Management of Preventable Deaths due to Road Traffic Injuries in Prehospital Phase; a Qualitative Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
Introduction: Prehospital care plays an important role in decreasing the number of deaths due to road traffic injuries (RTIs). This study aimed to identify the challenges of preventable deaths due to RTIs in the prehospital phase based on the attitudes of stakeholders.
Methods: Conventional content analysis of qualitative study was used to analyze the data. The participants were 24 RTI prevention experts from fire-fighting organization, traffic police, the Red Crescent, Emergency Medical Services staff, emergency medicine specialists, and hospital emergency nurses who were selected by means of purposive sampling. Data were collected using unstructured interviews and analyzed by means of data coding, followed by extracting sub-categories, and main categories.
Results: Six main categories were extracted as the major challenges of preventable deaths in RTIs in the prehospital phase including â€œpoor management of the crash sceneâ€ with two subcategories of lack of rapid access to the patient and lack of scene safety, â€œlack of adequate rules and regulationsâ€ with two subcategories of lack of protocols and guidelines and lack of clear duties checklists, â€œpoor management of timeâ€ with two subcategories of elongated response time at the crash scene and elongated time of victim transport, â€œlow quality of trainingâ€ with two subcategories of insufficient training of Emergency Medical Services (EMS) staff and inadequate public training, â€œpoor communication and coordinationâ€ with two subcategories of poor communication of EMS staff and lack of uniform commandership at the crash scene, and â€œlow quality of victim managementâ€ with two subcategories of low quality of clinical care and lack of accurate clinical assessment.
Conclusion: The following measures are necessary to reduce preventable deaths due to RTIs in the prehospital phase: accurate clinical assessment of the victim on the scene, provision of high quality and accurate clinical care, enforcement of legal obligations and using protocols in the field of victim management, coordination of the involved organizations through identifying the duties and responsibilities of each organization, and full management of the crash scene by assigning a unique commander to each unit and creation of the highest level of safety on crash scene.
- emergency medical services
How to Cite
World Health Organization. Global status report on road safety 2013: supporting a decade of action: World Health Organization; 2013.
World Health Organization. 10 facts on global road safety 2015 [Available from: https://www.who.int/features/factfiles/roadsafety/en/.
Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. World Health Organization Geneva; 2004.
Eftekhari A, Khorasani-Zavareh D, Nasiriani K. The Importance of Designing a Preventable Deaths Instrument for Road Traffic Injuries in Pre-hospital Phase. Health in Emergencies and Disasters Quarterly. 2018;3(4):177-78.
Gopalakrishnan S. A public health perspective of road traffic accidents. Journal of family medicine and primary care. 2012;1(2):144-50.
Bakke HK, Steinvik T, Eidissen SI, Gilbert M, Wisborg T. Bystander first aid in traumaâ€“prevalence and quality: a prospective observational study. Acta Anaesthesiologica Scandinavica. 2015;59(9):1187-93.
Khorasani-Zavareh D. System versus traditional approach in road traffic injury prevention: a call for action. J Inj Violence Res. 2011;3(2):61.
Motamedi MHK, Dadgar E, Ebrahimi A. Curbing Road Traffic Accidentsâ€“The Major Cause of Facial Fractures. International journal of emergency mental health. 2014;16(2):326-7.
Balikuddembe JK, Ardalan A, Khorasani-Zavareh 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 emergency medicine. 2017;17(1):29.
Rutstein DD, Berenberg W, Chalmers TC, Child 3rd CG, Fishman AP, Perrin EB, et al. Measuring the quality of medical care: a clinical method. New England Journal of Medicine. 1976;294(11):582-8.
Oliver GJ, Walter DP. A call for consensus on methodology and terminology to improve comparability in the study of preventable prehospital trauma deaths: a systematic literature review. Academic emergency medicine. 2016;23(4):503-10.
Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification strategies for establishing reliability and validity in qualitative research. International journal of qualitative methods. 2002;1(2):13-22.
Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.
Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low-and middle-income countries: recommendations for action. Bulletin of the World Health Organization. 2005;83:626-31.
Kironji AG, Hodkinson P, de Ramirez SS, Anest T, Wallis L, Razzak J, et al. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC health services research. 2018;18(1):291.
Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS One. 2009;4(9):e6955.
Tannvik T, Bakke H, Wisborg T. A systematic literature review on first aid provided by laypeople to trauma victims. Acta Anaesthesiologica Scandinavica. 2012;56(10):1222-7.
Bahadori M, Ghardashi F, Izadi AR, Ravangard R, Mirhashemi S, Hosseini SM. Pre-hospital emergency in Iran: A systematic review. Trauma monthly. 2016;21(2):e31382.
Ahmadi Amoli Hadi TH, Khashayar Patrishiah, Panahi Farzad, Alavi Moghadam Mostafa , Ahmadi Amoli Mohsen. Evaluating the adequacy of pre-hospital emergency procedures in referral trauma patients to the emergency department of Sina Hospital from September 2003 to September 2004. Pajoohandeh. 2009;13(3):203-11.
Hosseini SMR, Maleki M, Gorji HA, Khorasani-Zavareh D, Roudbari M. Factors affecting emergency medical dispatchersâ€™ decision-making: a qualitative study. Journal of Multidisciplinary Healthcare. 2018;11:391-8.
Joshipura M, Mock C, Goosen J, Peden M. Essential trauma care: strengthening trauma systems round the world. Injury. 2004;35(9):841-5.
Haghani F, Sadeghi N. Training in Pre-hospital Emergency: Needs and Truths. Iranian Journal of Medical Education. 2011;10(5):1273-80.
Khankeh H, Ainia SH, GH M, Khorasani- Zavareh D, al. e. Pre-hospital services with emphasis on traffic accidents: A review of developed and developing countries. Quarterly Journal of Health Promotion Management. 2013;2(2):71-9.
Mohan D, Tiwari G, Meleckidzedeck K, Fredrick MN. Road traffic injury prevention training manual. Geneva: World Health Organization and Indian Institute of Technlogy Delhi; 2006.
Khorasani-Zavareh D, Mohammadi R, Bohm K. Factors influencing pre-hospital care time intervals in Iran: a qualitative study. Journal of injury and violence research. 2018;10(2):83.
Ebben RH, Vloet LC, Verhofstad MH, Meijer S, Mintjes-de Groot JA, van Achterberg T. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine. 2013;21(1):9.
Heidari M, Aryankhesal A, Khorasani-Zavareh D. Laypeople roles at road traffic crash scenes: a systematic review. International journal of injury control and safety promotion. 2018:1-10.
Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World journal of surgery. 2009;33(12):2512-21.
Esmaeili A AH, Zahiri M. Investigating the role of road policing in the field of road accidents management: Ardabil province. Quarterly Journal of Traffic Management Studies. 2011;5(17):1-23.
Amiri M SH, Khankeh H, Momeni E, Eini E. Factors Affecting Crash Scenario Management: A Study of Theory of Land in the Islamic Republic of Iran. Quarterly research studies. 2015;3(11).
Koerselman G, Korzec A. A proposed checklist when deviating from guidelines. Nederlands tijdschrift voor geneeskunde. 2008;152(32):1757-9.
Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Medical care. 1994:202-13.
Trauma ACoSCo. Advanced Trauma Life Support for Doctors.: American College of Surgeons. Chicago; 1997.
Roudsari BS, Shadman M, Ghodsi M. Childhood trauma fatality and resource allocation in injury control programs in a developing country. BMC public health. 2006;6(1):117.
Zargar M, Kalantar Motamedi SMR, Karbakhsh M, Ghodsi SM, Rahimi-Movaghar V, Panahi F, et al. Trauma care system in Iran. Chinese Journal of Traumatology. 2011;14(3):131-6.
Jacobs LM, Sinclair A, Beiser A, D'agostino RB. Prehospital advanced life support: benefits in trauma. The Journal of trauma. 1984;24(1):8-13.
Cunningham P, Rutledge R, Baker CC, Clancy TV. A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. Journal of Trauma and Acute Care Surgery. 1997;43(6):940-6.
Petri RW, Dyer A, Lumpkin J. The effect of prehospital transport time on the mortality from traumatic injury. Prehospital and disaster medicine. 1995;10(1):24-9.
Pepe PE, Wyatt CH, Bickell WH, Bailey ML, Mattox KL. The relationship between total prehospital time and outcome in hypotensive victims of penetrating injuries. Annals of emergency medicine. 1987;16(3):293-7.
Dadashzadeh A DJ, Shams Vahdati S, Soheili A, Sadeghi Bazarghani H. The Nature of Prehospital Medical Interventions Delivered to Traumatic Patients in Tabriz. The J Urmia Nurs Midwifery Fac. 2017;15(3):159-67.
Rakei M, Nader F. Mean arrival time for patients with head injury in Mobasher kashani hospital in 2001. Journal of Shiraz University of Medical Sciences. 2002;9:107.
Moradian MJ PM, Ettehadi R. Studying the Time of Response and Results of Delay in Emergency Medical System's (EMS) missions in Shiraz. Quarterly Scientific Journal of Rescue & Relief. 2013;5(2):30-9.
Sheikh Rabari A SM, Saberi Anari M, Ghaedi Heidari F. Assessing Educational Needs of Emergency Medical Technicians. Iranian Emergency Medicine Journal. 2016;4(3):111-7.
Husum H, Gilbert M, Wisborg T. Training pre-hospital trauma care in low-income countries: the'Village University'experience. Medical teacher. 2003;25(2):142-8.
Kahoee M, Alaee S. Understanding information needs of nursing students in emergency medicine eduction. Koomesh. 2010:155-62.
Hajiabady F BM, editor The compertment survey of the situational assessment teaching rate in crisis situation between nursing and emergency student in Mashsd nursing and midwifery faculty in 2005. Proceeding of the 3rd International Congress of Cure and Health and Crisis Management in Disaster 2001; Iran.
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