The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study

Abstract

ObjectivesWe sought to characterise the prehospital experience of Tanzanian trauma patients, and identify barriers and facilitators to implement community-based emergency medical systems (EMS).SettingsOur study was conducted in the emergency department of an urban national referral hospital in Tanzania.ParticipantsA convenience sample of 34 adult trauma patients, or surrogate family members, presenting or referred to an urban referral emergency department in Tanzania for treatment of injury, participated in the study.InterventionsParticipation in semistructured, iteratively developed interviews until saturation of responses was reached.OutcomesA grounded theory-based approach to qualitative analysis was used to identify recurrent themes.ResultsWe characterised numerous deficiencies within the existing clinic-to-hospital referral network, including missed/delayed diagnoses, limited management capabilities at pre-referral facilities and interfacility transfer delays. Potential barriers to EMS implementation include patient financial limitations and lack of insurance, limited public infrastructure and resources, and the credibility of potential first aid responders. Potential facilitators of EMS include communities’ tendency to pool resources, individuals’ trust of other community members to be first aid responders, and faith in community leaders to organise EMS response. Participants expressed a strong desire to learn first aid.ConclusionsThe composite themes generated by the data suggest that there are myriad structural, financial, institutional and cultural barriers to the implementation of a formal prehospital system. However, our analysis also revealed potential facilitators to a first-responder system that takes advantage of close-knit local communities and the trust of recognised leaders in society. The results suggest favourable acceptability for community-based response by trained lay people. There is significant opportunity for care improvements with short trainings and low-cost supply planning. Further research looking at the effects of delay on outcomes in this population is needed.

Defining and improving the role of emergency medical services in Cape Town, South Africa

“…A systematic review of qualitative studies on maternal transport revealed eight major themes: time for transport, transport options, geography, local support, autonomy, culture, finance and ergonomics 21. A key recommendation was that clearer guidance should be provided to allow prioritisation of cases for emergency transport 11 12 21. Our study also revealed that errors in triage were key contributors to delays in transport.…”

“…In a recent study which was a key driver to this work, Hodkinson et al 10 described a 12 month review of all patients admitted to the paediatric intensive care unit (PICU) at the Red Cross Children's Hospital, Cape Town; they found that 30% of PICU admissions were potentially avoidable. The study team identified that delays within the EMS system and poor prehospital clinical care were key contributors to the morbidity and mortality of critically ill and injured children A survey of LMIC EMS systems identified 22 barriers to prehospital care,6 and local studies in Gabon and Tanzania have identified barriers to EMS and areas for targets improvement 11 12. Identifying areas for focused quality improvement interventions can provide significant benefit, both in LMIC and high income settings 13.…”

“…Addressing delays and barriers within emergency care is critical to improving the morbidity and mortality of critically ill children in LMIC settings 14. Given the expansion of EMS systems in LMIC settings, and the importance of EMS in improving outcomes for critically ill and injured children, we undertook a study to identify barriers to care within EMS in Cape Town 11 12 15–19…”

Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals

“…Our study represents one of the most comprehensive assessments of one-day trauma burden presenting to acute intake areas in districts and regional public hospitals of Tanzania. Most of the previous studies [ 19 , 20 , 24 ] had focused on the cities and areas with moderately- to highly-resourced hospitals, which left a gap in understanding the nature of injury and care in areas with different socio-economic settings. This study involved those areas but also many places not previously studied providing much-needed foundational knowledge of Tanzania’s trauma burden.…”

Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey

“…Most of RTI victims get to the hospital facilities from the scene through the efforts of untrained civilians and medically unknowledgeable lay responders such as police officers [ 7 , 8 ]. Although lay responders play a significant role in helping to transfer RTI victims from an accident scene to a health facility, they are generally not trusted by the victims to whom they provide care due to their low skills in managing casualties [ 9 ]. If effective care is to be provided, there is a need to strengthen the capacity of lay responders and for them to become competent in the provision of post-crash care [ 10 – 13 ].…”