The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review

Quake, Sharmaine Yen Ling; Khoda, Fatimah; Rad, Arian Arjomandi; Ponniah, Hariharan Subbiah; Vardanyan, Robert; Frisoni, Paolo; Rad, Hoshang Arjomandi; Brasesco, Martina; Mustoe, Sophie; Godfrey, Jenna; Miller, George; Malawana, Johann

doi:10.1080/10903127.2023.2165744

Cited by 6 publications

(4 citation statements)

References 34 publications

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“…A significant challenges is the lack of access to medical resources that are typically available in a hospital setting [74]. This means that prehospital providers must be able to make quick decisions based on the information they have available, often with limited resources at their disposal.…”

Section: Safety Concernsmentioning

confidence: 99%

Clinical Research in Prehospital Care: Current and Future Challenges

Cimino,

Braun

2023

Clinics and Practice

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Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, and several challenges and opportunities have emerged. There is an urgent need to adapt clinical research methodology to a context of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. Among these, this review allows the highlighting of limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, selection of a homogeneous study group, etc. The analysis of the literature also highlights solutions such as strong collaboration between emergency medical services (EMS) and hospital care, use of (mobile) health technologies and artificial intelligence, use of standardized protocols and guidelines, etc. Overall, the purpose of this narrative review is to examine the current state of clinical research in prehospital care and identify gaps in knowledge, including the challenges and opportunities for future research.

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Section: Safety Concernsmentioning

confidence: 99%

Clinical Research in Prehospital Care: Current and Future Challenges

Cimino,

Braun

2023

Clinics and Practice

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“…Cognizant of this fact, pre-hospital care systems are rapidly developing in LMIC, especially in remote areas to reduce morbidity and mortality in the region [ 8 , 9 ]. Yet, empirical evidence shows that the level of ambulance utilization to take patients to emergency departments (ED) of nearby health center is very low across LMICs, ranging from 4% to 37%, which implies that majority of the patients suffer from shortage of ambulance services [ 10 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia

Adem,

Tezera,

Agegnehu

2024

BMC Emerg Med

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Background In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City. Method A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05. Results Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7). Conclusion Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.

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“…A lack of resources results in non-or underprovision of care for injuries requiring surgical treatment, including a lack of specialized surgical staff, surgical equipment, and infrastructure [3]. Furthermore, rural areas are often difficult to access [4], and most deaths occur during the pre-hospital phase [5,6].…”

Section: Introductionmentioning

confidence: 99%

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

Deininger,

Wichlas,

Necchi

et al. 2024

JCM

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Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

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The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review

Abstract: The current status and challenges of prehospital trauma care in low-and middle-income countries: A systematic review Type Article URL https://clok.uclan.ac.uk/45327/ DOI ##doi## Date 2023 Citation

Cited by 6 publications

References 34 publications

Clinical Research in Prehospital Care: Current and Future Challenges

Clinical Research in Prehospital Care: Current and Future Challenges

The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

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