State of Post-injury First Response Systems in Nepal—A Nationwide Survey

Banstola, Amrit; Smart, Gary; Raut, Raju; Ghimire, Krishna Prasad; Pant, Puspa Raj; Joshi, Prerita; Joshi, Sunil; Mytton, Julie

doi:10.3389/fpubh.2021.607127

Cited by 6 publications

(3 citation statements)

References 22 publications

(21 reference statements)

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“…The development of an EMS system is in progress in Nepal [25]. However, the quality of the ambulance services still varies greatly [28]. The physicians in this study pointed out that the EMS system was to some extent developed in Kathmandu, but also noted that this degree of development had not yet sufficiently reached other areas of Nepal.…”

Section: Discussionmentioning

confidence: 67%

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Hansen

Bratholm²,

Pradhan³

et al. 2022

Int J Emerg Med

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Background Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience challenges or barriers in their treatment of patients. This study aimed to investigate physicians’ perspectives on emergency and prehospital patient management in a low-income country, Nepal, and to understand the challenges and barriers they perceive in emergency treatment including both the prehospital treatment and the immediate in-hospital treatment at the emergency department. Methods Using a qualitative study, eight semi-structured interviews with physicians working in a Nepalese emergency department were performed. The interviews were conducted between September and November 2021 and were audio-recorded and transcribed verbatim. Data were subsequently analyzed using the systematic text condensation method. Results Four main themes and associated sub-themes were identified: (1) patients’ sociocultural, educational, and financial factors (such as financial issues and financial inequality) and regional differences; (2) emergency department’s organization and resources concerning human and material resources, protocols, and guidelines; (3) problems with the emergency department (ED) service’s qualities and availability caused by an insufficient integration of the ED and the EMS, prehospital resources, and financial interests in the EMS; and (4) surrounding healthcare system’s impact on the ED where, especially, the levels of organized primary care, governmental responsibilities, and healthcare structure were addressed. Conclusions The physicians identified numerous regularly encountered challenges and barriers. These challenges stretched beyond the ED and into various aspects of society. The patients’ financial problems were described as the greatest problem, restricting the treatment due to a given patient’s inability or unwillingness to pay for the required procedures. The physicians were thus restricted in completing their duties to the desired levels. The low quality of prehospital care and a lack of education and awareness of common diseases and symptoms in a significant proportion of patients were identified by many participants as being significant issues. The aforementioned challenges or barriers directly resulted in patients arriving in critical conditions that could have been avoided if the disease were treated earlier.

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Section: Discussionmentioning

confidence: 67%

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Hansen

Bratholm²,

Pradhan³

et al. 2022

Int J Emerg Med

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“…Training lay people is recognized as necessary in first responder care, especially in resource-poor settings [29] , [30] , [31] , [32] , [33] , [34] , [35] . Training and certification in wilderness first aid is important for mountaineering practitioners.…”

Section: Discussionmentioning

confidence: 99%

Training and certification in first responder care among mountaineering practitioners in east Africa

Muthomi

Wachira

Ooko³

2022

African Journal of Emergency Medicine

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“…In 2017, an estimated 7524 deaths (4.11% of all deaths in Nepal) were attributed to transport injuries, making it the 7th leading cause of death in the country [ 4 ]. Prehospital care in Nepal is sub-optimal, and with a few notable exceptions, there is a lack of regulated and standardized EMS systems [ 5 , 6 , 7 , 8 ]. Most ambulances are poorly equipped with only an oxygen tank and a single driver who may or may not have received basic first-aid training.…”

Section: Introductionmentioning

confidence: 99%

Post-Crash First Response by Traffic Police in Nepal: A Feasibility Study

Smart

Banstola

Raut

et al. 2022

IJERPH

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Background: Road traffic injuries are a significant and increasing public health burden in Nepal, but there is no national coverage of regulated and standardized emergency medical service systems. Therefore, this study was designed to develop a first responder trauma training program for the Nepal traffic police and to evaluate the feasibility of its delivery and follow up. Methods: A training needs assessment with traffic-police officers in a single district of Nepal informed the development of a 3-day first-response course which was provided to officers in May 2019. Participants were supplied with a trauma-pack and asked to complete a report form when first-responder skills were used. Knowledge and confidence face-to-face surveys were used before and after training to assess learning, and were repeated at 6 months to assess retention of knowledge. The surveys at 6 months assessed the factors affecting application of first response skills. Results: Most (97%) participants believed giving first-aid was part of their responsibilities and 95% had experience of transporting road crash victims to hospital with a range of injuries. Low levels of first-aid training and variable course content were reported. Knowledge and confidence scores improved post-intervention but were reduced at 6-months. During attendance at 303 road crashes in the 6-months follow-up period, 44% of the participants self-reported using at least one skill from the course; applying them on 92 occasions. Incident report-forms were frequently not completed. Barriers to providing treatment included: the patient already en-route to hospital when police arrived at scene; resistance to providing care from relatives or bystanders; and competing police duties (e.g., traffic management). Conclusions: Delivering a first-response training program for traffic-police in Nepal is feasible. Knowledge was retained and used, and skills were in frequent demand. A study of effectiveness and cost-effectiveness appears warranted to determine if extending the training to other districts can improve outcomes in road traffic injury patients in the absence of formal emergency medical services.

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State of Post-injury First Response Systems in Nepal—A Nationwide Survey

Cited by 6 publications

References 22 publications

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Training and certification in first responder care among mountaineering practitioners in east Africa

Post-Crash First Response by Traffic Police in Nepal: A Feasibility Study

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