Improvements in prehospital trauma care in an African country with no formal Emergency Medical Services

Background: A large proportion of trauma patients in developing countries do not have access to formal Emergency Medical Services. We sought to assess the efficacy of a program that builds on the existing, although informal, system of pre-hospital transport in Ghana. In that country; the majority of injured persons are transported to the hospital by some type of commercial vehicle, such as a taxi or bus. Methods: A total of 335 commercial drivers were trained using a 6-hour basic first aid course. The efficacy of this course was assessed by comparing the process of prehospital trauma care provided before versus after the course, as determined by self-report from the drivers. Results: Follow-up interviews were conducted on 71 of the drivers a mean of 10.6 months after the course. Sixty-one percent indicated that they had provided first aid since taking the course. There was considerable improvement in the provision of the components of first aid in comparison to what was reported before the course: crash scene management (7% before vs. 35% after), airway management (2% vs. 35%), external bleeding control (4% vs. 42%), and splinting of injured extremities (1 vs. 16%). Conclusion: Even in the absence of formal Emergency Medical Services, improvements in the process of prehospital trauma care are possible by building on existing, although informal, patterns of prehospital transport.