Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia

Abstract

BackgroundAfrica accounts for one sixth of global road traffic deaths—most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined.MethodsThis is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes.ResultsOver half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16–4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86–2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49–1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity.ConclusionsDespite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0158-5) contains supplementary material, which is available to authorized users.

A woman’s worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa

“…May occur in or out of the hospital setting, and may involve physicians, pre-hospital providers and other licensed professionals. Bystanders may also provide emergency care (for cardiopulmonary resuscitation for example), if well trained Emergency Medical Services (EMS) Emergency Medical Services (EMS), a coordinated system of EC response [25], have been identified by the WHO as an effective public health intervention for addressing the disproportionately high burden of maternal mortality [26][27][28][29][30][31][32][33][34][35]. Across the African region, prehospital emergency care systems are being developed to provide care and transportation for critical, timesensitive obstetric and other emergencies for diverse populations of varying socioeconomic strata [26,[28][29][30][31][32][33][34][35][36][37][38][39].…”

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

“…Contextualized, informal lay provider networks as employed on a small scale by some parts of Madagascar, Uganda, Ghana, and southern Nigeria [ 71 – 75 ] can be strengthened to decrease prehospital trauma mortality rates; however, this should not be used to excuse the absence of tier-2 systems which ideally represent the highest quality of prehospital surgical care [ 76 ]. The percentage of injured patients that arrive at health facilities by ambulance in SSA varies widely by country and facility, from 59% in Ethiopia [ 77 ] to 5.9% in Zambia [ 78 ] and 5% in Mozambique [ 79 ].…”

Waveform capnography in a South African prehospital service: Knowledge assessment of paramedics

“…Nearly all participants (53/58 (91%)) indicated that they would like further training in the use of ETCO 2 , with 18 of the 58 respondents indicating that they considered themselves out of date or that their initial training was not sufficient with respect to capnography. When asked how training should be delivered the following key words were identified in the analysis: continuous medical education [14] , online training [9] , lectures [12] , workshops [7] , and practical training [6] .…”

“…Despite the widespread international acceptance, and use of capnography, there is little published research on its use in Africa outside of SA, even in national referral hospital anaesthetic practice, capnography is apparently rarely available or used in East and West Africa [9] , [10] , [11] . Prehospital services are in their infancy in much of Africa, and looking to other develop their systems currently [12] , [13] , [14] . Rational use of this important, although still expensive resource, and including it in training programs is important yet understudied.…”