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ABSTRACT: Injury and other medical emergencies are becoming increasingly common in low- and middle-income countries (LMICs). Many to most of the deaths from these conditions occur outside of hospitals, necessitating the development of prehospital care. Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most LMICs.
In order to better plan for development of prehospital care globally, this study sought to better understand the current status of prehospital care in a wide range of LMICs.
A survey was conducted of emergency medical services (EMS) leaders and other key informants in 13 LMICs in Africa, Asia, and Latin America. Questions addressed methods of transport to hospital, training and certification of EMS providers, organization and funding of EMS systems, public access to prehospital care, and barriers to EMS development.
Prehospital care capabilities varied significantly, but in general were less developed in low-income countries and in rural areas, where utilization of formal EMS was often very low. Commercial drivers, volunteers, and other bystanders provided a large proportion of prehospital transport and occasionally also provided first aid in many locations. Although taxes and mandatory motor vehicle insurance provided supplemental funds to EMS in 85% of the countries, the most frequently cited barriers to further development of prehospital care was inadequate funding (36% of barriers cited). The next most commonly cited barriers were lack of leadership within the system (18%) and lack of legislation setting standards (18%).
Expansion of prehospital care to currently underserved or unserved areas, especially in low-income countries and in rural areas, could make use of the already-existing networks of first responders, such as commercial drivers and laypersons. Efforts to increase their effectiveness, such as more widespread first-aid training, and better encompassing their efforts within formal EMS, are warranted. In terms of existing formal EMS, there is a need for increased and more regular funding, integration and coordination among existing services, and improved organization and leadership, as could be accomplished by making EMS administration and leadership a more desirable career path.
Prehospital Emergency Care 04/2012; 16(3):381-9. · 1.78 Impact Factor
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ABSTRACT: Reducing the global burden of injury requires both injury prevention and improved trauma care. We sought to provide an estimate of the number of lives that could be saved by improvements in trauma care, especially in low income and middle income countries.
Prior data showed differences in case fatality rates for seriously injured persons (Injury Severity Score ≥ 9) in three separate locations: Seattle, WA (high income; case fatality 35%); Monterrey, Mexico (middle income; case fatality 55%); and Kumasi, Ghana (low income; case fatality 63%). For the present study, total numbers of injury deaths in all countries in different economic strata were obtained from the Global Burden of Disease study. The number of lives that could potentially be saved from improvements in trauma care globally was calculated as the difference in current number of deaths from trauma in low income and middle income countries minus the number of deaths that would have occurred if case fatality rates in these locations were decreased to the case fatality rate in high income countries.
Between 1,730,000 and 1,965,000 lives could be saved in low income and middle income countries if case fatality rates among seriously injured persons could be reduced to those in high income countries. This amounts to 34-38% of all injury deaths.
A significant number of lives could be saved by improvements in trauma care globally. This is another piece of evidence in support of investment in and greater attention to strengthening trauma care services globally.
World Journal of Surgery 03/2012; 36(5):959-63. · 2.36 Impact Factor
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Bulletin of the World Health Organisation 03/2012; 90(3):239-40. · 4.64 Impact Factor
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Charles Mock
The Journal of trauma 06/2011; 70(6):1307-16. · 2.48 Impact Factor
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ABSTRACT: The mortuary is an important foundation for injury surveillance. However, mortuary data are incomplete in many developing countries. The Komfo Anokye Teaching Hospital (KATH) mortuary handles most injury deaths for Kumasi, Ghana. During 1994-1995, many cases in KATH's mortuary logbooks had missing information deaths. A low-cost pilot programme was adopted to improve recording of injury deaths. During 1996-1999, 633 deaths per year were recorded. Project sustainability assessment in 2006 showed that reporting was high, with 773 cases per year. Data quality was standard with similar per cents of missing values for key variables compared with the pilot period. Supplemental data constituting 20% was obtained from the intensive care unit, for which data recording in the mortuary was incomplete. Low-cost improvements can lead to improved mortuary reporting of injury deaths. Collation of data from multiple sources remains a problem at KATH. Improved organisation and training could remedy the situation.
International Journal of Injury Control and Safety Promotion 06/2010; 17(2):79-85. · 0.67 Impact Factor
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Sam Luboga,
Sarah B Macfarlane,
Johan von Schreeb,
Margaret E Kruk,
Meena N Cherian,
Staffan Bergström,
Paul B M Bossyns,
Ernest Denerville,
Delanyo Dovlo,
Moses Galukande, [......],
Charles A Mkony,
Pascoal Mocumbi,
Jean Bosco Ndihokubwayo,
Pierre Ngueumachi,
Gebreamlak Ogbaselassie,
Evariste Lodi Okitombahe,
Cheikh Tidiane Toure,
Fernando Vaz,
Charlotte M Zikusooka,
Haile T Debas
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ABSTRACT: In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa.
PLoS Medicine 12/2009; 6(12):e1000200. · 16.27 Impact Factor
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Charles Mock
World Journal of Surgery 10/2009; 33(12):2510-1. · 2.36 Impact Factor
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ABSTRACT: Efforts to promote wider access to surgical services globally would be aided by developing consensus among clinicians, the public health policy community, and other stakeholders as to which surgical conditions warrant the most focused attention and investment. This would add value to other, ongoing efforts, especially in helping to define unmet need and effective coverage.
In this concept paper, we introduce preliminary ideas on how priorities for surgical care could be better defined, especially as regards the interface between the surgical and public health worlds. Factors that would come into play in this process include the public health burden of the condition and the successfulness and feasibility of the procedures to treat those conditions.
The implications of the prioritization process are that those conditions with the highest public health burden and that have procedures that are highly successful and feasible to promote globally, including in the most resource-constrained environments, should be the main focus of national and international efforts.
World Journal of Surgery 10/2009; 34(3):381-5. · 2.36 Impact Factor
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Doruk Ozgediz,
Peter Dunbar, Charles Mock,
Meena Cherion,
Selwyn O Rogers,
Robert Riviello,
John G Meara,
Dean Jamison,
Sarah B Macfarlane,
Frederick Burkle,
Kelly McQueen
Bulletin of the American College of Surgeons 06/2009; 94(5):14-20.
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Burns: journal of the International Society for Burn Injuries 06/2009; 35(5):615-7. · 1.95 Impact Factor
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Bulletin of the World Health Organisation 06/2009; 87(5):326. · 4.64 Impact Factor
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ABSTRACT: Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.
Bulletin of the World Health Organisation 06/2009; 87(5):382-9. · 4.64 Impact Factor
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ABSTRACT: Quality improvement (QI) programs are an integral part of well-developed trauma systems. However, they have not been extensively implemented globally. To promote greater use of effective QI programs, the World Health Organization (WHO) and the International Association for Trauma Surgery and Intensive Care (IATSIC) have been collaboratively developing the upcoming Guidelines for Trauma Quality Improvement Programmes. As part of the development of this publication and to satisfy global demands for WHO guidelines to be evidence based, we conducted a thorough literature search on the effectiveness of trauma QI programs.
The review was based on a PubMed search of all articles reporting an outcome from a trauma QI program.
Thirty-six articles were identified that reported results of evaluations of a trauma QI program or in which the trauma QI program was integrally related to identification and correction of specific problems. Thirteen of these articles reported on mortality as their main outcome; 12 reported on changes in morbidity (infection rates, complications), patient satisfaction, costs, or other outcomes of tangible patient benefit; and 11 reported on changes in process of care. Thirty articles addressed hospital-based care; four system-wide care; and two prehospital care. Thirty-four articles reported an improvement in the outcome assessed; two reported no change; and none reported worsening of the outcome. Five articles also reported cost savings.
Trauma QI programs are consistently shown to improve the process of care, decrease mortality, and decrease costs. Further efforts to promote trauma QI globally are warranted. These findings support the further development and promulgation of the WHO-IATSIC Guidelines for Trauma QI Programmes.
World Journal of Surgery 04/2009; 33(5):1075-86. · 2.36 Impact Factor
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ABSTRACT: Musculoskeletal injuries are a major public health problem globally, contributing a large burden of disability and suffering. This burden could be considerably lowered by implementation of affordable and sustainable strategies to strengthen orthopaedic trauma care, especially in low- and middle-income countries. This article summarizes the global burden of musculoskeletal injuries and provides several examples of successful programs that have improved care of injuries in health facilities in low- and middle-income countries. Finally, it discusses WHO efforts to build on the country experiences and to make progress in lowering the burden of musculoskeletal injuries globally.
Clinical Orthopaedics and Related Research 11/2008; 466(10):2306-16. · 2.53 Impact Factor
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Bulletin of the World Health Organisation 07/2008; 86(6):420. · 4.64 Impact Factor
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ABSTRACT: Empirical evidence from road safety literature suggests that vehicular speed is an important risk factor in the incidence and severity of road traffic crashes globally. Speed studies are at rudimentary stages in developing countries, thus making vehicular speed research imperative. The main aim of the study was to establish two major speed parameters, namely, the mean and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana. Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 28,489 vehicles at 15 different inter-urban locations on three highway categories. Excessive speeding is very pervasive on all highway categories in Ghana. Travelling speeds through settlements where a speed limit of 50 km/hour is mandatory were particularly excessive. Generally, 98%, 90% and 97% of vehicles exceeded the posted speed limit of 50 km/hour on national, inter-regional and regional roads respectively. Mean speeds and speed dispersions (as assessed by the standard deviations) through built-up areas were 81.3 +/- 17.3 km/hour on national roads, 64.7 +/- 12.3 km/hour on inter-regional roads and 72.6 +/- 13.4, km/hour on regional roads. On rural undivided highways with an 80 km/hour speed limit, mean and speed dispersions were 90 +/- 18.9 km/hour on national roads, 80.1 +/- 16 km/hour on inter-regional roads and 84.4 +/- 15.6 on regional roads; also translating into 66%, 47% and 60% of vehicles exceeding recommended speeds. In all cases, speed dispersions were notably higher than the value of 10 km/hour generally found in developed countries. Excessive speeding and wide speed dispersions are highly prevalent on Ghana's highways. These factors likely account for the high incidence of traffic crashes and fatalities in Ghana. An integrated speed monitoring and control programme and by-passing small and medium settlements would be required for the reduction of speed-related crashes, fatalities and injuries.
International Journal of Injury Control and Safety Promotion 06/2008; 15(2):83-91. · 0.67 Impact Factor
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ABSTRACT: On May 23, 2007, the World Health Assembly (WHA) adopted WHA Resolution 60.22, "Health Systems: Emergency Care Systems," which called on the World Health Organization (WHO) and governments to adopt a variety of measures to strengthen trauma and emergency care services worldwide. This resolution constituted some of the highest level attention ever devoted to trauma care worldwide. This article reviews the background of this resolution and discusses how it can be of use to surgeons, emergency physicians, and others who care for the injured, especially in low- and middle-income countries.
World Journal of Surgery 05/2008; 32(8):1636-42. · 2.36 Impact Factor
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ABSTRACT: Motor vehicle collisions are the leading cause of trauma-related death in the United States. Reclined seatbacks may alter crash kinetics and affect occupant outcome. We examined the effect of reclined seatbacks on occupant mortality.
Our study population consisted of United States traffic crashes from 1995 to 2005, using data from the Crash Injury Research and Engineering Network and the National Automotive Sampling System Crashworthiness Data System. Phase 1, we performed a detailed review of crash kinetics and biomechanical factors resulting in injury patterns in fully reclined occupants. Phase 2, we performed a population-based retrospective cohort study comparing outcome in upright, partial, and full recline positions. Primary outcome measure was 30-day mortality.
Phase 1, flexion and compression injuries over pretensioned lap and shoulder belts resulted in severe thoracoabdominal and spine injuries in restrained occupants, with a high associated mortality. Increased lower extremity injuries from additional force loads into bolsters and panels were also noted. Phase 2, the majority (>50%) of front-seat occupants was partially reclined. Fully reclined occupants were younger (30 vs. 39 years, p < 0.0001), more likely to be male (70% vs. 49%, p < 0.0001) and less likely to wear a seat belt (58% vs. 78%, p < 0.0001) than upright or partially reclined occupants. Mortality was increased in both partially (adjusted odds ratio 1.15, 95% confidence interval 1.05-1.26) and fully reclined occupants (adjusted odds ratio 1.77, 95% confidence interval 1.09-2.88).
The reclined position is associated with increased occupant mortality in motor vehicle collisions.
The Journal of trauma 03/2008; 64(3):614-9. · 2.48 Impact Factor
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Journal of emergency nursing: JEN: official publication of the Emergency Department Nurses Association 01/2008; 33(6):540-4. · 0.36 Impact Factor
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ABSTRACT: In Mexico and most other Latin American countries, many emergency medical services (EMS) systems rely on employees and volunteers with only on-the-job training and without formal Emergency Medical Technician (EMT) certification. This study sought to evaluate the costs and effectiveness of providing EMT certification to all personnel working in an EMS service in a Mexican city.
At baseline, only 20% of the prehospital personnel (medics) working for the EMS service in Santa Catarina, Nuevo Leon, Mexico had EMT certification. During a 14-month period, all such medics obtained EMT certification. The process and outcome of trauma care were assessed before and after this training.
Mortality among persons treated by this EMS service decreased from 1.8% Before to 0.5% after the training. The injury severity, as reflected by the prehospital index (PHI), was different between the two periods. Hence, adjustment for PHI by logistic regression was performed. The PHI- adjusted odds ratio for death in the after period was 0.55 compared with the before period, representing a 45% reduction in risk of death after EMT training.
These data support the promotion of policies that require and enable EMT certification for all prehospital care providers in Mexico and potentially also in other Latin American and other middle-income developing countries.
The Journal of trauma 11/2007; 63(4):914-9. · 2.48 Impact Factor
