Police Transportation Following Vehicular Trauma and Risk of Mortality in a Resource‐Limited Setting

Abstract

Background In resource-limited settings, prehospital trauma care and transportation from the scene to a hospital is not well developed. Critically injured patients present to the hospital via privately owned vehicles (PV), public transportation, or the police. We aimed to determine the mortality following road traffic injury based on the mode of transportation to our trauma center. Methods We performed a retrospective analysis of the Kamuzu Central Hospital (KCH) Trauma Registry from January 2011 to May 2018. Patients with road traffic injuries, presenting from the scene, were included. Those brought in dead or discharged from casualty were excluded. Bivariate analysis was performed over mortality. A Poisson multivariate regression determined the relative risk of mortality by prehospital transportation. Results 2853 patients were included; 7.8% (n = 223) died. Patients were transported by PV (n = 1963, 68.8%), minibus (n = 497, 17.4%), and police (268, 9.4%). No patients were transported by ambulance. Patients transported by police (1 h, IQR 0-2) and PV (1 h, IQR 0-2), arrived earlier than those transported by minibus (2 h, IQR 0-27), p \ 0.001. There was no difference in injury severity between the transportation cohorts. Compared to PV, patients transported by police (RR 1.56, 95% CI 1.13-2.17, p = 0.008) have an increased risk of mortality after controlling for injury severity. There was no difference in mortality in patients presenting by minibus (RR 0.83, 95% CI 0.55-1.24, p = 0.4). Conclusion Patients transported to KCH via police have a higher risk of mortality than those transported via private vehicle after controlling for injury severity. Training police in basic life support may be an initial target of intervention in reducing trauma mortality. Overall, the creation of a functional prehospital ambulance system with a cadre of paramedics is necessary for both trauma and non-trauma patients alike. This can only be achieved by training all stakeholders, the police, public transport drivers, and the public at large.

Tri‐modal Distribution of Trauma Deaths in a Resource‐Limited Setting: Perception Versus Reality

“…Data from neighboring countries in sub‐Saharan Africa have been mixed, with some reports showing no adverse outcomes related to police transport [21, 22]. However, evidence from Malawi showed that police transfer to the hospital after a motor vehicle injury increased the adjusted risk of death by 50% compared to private vehicle transportation [23].…”

“…Data from neighboring countries in sub-Saharan Africa have been mixed, with some reports showing no adverse outcomes related to police transport [21,22]. However, evidence from Malawi showed that police transfer to the hospital after a motor vehicle injury increased the adjusted risk of death by 50% compared to private vehicle transportation [23]. In environments with limited pre-hospital care availability, the police or private vehicles will inevitably transport patients to the hospital, especially after motor vehicle collisions or assaults.…”