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: Traumatic spine injuries are on the rise. The literature is sparse regarding epidemiology of patients with traumatic spine injuries from this part of the world. To analyse the following in patients with traumatic spine injuries with neurological deficits: demographic and social profile, common modes of injury, pre-hospitalisation practices, region of spine affected, severity of neurological deficit and the lay individuals' awareness about traumatic spine injuries. The study sample comprised 52 adult patients with traumatic spine injuries with neurological deficits. We collected data on demographic and social characteristics, mode of injury, pre-hospitalisation treatment, interval between injury and presentation, spine region affected and severity of neurological deficits and patient's knowledge about such injuries. The average patient age was 31.32y. The male: female ratio was 2.25:1, and the most common modes of injury were fall from height, followed by traffic accident. More than half of the patients suffered cervical spine injuries, followed by dorsolumbar spine injuries. Only 9.61% of patients received pre-hospitalisation treatment. All patients understood there could be complete functional recovery after treatment for traumatic spine injuries. There is a growing need to improve railway and roadway safety equipment and to make it accessible and affordable to the susceptible economically weaker population. Attempts should be made to increase awareness regarding traumatic spine injuries. Trauma; Spine; Deficit; Poor; safety; awareness.03/2013; 7(1):36-40. DOI:10.5704/MOJ.1303.014
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ABSTRACT: Objective: To determine how the use of a proforma affects the completeness of assessment of spinal cord injured patients at the casualty of the University of Abuja Teaching Hospital Gwagwalada, Abuja. Background: Spinal cord injury (SCI) is a well documented problem. Assessment protocol of SCI has not been fully established in the casualty of most major trauma centre in Nigeria and where it is used there has not been any report of its efficacy in the literature. Our hypothesis is that proforma based assessment protocol use would improve the assessment of patients with spinal cord injury. Methods: Data on all spinal cord injured patients were prospectively documented over a 12 month period of 2009. The University of Abuja Teaching Hospital (UATH) Gwagwalada spine assessment proforma lists all items considered to be essential for a complete assessment of spinal cord injured patients in the casualty. This was then compared to the data obtained from patients admitted for spinal cord injury from 1997 to 2007 before the introduction of the proforma in December 2008. Results: Preproforma, 202 patients were assessed and 196 (97%) had one or more items missing from their reports compared to only 10/86 (11.6%) patients postproforma (p=0.001). Prehospital care, mechanism of injury, extrication, evacuation, fracture pattern, bulbocavernous reflex and standardized neurologic assessment were the items most often absent, being significantly more frequently reported after the proforma . Conclusion: Proforma based assessment protocol would help in accurate data collection and provide adequate data for informed, objective and standardized management of spinal cord injured patients.
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ABSTRACT: We present our experience organizing an orthopaedic camp in rural part of India in a mobile surgical unit (Life Line Express) on a train. The camp was held for 15 days from 25th may to 10th June 2009. We performed deformity correction surgeries; corrective plaster castings and follow up the cases for the next six month. We assess the pros and cons of this orthopaedic camp on a train where minor and major procedures were carried out.