which is available to authorized users.
Acute poisoning remains a public health problem in our community. Bleach is the most common poisons. Our present findings indicate the necessity of educational programmes on preventable reasons of acute poisonings and their outcomes on pregnant and non-pregnant women.
Despite the growing vulnerability, it has proven to be difficult to identify the most vulnerable persons. Methods: Data used for the analysis comes from the RAI-HC database in Ontario (n = 275,854). Data links were made between the RhAI-HC data and the 2013 hydro outage data (n = 10,748). The results were compared to non-exposed client data (n = 12,072). Methods used included frequency tabulation, bivariate and multivariate logistic regression, as well as Kaplan-Meier survival plotting and Cox proportional hazards ratios. Results: The study led to the development of the Vulnerable Persons at Risk (VPR) and VPR Plus algorithms. These algorithms were highly predictive of mortality, LTC admission, and hospitalization. To test the ability and identify those most vulnerable, home care clients during disasters, the algorithms were applied to home care clients exposed and not exposed to the 2013 hydro outage. This analysis showed that exposed high-risk clients, identified by the VPR and VPR Plus, were more likely to die and to be admitted to LTC than non-exposed high-risk clients.
Conclusion:The analysis has shown the usefulness of information collected, as routine clinical practice, using inter-RAI assessment instruments during emergencies and disasters. The analysis further showed that the VPR/VPR Plus are valid and reliable algorithms. Conclusion: In Addis Ababa, many patients being referred to a specialized trauma hospital after RTA have low triage acuity. Nevertheless, these referrals place highest demand on limited ambulance services, and often occur without clear communication between facilities. Strengthening primary health institutions to manage low-acuity RTA victims without referral may decrease strain on pre-hospital transport and trauma center resources, which may instead be directed toward RTA patients from the scene, and those suffering from more critical injuries.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.