Assessment of pre-hospital care of road traffic injured patients admitted at Muhimbili National Hospital and Muhimbili orthopedic institute, Dar es salaam, Tanzania.

Abstract

Background: Injury and other medical emergencies are becoming increasingly common in low and middle-income countries. Most of the deaths from these conditions occur outside of hospitals, necessitating the development of pre-hospital care which is inadequately developed in Tanzania to meet the growing needs for emergency care. Objective: The aims of the study was to assess and describe the current status of pre-hospital care of road traffic injured victims, establish the monthly prevalence of RTI patients admitted at Muhimbili National Hospital and Muhimbili Orthopedic Institute, and determine the resulting disabilities caused by road traffic crash injuries. Methods: A descriptive cross-sectional study design using quantitative research methods was used. A non-probability convenience sampling method was used to select 161 road traffic injured patients from surgical, orthopedic and neurosurgical departments at MNH and MOI. A structured questionnaire which contained closed-ended questions was used to collect information. The total number of inpatients during study period was gathered through hospital data. Results: Majority of patients 121(75.2%) were aged between 18–40 years with the mean age of 33.66 ± SD11.3years. Most 121(75.2%) were males with male to female ratio of 3:1. Primary school leavers and self employed patients were the largest groups of road traffic crash victims. Most crashes occurred along the highways and passengers were the most injured followed by drivers and pedestrians. Almost 12.4% of the respondents had used alcohol 6 hours before injury. Motorcycles were responsible for most road traffic crashes followed by motor vehicles. Most cars (31.7%) did not have seat belt. Regarding helmet use most victims (46.0%) reported to have used helmet sometimes and 21(13%) have never used helmet in the past 30 days before injury. Most victims (55.3%) sustained multiple injuries followed by fractures (32.9%) and most of them were transported to health facility by private cars. A bigger proportion of RTI patients 97.5% received some form of pre-hospital care with some first aid before reaching the health facility. However, only 1.3% of these patients had pre-hospital care been provided by trained ambulance personnel. The pre-hospital care was unsatisfactory in the sense that it was provided by untrained and unskilled bystanders. Regarding the nature of pre-hospital care received most of them 137(87.3%) reported that they were removed from the wreck only and sent to health facility. Majority 149(92.5%) reported to have disability following the current road traffic injury mostly 92(61.7%) inability/difficult to use lower limbs and upper limbs.

Conclusion: There is an urgent need for the government to establish Emergence Medical Care System and shift informal pre-hospital care provided by untrained society to formal one rendered by trained and skilled health care professionals. Also there is a need to improve and reinforce the existing system of informal pre-hospital care provided by bystanders, friends/family and police with adequate and skillful training.