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Rural Prehospital Trauma Systems Improve Trauma Outcome in Low-Income Countries: A Prospective Study from North Iraq and Cambodia

Husum, Hans MD; Gilbert, Mads MD, PhD; Wisborg, Torben MD, DEAA; Van Heng, Yang paramedic; Murad, Mudhafar MD

Journal of Trauma and Acute Care Surgery: June 2003 - Volume 54 - Issue 6 - p 1188–1196
doi: 10.1097/01.TA.0000073609.12530.19

Background: A five-year prospective study was conducted in North Iraq and Cambodia to test a model for rural prehospital trauma systems in low-income countries.

Results: From 1997 to 2001, 135 local paramedics and 5,200 lay First Responders were trained to provide in-field trauma care. The study population comprised 1,061 trauma victims with mean evacuation time 5.7 hours. The trauma mortality rate was reduced from pre-intervention level at 40% to 14.9% over the study period (95% CI for difference 17.2-33.0%). There was a reduction in trauma deaths from 23.9% in 1997 to 8.8% in 2001 (95% CI for difference 7.8-22.4%), and a corresponding significant improvement of treatment effect by year. The rate of infectious complications remained at 21.5 percent throughout the study period.

Conclusion: Low-cost rural trauma systems have a significant impact on trauma mortality in low-income countries.

From the, Tromsoe Mine Victim Resource Center (H.H) and the Department of Anesthesiology (M.G., T.W.), Institute of Clinical Medicine, University Hospital of Northern Norway, Tromsoe, Norway, and the Trauma Care Foundation (Y.V.H., M.M.), Suleimaniah, North Iraq and Battambang, Cambodia.

Submitted for publication June 14, 2002.

Accepted for publication October 14, 2002.

The study is sponsored by the Norwegian Ministry of Foreign Affairs; Health and Rehabilitation, Norway; Medical Research in Finnmark; Laerdal Foundation for Acute Medicine; University Hospital of Northern Norway; and Hammerfest Hospital, Norway.

Address for correspondence: Hans Husum, MD, Institute of Clinical Medicine, Tromsoe Mine Victim Resource Center, P.O. Box 80, N-9038 University Hospital of Northern Norway, Tromsoe, Norway; email:

© 2003 Lippincott Williams & Wilkins, Inc.