Patel Anjni, Vissoci João Ricardo Nickenig, Hocker Michael, Molina Enio, Gil Nelly Moraes, Staton Catherine
Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA.
Department of Emergency Medicine, Section of Prehospital and Disaster Medicine, Emory University, Atlanta, Georgia, USA.
BMC Health Serv Res. 2017 Dec 2;17(1):804. doi: 10.1186/s12913-017-2762-6.
Road traffic injuries (RTIs) are the eighth leading cause of death worldwide, with an estimated 90% of RTIs occurring in low- and middle-income countries (LMICs) like Brazil. There has been minimal research in evaluation of delays in transport of RTI patients to trauma centers in LMICs. The objective of this study is to determine specific causes of delays in prehospital transport of road traffic injury patients to designated trauma centers in Maringá, Brazil.
A qualitative method was used based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) approach. Eleven health care providers employed at prehospital or hospital settings were interviewed with questions specific to delays in care for RTI patients. A thematic analysis was conducted.
Responses to primary causes of delay in treatment to RTI patients fell into the following categories: 1) lack of public education, 2) traffic, 3) insufficient personnel/ambulances, 4) bureaucracy, and 5) poor location of stations. Suggestions for improvement in delays fell into the categories of 1) need for centralized station/avoid traffic, 2) improving public education, 3) Increase personnel, 4) increase ambulances, 5) proper extrication/rapid treatment.
Our study found varied responses between hospital and SAMU providers regarding specific causes of delay for RTI patients; SAMU providers cited primarily traffic, bureaucracy, and poor location as primary factors while hospital employees focused more on public health aspects. These results mirror prehospital system challenges in other developing countries, but also provide solutions for improvement with better infrastructure and public health campaigns.
道路交通伤害（RTIs）是全球第八大死因，估计90%的道路交通伤害发生在巴西等低收入和中等收入国家（LMICs）。在低收入和中等收入国家，对道路交通伤害患者转运至创伤中心的延误评估研究极少。本研究的目的是确定巴西马林加市道路交通伤害患者院前转运至指定创伤中心延误的具体原因。
采用基于定性研究报告统一标准（COREQ）方法的定性研究方法。对11名在院前或医院工作的医护人员进行了访谈，询问了与道路交通伤害患者护理延误相关的具体问题。进行了主题分析。
对道路交通伤害患者治疗延误的主要原因的回答分为以下几类：1）缺乏公众教育，2）交通，3）人员/救护车不足，4）官僚作风，5）站点位置不佳。改善延误的建议分为以下几类：1）需要集中站点/避开交通，2）改善公众教育，3）增加人员，4）增加救护车，5）正确解救/快速治疗。
我们的研究发现，医院和紧急医疗服务（SAMU）提供者对道路交通伤害患者延误的具体原因有不同的回答；紧急医疗服务提供者主要将交通、官僚作风和位置不佳列为主要因素，而医院工作人员则更关注公共卫生方面。这些结果反映了其他发展中国家院前系统面临的挑战，但也为通过改善基础设施和开展公共卫生运动来改进提供了解决方案。
