Prehospital Research in Sub‐Saharan Africa: Establishing Research Tenets

Abstract

Prehospital care constitutes an important link in the continuum of emergency care and confers a survival benefit to injured and ill persons. As development of acute and emergency care in sub-Saharan Africa expands, there is a strong need to improve the delivery of prehospital care to help relieve the overwhelming regional morbidity and mortality attributable to time-sensitive, life-threatening conditions. Effective research is integral to prehospital care development, as it helps quantify the need for prehospital care and tests effective solutions. Unfortunately, there is limited consensus guiding such research in the low-resource nations of sub-Saharan Africa that face unique challenges. This article aims to assimilate the current pertinent literature to demonstrate research success stories and challenges, and ultimately to build on previous efforts to establish prehospital research priorities for sub-Saharan Africa. Region-specific obstacles hindering prehospital research include the lack of epidemiologic data on emergency conditions, the underdevelopment of in-hospital emergency care, confusing prehospital terminology, poorly defined prehospital research priorities, the lack of qualified local prehospital researchers, and a poor understanding of local prehospital care systems. Solutions are offered to overcome each challenge by building on previous recommendations, by proposing new guiding principles, and by identifying areas where further consensus-building is needed. These guiding principles and suggestions are designed to steer discussions and output from future global health meetings targeted at improving prehospital research and development in sub-Saharan Africa.ACADEMIC EMERGENCY MEDICINE 2013; 20:1304-1309

26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

“…The majority of studies in HICs have shown that prehospital interventions for TBI patients to be life-saving (Alspaugh et al, 2000;Bernard et al, 2010;Lendrum, Kotze, Lockey, & Weaver, 2013;N. K. Mould-Millman, Sasser, & Wallis, 2013;Rudehill et al, 2002).…”

“…In researching prehospital trauma systems Mould-Millman et al provide tenets for best practice, including delineating prehospital care research priorities well in the context of the full continuum of trauma care since it is just one link in the chain of survival (N. K. Mould-Millman et al, 2013). A study in Tanzania has shown that trauma resulting from RTIs is a leading cause of intensive care utilization and differences in survival is linked to poor pre-hospital care and lack of EMS (Chalya et al, 2011).…”

“…In order to sustain such a system emergency medicine training is key throughout the continuum of trauma system care in order to realize the full benefits of any prehospital intervention (Martel et al, 2014;N. K. Mould-Millman et al, 2013).…”

Assessment of emergency medical services in the Ashanti region of Ghana

“…8 The extent to which the formal and the informal transport system contribute to morbidity and mortality remain unknown. 6,10,11 In the Ashanti Region, patients requiring emergency inter-facility referrals are predominantly transported to a modern, 100 bed, National Accident and Emergency Center (AEC) at Komfo Anokye Teaching Hospital (KATH), in the regional capital, Kumasi. Built in 2008, the KATH AEC is home to the first emergency medicine (EM) residency training program in Ghana.…”

Challenges in Emergency Medical Services in a ResourceLimited Setting in Sub-Sahara Africa; Perspectives from Cameroon: a Review Article

“…This ideally triggers a cascade of events resulting in a timely response of expertise, resources, and service directed to patient stabilization and/or safe emergency patient transportation to the nearest appropriate facility (1,6,7) . (4,8,9) . This reflected the efforts of pioneering physicians around the world who independently realized the need for a specialist in emergencies who would be available to patients at all times or day or night.…”