Prehospital care for traumatic spinal cord injury by first responders in 8 sub-Saharan African countries and 6 other low- and middle-income countries: A scoping review

Abstract

Introduction Traumatic spinal cord injury (TSCI) constitutes a considerable portion of the global injury burden, disproportionately affecting low- and middle-income countries (LMICs). Prehospital care can address TSCI morbidity and mortality, but emergency medical services are lacking in LMICs. The current standard of prehospital care for TSCI in sub-Saharan Africa and other LMICs is unknown. Methods This review sought to describe the state of training and resources for prehospital TSCI management in sub-Saharan Africa and other LMICs. Articles published between 1 January 1995 and 1 March 2020 were identified using PMC, MEDLINE, and Scopus databases following PRISMA-ScR guidelines. Inclusion criteria spanned first responder training programs delivering prehospital care for TSCI. Two reviewers assessed full texts meeting inclusion criteria for quality using the Newcastle-Ottawa Scale and extracted relevant characteristics to assess trends in the state of prehospital TSCI care in sub-Saharan Africa and other LMICs. Results Of an initial 482 articles identified, 23 met inclusion criteria, of which ten were set in Africa, representing eight countries. C-spine immobilization precautions for suspected TSCI patients is the most prevalent prehospital TSCI intervention for and is in every LMIC first responder program reviewed, except one. Numerous first responder programs providing TSCI care operate without C-collar access (n = 13) and few teach full spinal immobilization (n = 5). Rapid transport is most frequently reported as the key mortality-reducing factor (n = 11). Despite more studies conducted in the Southeast Asia/Middle East (n = 13), prehospital TSCI studies in Africa are more geographically diverse, but responder courses are shorter, produce fewer professional responders, and have limited C-collar availability. Discussion Deficits in training and resources to manage TSCI highlights the need for large prospective trials evaluating alternative C-spine immobilization methods for TCSI that are more readily available across diverse LMIC environments and the importance of understanding resource variability to sustainably improve prehospital TSCI care.

Prehospital hemorrhage management in low‐ and middle‐income countries: A scoping review

“…Similar to previous scoping reviews on airway management and spinal cord injury, 52,53 an accessibility challenge to prehospital HM in LMICs persists. In high‐income countries (HICs), effective bioengineered hemostatic agents, such as RickClot Combat Gauze (QCG), Tranexamic Acid (TXA), and RevXSTAT (XSTAT), are first‐line agents for life‐threatening bleeds not controlled by tourniquets 54 .…”

Prehospital Airway Management for Trauma Patients by First Responders in Six Sub‐Saharan African Countries and Five Other Low‐ and Middle‐Income Countries: A Scoping Review

“…Data collected from studies focused on: authors, title, publication year, study setting and World Bank income country income classification, occupation of individuals providing prehospital AM care and the level of training received (LFR, BLS, PHTLS, ALS), training duration for care providers, curricular elements involved in training, equipment used in the provision of prehospital care, frequency of reported interventions, frequency of reported adverse events, clinical impact of prehospital interventions taken, and the number trained or surveyed. Interventions taken were also further classified as basic AM or advanced AM following basic and advanced life support protocol [22][23][24] (Table 2). EMS personnel are trained as professional first responders who transport patients from an injury scene to a clinical setting for definitive care as their full-time or part-time occupation.…”

Clinical profile and predictors of early outcome in patients with traumatic spinal cord injury in Jos, North-Central Nigeria

“…[ 5 ] The global burden of acute TSCI, constitutes a considerable portion of the global injury burden as published by the 2019 Global Burden of Disease study group. [ 5 8 ] Although the study revealed that from 1990 to 2016, there was no significant change in the age standardised incidence or prevalence of TSCI, the population of people living with the consequences of TSCI is expected to rise, due to population growth in the near future, leading to an increase in the demand for specialised care of patients with this injury. [ 5 ] The prevalence and incidence of TSCI might not have changed much over time, however, there are marked variations in the incidence, prevalence and other clinical characteristics of this injury across, and within different countries and regions of the world.…”