Two thirds of the world’s population live in the developing world, most of which are on the African continent, and suffer from a lack of access to primary health care. In 2001, injuries accounted for about 5.1 million deaths (about 20% of which are preventable by simple surgical intervention). Africa has the highest road traffic injury mortality rate in the world at 28/100,000 people, and has 50 deaths/10,000 vehicles compared to 1.7 deaths/10,000 vehicles in high-income countries. Injury accounts for more than deaths caused by tuberculosis (2.5%), diarrhea (4.3%) and malaria (2.9%), human immunodeficiency virus (6%) or cancer (5.2%). The worldwide leading cause of death among young life between 5 and 40 years is injury. Projections show that, between 2000 and 2020 road traffic deaths will increase by 83% in low- and middle-income countries. In contrast, there will be a further 30% decline in road traffic deaths in high-income countries, continuing a pattern that has been established in recent decades. Yet, the world’s focus, although important, remains focused on the prevention and care of communicable diseases such as malaria, HIV / AIDS and nutrition.
However, as nations simultaneously address their infectious contributors to mortality and as well develop transportation infrastructure, increasingly, trauma is becoming a major cause of morbidity and mortality in poverty stricken developing countries like Ghana. Effective trauma care requires sustenance and sufficiency of three components: Emergency Medical services (EMS), Emergency Departments to stabilize acute trauma victims and Orthopedic/Trauma healthcare resources. Motec Life – UK (Motec) is a multi-disciplinary charity organization based in the United Kingdom looking at developing a self sustaining Trauma Care in developing countries like Ghana.
In October 23rd 2008 a paramedic workshop was organized by Motec Life and the Ministry of Health represented by the Ghana National Ambulance Service, Directorate of Occupational Health and the Eastern Regional Directorate with the co-operation of the Ghana National Fire Service (ER) and the Professional Drivers Union of Ghana. The event held in Kofordiua was attended by 120 participants, and was the first national paramedic training program of this kind. The training workshop supported a morning of didactic teaching comprised of ambulance aid skills, paramedic aid skills and a broad overview of applicable ALS/ATLS. The afternoon comprised of split practical skills sessions – 4 stations: Cardio-Pulmonary Resuscitation, Spine Immobilisation, Emergency Intubation and Handling of Accident Victims. There was also a highly attended session on reinforcement of Cardio-Pulmonary Resuscitation, practical teaching on chest compressions and airway management, and updating the resuscitation algorithm.
Given the size of Ghana and the relatively few centers able to provide trauma care, transport times can vary from 30mins to 6 hours. There is also significant regional and seasonal variation in transport times as rains and flooding can obstruct major roadways and impede traffic. Thus, a significant proportion of injury deaths occur in the pre-hospital setting, which emphasizes the role of the paramedic team in providing temporizing medical care while en route to a definitive treatment facility. Effective trauma care development is slow as the government funds 80% of the public health services through general taxation and donor funds. The first approach to address this issue is to improve pre hospital care via paramedic training with workshops similar to the Motec conference. Of course, efforts to improve pre-hospital medical care should be mated with significant investments in improving hospital-based emergency care.
A barrier to development of trauma centers with Emergency medicine departments is the cash and carry system that is currently in place for supplies and medicines. As such many existing hospital models focus on making a diagnosis, and not on triage or rapid stabilization, and as such there is no conception of what we would consider emergency medicine. Once patients are dropped off by EMS there has to be a pick up on the part of the receiving hospital to provide rapid, effective emergency medical and surgical care. Thus only by simultaneous development of EMS, Emergency medicine care and trauma care will there be a significant dent in mortality and an improvement in injury related outcomes.