Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA.
Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Critical Care, Chicago, IL, USA; Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Injury. 2021 Feb;52(2):167-174. doi: 10.1016/j.injury.2020.12.014. Epub 2020 Dec 29.
Despite a significant burden of injury-related deaths, the Plurinational State of Bolivia (Bolivia), a lower- middle-income country in South America, lacks a formalized trauma system. This study sought to examine Bolivian trauma care from the patient perspective in order to determine barriers to care and targets for improvement.
Investigators conducted 15 semi-structured interviews with trauma patients admitted at four hospitals in Santa Cruz de la Sierra, Bolivia in June and July of 2016. Interviews were transcribed, translated, and analyzed through content and discourse analysis to identify key themes and perceptions of trauma care.
Participants primarily presented with orthopedic injuries due to road traffic incidents and falls. Only one participant reported receiving first aid from a layperson at the scene of injury. Of the 15 participants, 12 did not know any number to contact emergency medical services (EMS). Participants expressed negative views of EMS as well as concerns for slow response times and inadequate personnel and training. Two thirds of participants were initially brought to a hospital without adequate resources to care for their injuries. Participants generally expressed positive views regarding healthcare workers involved in their hospital-based medical care.
This region of Bolivia has a disorganized, underutilized, and distrusted trauma system. In order to increase survival, interventions should focus on improving prehospital trauma care. Potential interventions include the implementation of layperson trauma first responder courses, the establishment of a medical emergency hotline, the unification of EMS, the implementation of basic training requirements for EMS personnel, and public education campaigns to increase trust in EMS.
尽管伤害相关死亡的负担巨大，但南美洲中低收入国家多民族玻利维亚国（玻利维亚）缺乏正式的创伤系统。本研究旨在从患者角度探讨玻利维亚的创伤护理，以确定护理障碍和改进目标。
调查人员于 2016 年 6 月至 7 月在玻利维亚圣克鲁斯德拉谢拉的四家医院对 15 名创伤患者进行了 15 次半结构化访谈。通过内容分析和话语分析对访谈进行转录、翻译和分析，以确定创伤护理的关键主题和看法。
参与者主要因道路交通事故和跌倒导致骨科损伤。只有一名参与者报告在受伤现场接受过非专业人员的急救。在 15 名参与者中，有 12 人不知道可以联系紧急医疗服务（EMS）的号码。参与者对 EMS 持负面看法，并对反应时间慢以及人员和培训不足表示担忧。三分之二的参与者最初被带到没有足够资源来治疗其受伤的医院。参与者普遍对参与其医院医疗护理的医护人员表示肯定。
玻利维亚的这一地区存在混乱、利用不足和不信任的创伤系统。为了提高生存率，干预措施应侧重于改善院前创伤护理。潜在的干预措施包括实施非专业人员创伤急救员课程、建立医疗急救热线、统一 EMS、实施对 EMS 人员的基本培训要求以及开展公众教育运动以增加对 EMS 的信任。
