Pre-hospital care in Nigeria: A country without emergency medical services

Department of Surgery, University of Ilorin Teaching Hospital Ilorin, Nigeria.
Nigerian journal of clinical practice (Impact Factor: 0.53). 04/2009; 12(1):29-33.
Source: PubMed


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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    • "A study in Ghana in which a total of 335 commercial drivers were trained using a 6-h basic first aid course revealed a considerable improvement in the provision of the components of first aid in comparison to what was reported before the course (Mock, 2002). In a study by Solagberu et al. (2009) in Nigeria, 60% of the victims were transported to hospitals by both relatives and bye-standers from the crash scene as against those transported by ambulances of the federal road safety commission and police. A well structured pre-hospital trauma care is at present a challenge for most developing countries. "
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    ABSTRACT: The existing structure of pre-hospital trauma care in developing countries is largely deficient. The goal of this study was to determine the knowledge and attitude of young drivers towards the care of the road traffic injured. This was a descriptive cross sectional study which we carried out among undergraduates of the Ladoke Akintola University of Technology Campus, Ogbomosho, Oyo state, Nigeria using a stratified random sampling technique. Of the total 457 returned questionnaire, only 396 were sufficiently filled to warrant inclusion in the study. Of this number of respondents, 80% (317) were males. The mean age of the respondents was 23 years. While 82.2% (326) of the respondents will attempt to offer victims of road traffic crash some resuscitative measures at the scene, only 30% (119) claimed to have received some form of training in first aid care of the injured. Only 0.5% (2) of the total respondents knew the universal telephone number of 112 or 911 to call in the event of road traffic crash. Young drivers are well motivated and are more likely to confront emergency situations in road traffic crashes. Training them to function as pre-hospital care provider will add to the efficacy of pre hospital care.
    Full-text · Article · Dec 2014
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    • "In a country without emergency medical services[32] and in which comprehensive regional and national injury data is nonexistent,[30] there is an urgent need for defining the epidemiology of injury with a view to developing violence and injury prevention strategies. "
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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.
    Full-text · Article · Apr 2014 · Journal of Emergencies Trauma and Shock
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    • "For women delivering outside an EmOC facility, the probability of a successful referral depended on overcoming three categories of delays: delay in recognizing need for referral and being willing to go; delay in transport to referral facility; and delay in receiving appropriate care at appropriate EmOC facility. Assumptions about barriers to successful referral were based on country reports, published and grey literature, as well as in-country visits (between March and December 2010) to elicit expert local opinion [19,45-48]. We conducted an in-country survey of 121 healthcare facilities and 700 women aged 15–45 (see Additional file 1) to provide insight into the range of values for sensitivity analysis [49]. "
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    ABSTRACT: Background Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization).
    Full-text · Article · Sep 2012 · BMC Public Health
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