Emergency Trauma Care for Severe Injuries in a Moroccan Region: Conformance to French and World Health Organization Standards

Abstract

In Morocco, injuries account for 11% of total burden of disease. Better organization of emergency care can improve the outcome of trauma patients. In Morocco, these services have been reorganized recently, but were never evaluated. The objective was to assess actual structure and processes of emergency trauma care in a Moroccan region. This comparative qualitative study was carried out in the region of Fez. The process and structure of contacting emergency care and prehospital emergency care were compared with the French 2002 standards. Emergency care at the University Teaching Hospital (UTH) was compared with World Health Organization 2005 Essential Trauma Care guidelines. Predefined care items were categorized as conforming to the standards or not. An emergency call center with a dedicated dial-up number has been established in the region since January 2007. Compared with the standards, this center was not protected by any legislation and was run by interns only. The center was underutilized during triage to help transportation of severe trauma patients. At the prehospital care level, only 3 out of 15 ambulances were equipped with resuscitation equipment and were used rarely. Only one of the ambulance staff out of three was trained in required skills. At the UTH, emergency care equipment and staff was nearly adequate. This study identified several opportunities for improvement in organizing trauma care in Fez particularly at emergency call center and ambulance service. A quality assurance program would be useful to further identifying improvements in this system.

Trauma Care in Africa: A Status Report From Botswana, Guided by the World Health Organization’s “Guidelines for Essential Trauma Care”

“…These findings seem to correlate with findings in similar assessments from South America, Africa and from Asia [9][10][11][12]21]. The highest level facilities assessed seems to be more adequately staffed, equipped and trained, although with deficiencies, while districts are covered by generalist hospitals or clinics with very limited trauma care capacity and substantial trauma load, especially along the major roads, which highlights the need for improved trauma care in rural areas.…”

“…While similar studies have focused on regions of countries [9,10,11,21] or nationally representative samples from all over the country [12], our study provides for the first time a picture of hospital based trauma care capabilities in an entire country.…”

Assessing Trauma Care Capabilities of the Health Centers in Northern Ghana

“…Pulse oximetry monitors were present in the EDs in all the referral hospitals, but actually functional in only one facility. These findings are similar to previous studies from South America, Africa, and Asia, [8,[14][15][16] suggesting that opportunities to learn and improve from previous experience have not been acted upon or have failed ongoing maintenance. Although availability of most equipment increased from primary to district, regional, and teaching hospital, it is notable that, even in teaching hospitals, essential equipment is not available in the ED where an injured patient would first be seen.…”

“…From 1990 to 2010, the number of deaths due to injury increased 24 %, while deaths due to communicable diseases decreased 17 % [1]. Injury from motor vehicle crash (MVC) is the eighth leading cause of death overall and the most common cause of death for people aged [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In addition, MVC poses a disproportionate burden on lower middle-income countries (LMICs) [2].…”

Application of the Queuing Analytic Theory in Emergency Department

“…In Morocco, unlike most countries, emergency departments do not provide care for patients with acute severe conditions alone. Inappropriate uses of ED and underutilization of regulation centers during triage represent a burden on health system and increase the demand for ED (2, 3). I believe most emergency physicians in Morocco would presume that lack of such legal mandate concerning regulation use and appropriate consultation in ED would result in less crowd and difficulties in patient flow in emergency departments outside of Morocco.…”