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The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems.
MedLine Citation:
PMID:  23196339     Owner:  NLM     Status:  Publisher    
BACKGROUND: Trauma is one of the leading prehospital disease profiles in South Africa in general and in KwaZulu-Natal (KZN) in particular. The present study was designed to review the prehospital burden of injury in KZN, identify trauma burden to ambulance ratios, analyze system deficiencies, and propose a prehospital trauma system that is Afrocentric in nature. METHODS: Approval from the relevant ethics authorities was obtained. Using a convenience data set all Emergency Medical Service (EMS) call data for the months of March and September 2010 were reviewed for the three main EMS providers in KZN. Data were extrapolated to annual data and placed in the context of population, ambulance service, and facility. The data were then mapped for area distribution and prehospital workload relative to the entire province. Questionnaire-based assessments of knowledge and deficiencies of the current system were completed by senior officers of the provincial system as part of the analysis of the current system. RESULTS: The total annual call burden for trauma ranges between 94,840 and 101,420, or around 11.6 trauma calls per thousand of the population per year. Almost 70 % of calls were either for interpersonal intentional violence or vehicular collisions. Only 0.25 % of calls involved aeromedical resources. Some 80 % of patients were considered to be moderately to seriously injured, yet only 41 % of the patients were transported to a suitable level of care immediately, with many going to inappropriate lower level care facilities. Many rural calls are not attended within the time norms accepted nationally. Deficiencies noted by the questionnaire survey are the general lack of a bypass mechanism and the feeling among staff that most EMS bases do not have a bypass option or feel part of a system of care, despite large numbers of staff having been recently trained in triage and major trauma care. CONCLUSIONS: The prehospital trauma burden in KZN is significant and consumes vital resources and gridlocks facilities. A prehospital trauma system that is financially sustainable and meets the needs of the trauma burden is proposed to enable Afrocentric emergency care planning for low and middle income regions.
Timothy Craig Hardcastle; Melissa Finlayson; Marc van Heerden; Ben Johnson; Candice Samuel; David J J Muckart
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-30
Journal Detail:
Title:  World journal of surgery     Volume:  -     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Inkosi Albert Luthuli Central Hospital, Berea, South Africa,
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