Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study

Abstract

BackgroundPre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).MethodsA cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA.ResultsFrom 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities.ConclusionsThough some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.Electronic supplementary materialThe online version of this article (10.1186/s12873-017-0137-2) contains supplementary material, which is available to authorized users.

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

“… 58 On the other hand, fragmented, disjointed and poorly resourced EMS systems continue to create major challenges to post-trauma survival. 15 55 Our evidence fell short of defining efficacy of different types of life-saving interventions provided in Africa. While life-saving interventions are the core effective trauma responses, evidence associating the interventions such as BLS and ALS with post-trauma mortality is grossly lacking in African scientific literature.…”

“…Training lay responders on basic first aid can play a significant role in improving post-trauma survival in low-resource countries or environments. 15 56 57 Training lay responders can also be useful in addressing trained provider quality and quantity (capacity) gaps in low-resource environments. 15 56 57 Hiring, training, equipping and sustaining both quality prehospital care professionals and life-saving interventions have significant resource implications.…”

“…While this indirectly supports the value of the golden hour and ambulance transport in trauma distress responses, other studies refute this finding due to lack of strong evidence. 15 21 24 In effect, the ‘golden hour-60-minute concept’ remains a controversial subject in terms of care outcome benefits in LMICs.…”

The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey

“…In addition, we reviewed reports from previous EMS studies in Uganda [ 7 – 9 ], and filled gaps in information, especially concerning national-level leadership and governance issues as well as financing, through a key informant face to face interview with a senior MOH official.…”

“…With a well-established EMS system (i.e., with functional prehospital care, transportation, and hospital care) as is found in most high income countries, many emergency medical conditions can be resolved in a few hours or days [ 6 ]. While a few studies have been done to assess pre-hospital care in Kampala [ 7 – 9 ], to our knowledge, no study has been done to assess the status of EMS and acute health facility care in Uganda at national level. The Ministry of Health (MoH) recognized the need to improve these services, and through this study sought to establish the status of emergency medical services and acute health facility care in the country.…”