Pre-hospital care in Nigeria: a country without emergency medical services.
ABSTRACT Efficient pre-hospital transport (emergency medical services, EMS) is associated with improved outcomes in road traffic injuries (RTI). This study aims to discover possible interventions in the existing mode of transport.
Persons bringing all RTI victims to the Emergency room (ER) over a 4-year period and the injury arrival intervals were noted prospectively.
There were 2,624 patients (1,886 males and 738 females); only 2,046 (78%) had clear documentations of three categories of persons bringing victims to ER: Relatives (REL, 1,081, 52.83%); Police/Federal Road Safety Corps (P/F, 827, 40.42%) and Bystanders (BS, 138, 6.74%). No intervention was provided during transport: Within 1 hour, 986 victims (48.2% of 2,046) arrived ERbrought by P/F (448, 21.9%), REL (439, 21.5% of 2,046), and BS (99, 4.8%). These figures, in each instance, represent 40.6 % of total victims brought by REL; 54.2% by P/F and 71.7% by BS. However, after 6 hours, REL were the main active group as they brought 94.5% (359 of 380) patients of this period. In 91 victims (4.4%) the injury arrival time was not captured.
This study has identified three groups of persons involved in pre-hospital transport with nearly 50% getting to ER within 1 hour without any intervention or prior notification of ER. Absence of EMS obscures pre-hospital death records. The P/F responsible for only 40% of transport should be trained and equipped to offer basic trauma life support (BTLS). The REL and BS (both responsible for 60% of transport) represent a pool of volunteers for BTLS to be trained.
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ABSTRACT: Child pedestrian injuries and fatalities in developing countries continue to increase. We examined child pedestrian injuries and fatalities in the most populated urban agglomeration in Africa in order to develop control measures. Two-year prospective study of injured child pedestrians (≤15 years) at the Surgical Emergency Room (SER) to determine demography, vehicles involved, road location, injury mechanism, pre-hospital transport, injury-arrival time, regions injured, injury severity and fatalities was done. Some 226 pedestrians (114 boys and 112 girls) comprising 42 children aged ≤4 years, 91 aged 5-9 years and 93 aged 10-15 years were seen with car collisions (83 pedestrians, 36.7 %), motorcycles (76, 33.6 %), buses (41, 18.1 %), others (15, 6.6 %) and 11 undetermined vehicles. Injuries on the highways were 147 (65 %); inner-city roads 77 (34.1 %) and two undetermined roads. Crossing the road was responsible for 168 (74.3 %) pedestrian injuries; while three other mechanisms produced 58 (25.7 %) patients. Regions injured were head (42.9 %), lower limbs (35.4 %) and others (21.7 %). Relatives, bystanders and police/ambulance brought 186 (82.3 %), 31 (13.7 %) and eight (3.5 %) children, respectively; and within 6 h (43.4, 11.5 and 2.2 %) and after (38.9, 2.2 and 1.3 %). Nineteen deaths (10 brought-in-dead, nine SER deaths) occurred; 15 of them girls, 15 had severe head injury, 15 were brought by relatives. However, fatality risks were truck collisions (OR 5.97), female child (OR 4.25), head injury (OR 4.18) and age ≤4 years (OR 3.7). The equal sex incidence, worse female fatality despite similar exposure and injury severity with male, deserve further research. Improved pre-hospital and SER care is needed.Pediatric Surgery International 05/2014; · 1.22 Impact Factor
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ABSTRACT: Abstract Objectives Since the first pedestrian road fatality of 1896, pedestrians still remained vulnerable, with fatality from Africa being 55% of global statistics. Many previous reports from Nigeria have emphasized passengers and drivers over pedestrians; this study was done in the most densely populated Nigerian city with no previous publication exclusively dedicated to pedestrians-the megacity has been projected by the World Bank to be the third largest in the world by 2015 (after Tokyo and Mumbai) so that study results would aid injury control and reduce morbidity and mortality. Methods This is a one-year prospective study on pedestrians attending the surgical emergency room of the busiest referral hospital in Lagos, Nigeria detailing the age, sex, occupation, regions injured; the injury mechanism, incident vehicles, highway collisions and the immediate outcome. Results Some 702 pedestrians were seen; comprising 494 (70%) males with overall peak incidence in the third decade, but the peak incidence among females is lower and in the first decade. Common injuries sustained were to the head (40%), lower limb (35%), upper limbs (9%), multiple regions (6%), pelvis (3%) and others (7%). Gender differences also were noted- the predominant injury in males was head injury followed by lower limb injuries but vice versa in females even though both regional injuries were fewer in females than in males. Students were 20% of the entire pedestrians, with nearly half of them injured by the motorcycle. The mechanism of injury included crossing the highway (63%), by walking along the pavement (17%), standing by the bus stop (12%), at the shop/ house (5%) and others (3%). However, 76% injuries occurred on the highway, 22% in the inner city roads and 2% elsewhere. Vehicles injuring the pedestrians were motorcycles 33%, cars 27% and buses 22%, trucks 6%, tricycle 2.4% and others 9%. Overall fatality was 10% about half of them were knocked down by buses and cars. Conclusions This study suggests high incidence, and significant underreporting, of pedestrian injury. Morbidity and mortality reduction is possible (from head and lower limb injuries) by traffic calming techniques in crossing the highway especially from the motorcycles, cars and buses.Traffic injury prevention 05/2014;
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ABSTRACT: A plethora of injuries present at any accident and emergency unit, but the pattern of the injuries varies from region to region especially in ours with the increased ethno-religious clashes and terrorist attacks. This study aims to determine the epidemiology and type of injuries presenting to our center with the possibility of developing injury surveillance initiatives in our center and Nigeria as a whole. Injured patients consecutively presenting to the accident and emergency department of the Jos University Teaching Hospital within the period February 2011 to January 2012 were prospectively recorded. A total of 720 injured patients admitted with an age range of 8 months to 75 years (mean = 37.9; SD = ±52.4), which consists of 544 males and 176 females giving a male to female ratio of 3.1:1. Patients aged 20-29 years were in the majority (n = 220, 30.6%) with peak incidences in the period of communal clashes. Injuries sustained from motorcycles were the highest (n = 248, 34.4%). Others were 160 (22.2%) in other vehicular and pedestrian injuries, machete (n = 128), gunshots (n = 92), burns (n = 36), bomb blast injuries (n = 16), fall from heights (n = 32) and miscellaneous (n = 8). Injuries sustained in communal clashes and terrorist attacks accounted for 236 (32.8%) presentations. The most common site of injury was the head (n = 30 4, 42.2%). Relatives, passersby and law enforcement agencies brought patients to the hospital with times between injury and presentation ranging from 1 h to 3 weeks. 40 (5.6%) patients were brought in dead. A collective effort - on the part of the government and the citizenry is required to ensure better outcomes and a safer society for all.Journal of Emergencies Trauma and Shock 04/2014; 7(2):77-82.