Factors influencing willingness to intervene as bystanders among adult residents living in crash-prone areas in the Ashanti region of Ghana

Introduction Formal prehospital emergency medical services cover only a small percent of the population in most low- and middle-income countries. Increasing the involvement of laypersons in prehospital first aid can be an important part of the response to injuries and other medical emergencies. We sought to understand factors associated with the willingness of laypersons in Ghana to provide first aid to road traffic crash victims. Method This cross-sectional study purposively sampled four crash-prone areas in the Ashanti Region and 385 participants were interviewed. A structured questionnaire was used to ask about their demographic characteristics, first aid knowledge, and perceptions about first aid. Factors affecting willingness to provide first aid were assessed using multivariable logistic regression. Results Most participants were male (57.7%) and young (median age 28 years). A large majority (82.9%) were willing to provide first aid to crash victims. However, only 43.1% had been trained in first aid and only 40.4% had adequate knowledge of first aid (≥ 70% correct). Factors associated with willingness to provide first aid included first aid knowledge (aOR 17.27 for moderate knowledge vs. low knowledge, p=0.018; aOR 13.63 for adequate knowledge vs. low knowledge, p=0.030) and positive attitudes towards first aid, including the feeling that: every person should be trained in first aid (aOR 2.98, p=0.025), first aid increases survival (aOR 2.79, p=0.046), it is important to learn first aid (aOR 2.40, p=0.005), and bystanders have the responsibility to give first aid (aOR 4.34, p<0.001). Conclusion A high percentage of people in these crash-prone areas of Ashanti Region, Ghana were willing to provide first aid. However, under half had been trained in first aid or had adequate knowledge of first aid. A major implication of these findings is the need to increase the availability of quality training in first aid in these areas.

Barriers and facilitators to Electronic Medical Records usage in the Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana

The use of paper for record keeping (or a manual system) has been the order of the day in almost all health care facilities in resource poor countries. This system has presented numerous challenges, which the use of Electronic Medical Records (EMR) seeks to address. The objectives of the study were to identify the facilitators and barriers to EMR implementation in Komfo Anokye Teaching Hospital's (KATH) Emergency Centre (EC) and to identify lessons learned. These will help in implementation of EMR in ECs in similar settings.Methods:This was a non-interventional,descriptive cross-sectional and purely qualitative study using a semi-structured interview guide for a study population of 24. The interviews were manually recorded and analysed thematically. EMR implementation was piloted in the EC. Some of the EC staff doubled as EMR personnel. An open source EMR was freely downloaded and customised to meet the needs of the EC. The EMR database created was a hybrid one comprising of digital bio-data of patients and scanned copies of their paper EC records.Results:The facilitators for utilising the system included providing training to staff, the availability of some logistics, and the commitment of staff. The project barriers were funding, full-time information technology expertise, and automatic data and power backups. It was observed that with the provision of adequate human and financial resources, the challenges were overcome and the adoption of the EMR improved.Discussion:The EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics, and staff commitment represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation

Traffic related deaths in Nuevo Leon, Mexico: causes and associated factors

OBJECTIVE: The effects of alcohol on mortality due to motor vehicle accidents was studied. MATERIAL AND METHODS: During the first semester of 2003, a sample of 243 fatality victims of traffic-related accidents and their blood alcohol levels were analyzed in the state of Nuevo Leon, Mexico. The age-adjusted mortality rate for traffic accidents was 8.9/100000 pop. (13.2 for males and 3.21 for females, per 100000). Fatal accidents were more common in the Metropolitan Area (MA). RESULTS: Fatalities were four times greater in males and the mean age was 34.7±18.2 years. Blood alcohol was detected in almost half of the victims who were drivers of the vehicles; the other cases of fatalities may be associated with road/car condition, weather and other factors. CONCLUSIONS: Alcohol intoxication levels were primarily associated with male drivers ages 16 to 45 (p=0.029); levels increased with age. In females, alcohol played a lesser role, affecting mostly ages 31 to 45 y (p=0.055).

OBJETIVO:Durante seis meses de 2003 se estudió el efecto del alcohol en 243 víctimas fatales relacionadas con accidentes viales del estado de Nuevo León, México. MATERIAL Y MÉTODOS: Se realizó autopsia en todos los casos y se determinó el nivel de alcohol en sangre. La tasa de mortalidad ajustada por edad para accidentes viales fue 8.9/100000 hab. (13.2 para hombres y 3.21 para mujeres, por 100000). Accidentes fatales fueron comunes en el Área Metropolitana. RESULTADOS: Las fatalidades fueron cuatro veces mayores en hombres y la edad promedio fue de 34.7±18.2 años. Se detectaron niveles de alcohol en sangre en casi la mitad de los conductores que fueron víctimas; los otros casos de fatalidad fueron asociados con las condiciones del camino, el auto, factores meteorológicos, entre otros. CONCLUSIONES: Los niveles de intoxicación alcohólica fueron básicamente con conductores masculinos, de 16-45 años (p=0.029), aumentando con la edad. Entre las mujeres, el alcohol jugó un papel menos preponderante, afectando mayormente las de 31-45 años (p=0.055).

Barriles de absorción y contención del impacto: reducción de mortalidad por accidentes de tránsito / Impact-absorbing and containment barriers: reduction in accident mortality

OBJETIVO: Determinar el efecto en la reducción de la mortalidad por accidentes de tránsito de la instalación de un dispositivo de absorción y contención de impacto (BAFI),en cruceros de eje estrecho en la ciudad de Monterrey, México. MATERIAL Y MÉTODOS: Se obtuvo información sobre accidentes del 1 de enero de 2000 al 31 de diciembre de 2005 en cruceros con o sin BAFI. RESULTADOS:En el periodo de estudio se registraron 142 accidentes en cruceros de eje estrecho, con 59 muertes en cruceros sin BAFI y cinco en aquellos donde se instaló este dispositivo. CONCLUSIONES: Los dispositivos BAFI representan una medida rápida y de bajo costo para reducir la mortalidad y gravedad de lesiones por accidentes en cruceros de eje estrecho.

OBJECTIVE:Todetermine the effect of the installation of an impact absorption and containment device (Spanish abbreviation, BAFI) on the reduction of traffic accident fatalities at edge crossings in the city of Monterrey, Mexico. MATERIALS AND METHODS:Information about accidents was obtained from January 1,2000 to December 31,2005 from intersections with and without BAFI. RESULTS:During the study period, 142 accidents were registered in edge intersections, with 59 deaths in intersections without BAFIs and five in those where the devices were installed. CONCLUSIONS:The BAFI devices represent a quick and low-cost step for reducing mortality and serious injury due to accidents in edge crossings.

Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication

OBJETIVO: Identificar formas asequibles y sustentables de reforzar los recursos para la atención de heridos en México aplicando las pautas contenidas en Guidelines for Essential Trauma Care [Pautas para el tratamiento básico de los heridos], publicación de la Organización Mundial de la Salud y de la Sociedad Quirúrgica Internacional que contiene recomendaciones sobre los componentes de la atención de heridos que deben poseer los servicios de salud de distintos niveles en todos los países. MÉTODOS: Las pautas publicadas (Guidelines) sirvieron de base para llevar a cabo evaluaciones de las necesidades en tres estados mexicanos en 2003 y en 2004. Los estados se escogieron con la idea de que estuviese representada la amplia variedad de condiciones geográficas y económicas del país: Oaxaca (en el sur y de estrato económico inferior), Puebla (en el centro y con un estrato económico mediano) y Nuevo León (en el norte y con un estrato económico más alto). Se evaluaron dieciséis centros entre los cuales había puestos de salud rurales, hospitales pequeños y hospitales grandes. Se hicieron visitas a todos los centros para llevar a cabo la inspección directa de los recursos físicos en cada uno y entrevistar a miembros clave del personal administrativo y clínico. RESULTADOS: Los recursos humanos y físicos destinados a la atención de heridos eran de calidad satisfactoria en los hospitales, especialmente los más grandes. La encuesta reveló algunas deficiencias, tales como una escasez de succionadores rígidos, oxímetros de pulso y algunos medicamentos usados para tratar heridos. En todos los puestos se observaron dificultades con los equipos básicos de reanimación, a pesar de que algunos recibían un número bastante alto de heridos. En los centros de todos los niveles había margen para mejorar las funciones administrativas a fin de conseguir una atención de calidad que incluyese el mantenimiento de registros de heridos, programas para mejorar la atención de estos pacientes y uniformidad en el adiestramiento del personal durante el desempeño de sus funciones. CONCLUSIONES: En este estudio se identificaron varias formas baratas de reforzar la atención de pacientes heridos en México. También se subrayó la utilidad de las pautas recomendadas en la obra Guidelines for Essential Trauma Care como modelo estandarizado para evaluar los recursos para el tratamiento de heridos que poseen los países en cualquier parte del mundo.