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Improvements in Prehospital Trauma Care in an African Country with No Formal Emergency Medical Services

Mock, Charles N. MD, PhD; Tiska, Michael BA, EMT; Adu-Ampofo, Martin MD; Boakye, Gabriel MD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 90-97
Original Articles

Background  A large proportion of trauma patients in developing countries do not have access to formal Emergency Medical Services. We sought to assess the efficacy of a program that builds on the existing, although informal, system of prehospital transport in Ghana. In that country, the majority of injured persons are transported to the hospital by some type of commercial vehicle, such as a taxi or bus.

Methods  A total of 335 commercial drivers were trained using a 6-hour basic first aid course. The efficacy of this course was assessed by comparing the process of prehospital trauma care provided before versus after the course, as determined by self-report from the drivers.

Results  Follow-up interviews were conducted on 71 of the drivers a mean of 10.6 months after the course. Sixty-one percent indicated that they had provided first aid since taking the course. There was considerable improvement in the provision of the components of first aid in comparison to what was reported before the course: crash scene management (7% before vs. 35% after), airway management (2% vs. 35%), external bleeding control (4% vs. 42%), and splinting of injured extremities (1 vs. 16%).

Conclusion  Even in the absence of formal Emergency Medical Services, improvements in the process of prehospital trauma care are possible by building on existing, although informal, patterns of prehospital transport.

From Harborview Injury Prevention and Research Center, University of Washington (C.N.M.), Seattle, Washington, Department of Surgery, Kwame Nkrumah University of Science and Technology (C.N.M., M.A.-A., G.B.), Kumasi, Ghana, and George Washington University (M.T.), Washington, D.C.

Submitted for publication May 6, 2001.

Accepted for publication January 2, 2002.

Presented, in part, at the Fifth World Conference on Injury Control, March 5–8, 2000, New Delhi, India; and poster presentation at the 60th Annual Meeting of the American Association for the Surgery of Trauma, October 11–15, 2000, San Antonio, Texas.

Address for reprints: Charles N. Mock, MD, PhD, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104; email:

© 2002 Lippincott Williams & Wilkins, Inc.