Qualitative evaluation of trauma delays in road traffic injury patients in Maringá, Brazil

Abstract

BackgroundRoad traffic injuries (RTIs) are the eighth leading cause of death worldwide, with an estimated 90% of RTIs occurring in low- and middle-income countries (LMICs) like Brazil. There has been minimal research in evaluation of delays in transport of RTI patients to trauma centers in LMICs. The objective of this study is to determine specific causes of delays in prehospital transport of road traffic injury patients to designated trauma centers in Maringá, Brazil.MethodsA qualitative method was used based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) approach. Eleven health care providers employed at prehospital or hospital settings were interviewed with questions specific to delays in care for RTI patients. A thematic analysis was conducted.ResultsResponses to primary causes of delay in treatment to RTI patients fell into the following categories: 1) lack of public education, 2) traffic, 3) insufficient personnel/ambulances, 4) bureaucracy, and 5) poor location of stations. Suggestions for improvement in delays fell into the categories of 1) need for centralized station/avoid traffic, 2) improving public education, 3) Increase personnel, 4) increase ambulances, 5) proper extrication/rapid treatment.ConclusionOur study found varied responses between hospital and SAMU providers regarding specific causes of delay for RTI patients; SAMU providers cited primarily traffic, bureaucracy, and poor location as primary factors while hospital employees focused more on public health aspects. These results mirror prehospital system challenges in other developing countries, but also provide solutions for improvement with better infrastructure and public health campaigns.

Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

“…Bystander education and awareness has been identified as an important factor influencing this delay, and a qualitative study on trauma delays for patients who had road traffic injury in Brazil found that bystander capacity to provide care was low. 20 Simple interventions at the community level may be highly effective to mobilise first responders in low-resource settings. For example, interventions have included training commercial drivers in providing first aid 21 and training laypeople to be first responders.…”

Understanding factors of ambulance delay and crash to enhance ambulance efficiency: an integrative literature review

“…In the study conducted by Patel and his friends, 4 traffic conditions are the main cause of ambulance delays, followed by bad location and lack of personnel. In a study conducted by Noorani, 10 what influenced ambulance delay are traffic conditions, transportation availability, and distance of travel.…”

“…3 Statistics for Road Traffic Injuries (RTIs) also show that an estimated 90% of RTIs occur in low and middle-income countries. 4 Even in Indonesia every 3 hours, there are deaths due to traffic accidents. 5 Trauma patients require immediate medical treatment to improve survival and prevent disabilities.…”

Políticas e intervenciones para reducir lesiones por accidentes de tránsito: De la evidencia a la práctica

“…La literatura científica ha reportado experiencias donde los centros de asistencia y traumatología fueron efectivos en la reducción de las lesiones de AT, basándose en minimizar el tiempo entre la lesión y el tratamiento de reanimación hospitalaria; así, en Francia está basado en el triaje prehospitalario de las víctimas en la escena del accidente a fin de establecer la prioridad en la atención y la inclusión de personal médico entrenado en sus ambulancias para estabilizar al individuo lesionado en el menor tiempo posible 21 . Estudios sobre la atención de emergencias prehospitalarias y AT reportaron barreras que limitan la ejecución de sus intervenciones, las cuales fueron: la ausencia de un sistema integral de servicios médicos de emergencia (SME) entre la capital y el país, la baja calidad en los primeros auxilios brindados, insuficiente entrenamientos sobre respuesta inmediata, recursos inadecuados, demoras en la respuesta de atención y en el traslado a los SME 22 , el involucramiento negativo de ciudadanos, falta de coordinación entre las autoridades, inadecuados servicios prehospitalarios en número y distribución, deficiencias en infraestructura urbana y sistemas de comunicación 23,24,25 . El panel de expertos luego de analizar y contextualizar la evidencia recomendó: establecer una central de emergencia única que pueda derivar la información a las instancias correspondientes, elaborar un protocolo de atención prehospitala-ria con roles definidos para los policías, bomberos, personal de salud, fiscales y ciudadanos, así como la atención en foco con una priorización de víctimas como en accidentes masivos, desarrollar un sistema de educación continua al público que incluya: cómo informar la emergencia (que requisitos mínimos se requiere para poder hacer una llamada útil como, lugar, víctimas, puntos de referencia, y otros datos), concientizar sobre la importancia de la disponibilidad de la vía libre, de despejar esta vía para la circulación de las ambulancias.…”