Pre-hospital care in Nigeria: A country without emergency medical services

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Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania

<p>Abstract</p> <p>Background</p> <p>Road traffic crash is of growing public health importance worldwide contributing significantly to the global disease burden. There is paucity of published data on road traffic crashes in our local environment. This study was carried out to describe the injury characteristics and outcome of road traffic crash victims in our local setting and provide baseline data for establishment of prevention strategies as well as treatment protocols.</p> <p>Methods</p> <p>This was a prospective hospital based study of road traffic crash victims carried out at Bugando Medical Centre in Northwestern Tanzania between March 2010 and February 2011. After informed consent to participate in the study, all patients were consecutively enrolled into the study. Data were collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.</p> <p>Results</p> <p>A total of 1678 road traffic crash victims were studied. Their male to female ratio was of 2.1:1. The patients ages ranged from 3 to 78 years with the mean and median of 29.45 (± 24.22) and 26.12 years respectively. The modal age group was 21-30 years, accounting for 52.1% patients. Students (58.8%) and businessmen (35.9%) were the majority of road traffic crash victims. Motorcycle (58.8%) was responsible for the majority of road traffic crashes. Musculoskeletal (60.5%) and the head (52.1%) were the most common body region injured. Open wounds (65.9%) and fractures (26.3%) were the most common type of injuries sustained. The majority of patients (80.3%) were treated surgically. Wound debridement was the most common procedure performed in 81.2% of the patients. The complication rate was 23.7%. The overall average length of hospital stay (LOS) was 23.5 ± 12.3 days. Mortality rate was 17.5%. According to multivariate logistic regression analysis, patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with long bone fractures stayed longer in the hospital and this was significant (P < 0.001) whereas the age of the patient, severe trauma (Kampala Trauma Score II ≤ 6), admission Systolic Blood Pressure < 90 mmHg and severe head injury (Glasgow Coma Score = 3-8) significantly influenced mortality (P < 0.001).</p> <p>Conclusion</p> <p>Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. Early recognition and prompt treatment of road traffic injuries is essential for optimal patient outcome.</p

Citywide Trauma Experience in Mwanza, Tanzania: A Need for Urgent Intervention.

Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region

Protecting Vulnerable Road Users from Injury

Aymery Constant and Emmanuel Lagarde discuss policies to protect pedestrians, and pedal and motor cyclists, from injury

Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India

<p>Abstract</p> <p>Background</p> <p>Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash.</p> <p>Methods</p> <p>Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study.</p> <p>Results</p> <p>378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13–15, 12% a GCS of 9–12 and 11% a GCS of 3–8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08–0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 – 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23–20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet.</p> <p>Conclusion</p> <p>Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.</p

Knowledge and practice of cardiopulmonary resuscitation among Nigerian doctors

Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors. Methods: Questionnaires were distributed randomly to doctors in a Nigerian University Teaching Hospital. Respondents returned the unsigned questionnaires into a sealed box to protect their identity. There were 45 questions covering theories and practice of CPR. Results: Fifty-six of 94 (59.6 %) doctors returned their questionnaires; comprising 16 Interns, 21 Registrars, 8 Senior Registrars, 7 Consultants and 4 others. Twenty of the 56 respondents (35.7 %) would do CPR for only 20 minutes, 25%-89% respondents (mean 61.6% 24%) did not know items absolutely essential for CPR, 37 (66.1%) could not use adrenaline effectively either by route of administration or dosage, 25 (44.6%) would use inappropriate venous access, and majority (41 of 56, 73.2 %) would not use blood gas analysis, urine output, ECG to monitor response to CPR. Thirty-nine (69.9%) listed lack of materials as the greatest problem faced in carrying out CPR. Thirty-eight (67.9%) believed other doctors knowledge of CPR was inadequate and 54 (96%) felt doctors needed to update their knowledge of CPR. Conclusion: Cardiopulmonary resuscitation is associated with problems of lack of materials, and demonstrable inadequate knowledge and application of its pathophysiology as more than two thirds of the respondents believed other doctors' knowledge of CPR was inadequate. These three parameters may be responsible for the observed poor success rate in CPR. Efforts to correct these should improve CPR success rate among Nigerian doctors. Keywords: Cardiopulmonary resuscitation, Cardiac arrest, Respiratory failure, Nigeria. Nig. J. of Surgical Research Vol.4(1-2) 2002: 12-2

Trauma practice in Nigeria

Background: Trauma has assumed a pre-eminent epidemic proportion in the hierarchy of diseases afflicting the growing population of many developing countries including Nigeria competing with infections, cardiovascular diseases and cancers for attention and funding. The spectrum, quantum and future prospects of trauma and its practices have continued to expand but the response towards improving the current Nigerian situation is lagging behind. Objectives: To examine the current situation of trauma practice and the contribution of practitioners in the areas of research, training and community service in Nigeria and make suggestions for progress. Methodology: Electronic and manual bibliographic search was done using such words as trauma, injury, coupled with morbidity, mortality, death or fatality from publications across Nigeria. Personal contacts with colleagues for relevant papers were also done. Papers were reviewed for content, through the abstracts and all published works that provided information relevant to the objectives were read fully. Personal experience in the field was contributory. Results: Eight hundred and three abstracts were selected from the over 10,100 generated by the searches. Thirty four articles were contributed by colleagues and eleven were clearly used. Trauma from road traffic injuries and violence (gunshot, assault) constituted 40-90% of emergency room incidence with high rates in hospitals near highways. Autopsy reports confirmed road traffic injuries as commanding up to 80% of unnatural deaths in many teaching hospitals in Nigeria. There is no organized Emergency Medical Services but ambulance services are common in some cities. Many patients are largely transported by relations or bystanders when involved in trauma. Preventable Trauma Death rate is reportedly high, as much as 73.7% in one report. Conclusion: the spectre of trauma as an epidemic is receiving attention from practitioners and government but it is a far cry from what is needed. The spectrum is elongated in variety with the menace of motorcycle transport injuries overtaking other vehicle injuries in the some major cities and commanding an increasing prevalence in sub-urban areas. All health Institutions in Nigeria especially the Orthopaedic Hospitals and Federal Medical Centres need to improve on trauma research and publications just as the Nigeria Orthopaedic Association should intensify its championing of research efforts. A committee to evaluate and classify institutions on their level of trauma practice in order to guide referrals and sanction erring practitioners and establishments by complementing the Medical and Dental Council of Nigeria is desirable