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Piloting a Layperson Prehospital Care System in Rural Uganda

Published online by Cambridge University Press:  01 March 2023

Heather A. Brown Open the ORCID record for Heather A. Brown [Opens in a new window] ,
Amanda J. Stratton ,
Joseph Gill ,
Spencer F. Robinson ,
Vincent Tumisiime  and
Caroline Brady
Heather A. Brown*
Affiliation:
Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South Carolina USA
Amanda J. Stratton
Affiliation:
Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South Carolina USA
Joseph Gill
Affiliation:
Department of Emergency Medicine, UTHealth Houston/McGovern Medical School, Houston, Texas USA
Spencer F. Robinson
Affiliation:
Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South Carolina USA
Vincent Tumisiime
Affiliation:
Masindi Kitara Medical Center, Masindi, Uganda
Caroline Brady
Affiliation:
Department of Internal Medicine, Emergency Medicine Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
*
Correspondence: Heather A. Brown, MD, MPH, DTM&H Department of Emergency Medicine Prisma Health Midlands/University of South Carolina 14 Medical Park Drive, Suite 350 Columbia, South Carolina 29203 USA E-mail: Heather.brown2@prismahealth.org
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Abstract

Introduction:

In many low-income countries, basic prehospital Emergency Medical Services (EMS) remain under-developed, resulting in significant delays or the complete inability to access care.

Study Objective:

The purpose of this study was to analyze the effectiveness of a layperson EMS training targeting motorcycle taxi (boda) drivers in a rural region of Uganda.

Methods:

Fifty (50) adult boda drivers from Masindi, Uganda were selected for a one-day training course including lectures and simulation. Course content covered basic prehospital skills and transport. Participants were given a first responder kit at completion of the course. Understanding of material was assessed prior to training, immediately after course completion, and four months from the initial course using the same ten question test. Test means were analyzed using a standard linear regression model. At the four-month follow up, all 50 boda drivers participated in semi-structured small group qualitative interviews regarding their perception of the course and experiences implementing course skills in the community. Boda drivers were asked to complete a brief form on each patient transported during the study period. For patients transported to Masindi Kitara Medical Center (MKMC), hospital trauma registry data were analyzed.

Results:

Trainees showed both knowledge acquisition and retention with pre-test scores of 21.8% improving to 48.0% at course completion and 57.7% at the four-month follow up. Overall, participant’s scores increased by an average of 35% from the pre-test to the second post-test (P <.001). A total of 69 patient forms were completed on transported patients over the initial four-month period. Ninety-five percent (95%) of these were injured patients, and motorcycle crash was the predominant mechanism of injury (48% of injuries). Eight patients were transported to MKMC, but none of these patients were recorded in the hospital trauma registry. Major barriers identified through semi-structured interviews included harassment by police, poor road conditions, and lack of basic resources for transport. Ninety-four percent (94%) of trainees strongly agreed that the training was useful. Total costs were estimated at $3,489 USD, or $69 per trainee.

Conclusion:

Motorcycle taxi drivers can be trained to provide basic prehospital care in a short time and at a low cost. While there is much enthusiasm for additional training and skill acquisition from this cohort, the sustainability and scalability of such programs is still in question.

Keywords

developing countriesEmergency Medical Servicesemergency responderUganda
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 2 , April 2023 , pp. 179 - 184
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Lozano, R, Naghavi, M, Foreman, K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128.CrossRefGoogle ScholarPubMed
Kobusingye, OC, Hyder, AA, Bishai, D, Hicks, ER, Mock, C, Joshipura, M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626–631.Google ScholarPubMed
The World Health Organization. The top 10 causes of death. http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed May 25, 2021.Google Scholar
The World Bank. World Bank Country Groups. www.worldbank.org/en/country. Accessed May 11, 2021.Google Scholar
World Health Organization. Noncommunicable diseases (NCD) country profiles: Uganda, 2014. http://www.who.int/nmh/countries/uga_en.pdf?ua=1. Accessed July 29, 2021.Google Scholar
World Health Organization. Uganda: WHO statistical profile. http://www.who.int/gho/countries/uga.pdf?ua=1. Accessed July 29, 2021.Google Scholar
Suryanto, M, Plummer, V, Boyle, M. EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64–70.CrossRefGoogle ScholarPubMed
Balikuddembe, JK, Ardalan, A, Khorasani-Zavereh, D, Nejati, A, Raza, O. Weaknesses and capacities affecting the prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study. BMC Emerg Med. 2017;17(29):1–11.Google ScholarPubMed
Jayaraman, S, Mabweijano, JR, Lipnick, MS, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg. 2009;33(12):2512–2521.CrossRefGoogle ScholarPubMed
Kobusingye, OC, Guwatudde, D, Owor, G, Lett, RR. Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev. 2002;8(2):133–136.CrossRefGoogle Scholar
World Health Organization. Prehospital trauma care systems. Geneva, Switzerland, 2005. http://apps.who.int/iris/bitstream/handle/10665/43167/924159294X.pdf;jsessionid=EB18AA07FBB4D5C17FC9494BDA441AA2?sequence=1. Accessed May 23, 2022.Google Scholar
Callese, TE, Richards, CT, Shaw, P, et al. Layperson trauma training in low- and middle-income countries: a review. Journal Surg Res. 2014;190(1):104–110.CrossRefGoogle ScholarPubMed
Geduld, H, Wallis, L. Taxi driver training in Madagascar: the first step in developing a functioning prehospital emergency care system. Emerg Med J. 2011;28(9):794–796.CrossRefGoogle ScholarPubMed
Delaney, PG, Bamuleke, R, Lee, YJ. Lay first responder training in Eastern Uganda: transportation infrastructure to build an effective emergency care training program. World J Surg. 2018;42(8):2293–2302.CrossRefGoogle ScholarPubMed
Hancock, CJ, Delaney, PG, Eisner, ZJ, et al. Developing a lay first responder program in Chad: a 12-month follow-up evaluation of a rural prehospital emergency care program. Prehosp Disaster Med. 2020;35(5):546–553.Google ScholarPubMed
Boeck, MA, Callese, TE, Nelson, SK, et al. The development and implementation of a layperson trauma first responder course in La Paz, Bolivia: a pilot study. Injury. 2018;49(5):885–896.Google Scholar
Balhara, KS, Bustamante, ND, Sevan, A, et al. Bystander assistance for victims in low- and middle-income countries: a systematic review of prevalence and training interventions. Prehosp Emerg Care. 2019;23(3):389–409.CrossRefGoogle ScholarPubMed
Masindi District Local Government. District five-year development plan. Masindi, Uganda. https://www.masindi.go.ug/sites/default/files/MASINDI%20DDP%20FY%202015_2016%20%20_%20%202019_2020.pdf. Published 2015. Accessed July 27, 2022.Google Scholar
Brown, HA, Skaggs, J, Brady, C, Tumusiime, V, White, AS. Injury patterns of patients presenting to a non-governmental hospital in Western Uganda. Afr J Emerg Med. 2020;10(3):118–122.CrossRefGoogle ScholarPubMed
Varghese, M, Mohan, P. When Someone is Hurt…A First Aid Guide for Lay Persons and Community Workers. 1 st ed. Delhi, India: Indian Institute of Technology; 1998.Google Scholar
Wener, D, Thuman, C, Maxwell, J. Where There Is No Doctor - A Village Health Care Handbook. Rev ed. Berkeley, California USA: Hesperian Health Guides; 2011.Google Scholar
Iserson, KV. Improvised Medicine: Providing Care in Extreme Environments.1st ed. USA: The McGraw-Hill Companies, Inc; 2012.Google Scholar
Purcell, LN, Nip, E, Gallaher, J, Varela, C, Gondwe, Y, Charles, A. Design and implementation of a hospital-based trauma surveillance registry in a resource-poor setting: a cost analysis study. Injury. 2020;51(7):1548–1553.Google Scholar
Hollis, SM, Amato, SS, Bulger, E, Mock, C, Reynolds, T, Stewart, BT. Tracking global development assistance for trauma care: a call for advocacy and action. J Glob Health. 2021;11:04007.CrossRefGoogle Scholar