Tuesday, 4 June 2013 , Brian Bilal Mwebaze
Brian is back with his June column on the importance of the public being trained in basic first aid and post-crash care in low and middle-income countries. In places where roads are less accessible and post-crash vehicles are less readily available, Brian argues that a community focused approach to being able to handle injuries in the first instance can dramatically save lives.
Congratulations to every one for #stayingsafe #walkingsafe #lsw during the #globaroadsafetyweek that focused on pedestrian safety! (Lots of Hash-tags!) This year’s Global Road Safety Week was the best! I have never felt this solidarity feeling before: that innate feeling of ‘Yeah, road safety is our concern!’ from all corners of the continent in Africa and the wider world! That’s exactly what we love to see; dignitaries, children, mothers, fathers, young people, celebrities – needless to mention, animals #WalkingforSafety! I loved it! How about you? In English, they say ‘Keep the candle burning’…me I say ‘Keep a keen eye on a burning candle’…if you know what I mean 😉
Emergency health care facilities in Africa are flooded with road traffic crash victims; and there are the ‘few lucky ones’, who are referred for a touch of professionalism in advanced hospitals. It doesn’t make me proud to write such a true statement this month of June, (which reminds me that Christmas is 6 months away :P) but I find solace in the naked truth that road traffic crashes are preventable, and even after a crash, deaths are preventable and the impact of injuries can be mitigated by timely and effective emergency care.
Now, what really occurs when a road traffic crash happens? The first people on the scene are community members who usually don’t have any form of prior formal training in first aid and emergency medicine. Considering that the response time for emergence medical services or the police in developing countries depends on whether it is raining, whether there is fuel in the response cars (if they exist), whether the road is accessible (of course due to unnecessary traffic jams or congestion), many deaths from injuries, bleeding and avoidable disabilities come into existence; things which would have been addressed if the community members were empowered with basic life saving knowledge and skills.
In Africa, the quality of post-crash care varies greatly across the continent.
According to WHO (2013) Global Road Safety Report,
“The African region has the highest road traffic fatality rate. The risk of dying as a result of a road traffic injury is highest in the African Region (24.1 per 100 000 population), and lowest in the European Region (10.3 per 100,000)”.
While delivering the report, the current WHO director general Margaret Chan said, “Political will is needed at the highest level of government to ensure appropriate road safety legislation and stringent enforcement of laws by which we all need to abide.” “If this cannot be ensured, families and communities will continue to grieve, and health systems will continue to bear the brunt of injury and disability due to road traffic crashes.”
Many times, as implementing organizations, we are judged by the impact that we do: Our friend has done and published his evidence: Tiska MA, et al (2012) In Ghana most roadway casualties receive care and transport to the hospital from taxi, bus, or truck drivers. This study reports that control of external hemorrhage was quickly learnt and used appropriately by the drivers. Areas identified needing emphasis in future trainings included consistent use of universal precautions and protection of airways in unconscious persons using the recovery position.
Clearly, it’s possible for low income countries; prehospital trauma care for roadway casualties can be improved by training laypersons already involved in prehospital transport and care. Training should be locally devised, evidence based, educationally appropriate, and focus on practical demonstrations (as visible in the photos in the right column from Uganda Red Cross).
Quite often, we affiliate this ‘Prehospital care and crash stuff’ to medical people! I can tell you that’s not true (because I’ve never spent 6 years or so in medical school, rather 6 months of emergence medicine and prehospital skill training). In fact the Red Cross offers 1 day, 3 days, 5 days + courses on emergence health care and response…so you cant be excused really for saying, the courses are long! LOL.
It is clear that there are many factors that make up the road safety system.
Fact is, the post-crash phase is not only the job of emergency health care workers. The pre-crash phase is also incredibly important whereby road traffic engineers can play a vital role in facilitating access of emergency response teams to crash scenes, by designing emergency lanes or including messages on roadside information screens regarding the positions of emergency vehicles. Road incident management after a crash involves many disciplines, including traffic officials, the police, and the fire department and emergency health care workers. The safe, effective management of a crash scene allows speedy emergency care for the injured. The training of non-medical officials in elementary triage and basic life support would also improve communication between the disciplines and, often, speed up the provision of basic emergency care.
The ultimate goal of road safety is not merely crash prevention, but actually death and disability prevention. With this aim in mind, urgent action should be taken to improve post-crash responses and patient care because prehospital care and post crash care enjoy a husband-wife relationship in road safety in Africa. If we call upon our leaders to take action to improve road safety systems, we benefit all round!
So, exactly what are you waiting for? Get your certification or your organization thinking of certifying their staff, communities in basic life support! The next life to be saved may be YOURS! Oh, and wish me luck in participating in the 27th First Aid Convention Europe this June…hoping to learn as much as my head can take! Until next time #StaySafe 😛
Same article appears here on the UN Youth wing on road safety: http://www.youthforroadsafety.org/activities/news/news_item/t/brian_s_column_community_focused_post_crash_care_can_save_lives