Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK.
Prehosp Emerg Care. 2024;28(1):76-86. doi: 10.1080/10903127.2023.2165744. Epub 2023 Feb 17.
This review aims to understand the present circumstances on the provision of prehospital trauma care in low- and middle-income countries (LMICs), particularly scoping the challenges experienced by LMICs in this regard. The objective is to systematically evaluate the currently available evidence on this topic. Based on the themes and challenges identified in the provision of prehospital trauma care in LMICs, we provide a series of recommendations and a knowledge base for future research in the field.
A systematic database search was conducted of original articles that explored and reported on prehospital trauma care in LMIC in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to March 2022. All original articles reporting on prehospital trauma care from 2010 to 2022 in LMICs were assessed, excluding case reports, small case series, editorials, abstracts, and pre-clinical studies; those with data inconsistencies that impede data extraction; and those with study populations fewer than ten.
The literature search identified 2,128 articles, of which 29 were included in this review, featuring 27,848 participants from LMICs countries. Four main areas of focus within the studies were identified: (1) exploring emergency service systems, frameworks, and interconnected networks within the context of prehospital trauma care; (2) transportation of patients from the response site to hospital care; (3) medical education and the effects of first responder training in LMICs; and (4) cultural and social factors influencing prehospital trauma care-seeking behaviors. Due to overarching gaps in social and health care systems, significant barriers exist at various stages of providing prehospital trauma care in LMICs, particularly in injury identification, seeking treatment, transportation to hospital, and receiving timely treatment and post-intervention support.
The provision of prehospital trauma care in LMICs faces significant barriers at multiple levels, largely dependent on wider social, geographic, economic, and political factors impeding the development of such higher functioning systems within health care. However, there have been numerous breakthroughs within certain LMICs in different aspects of prehospital trauma care, supported to varying degrees by international initiatives, that serve as case studies for widespread implementation and targets. Such experiential learning is essential due to the heterogenous landscapes that comprise LMICs.
本综述旨在了解中低收入国家（LMICs）院前创伤救护的现状，特别是 LMICs 在这方面面临的挑战。目的是系统评估该主题的现有证据。根据在 LMICs 中提供院前创伤救护时确定的主题和挑战，我们为该领域的未来研究提供了一系列建议和知识库。
对 EMBASE、MEDLINE、Cochrane 数据库和 Google Scholar 从成立到 2022 年 3 月期间发表的关于 LMIC 院前创伤救护的原始文章进行了系统的数据库搜索。评估了所有报告 2010 年至 2022 年期间 LMICs 院前创伤救护的原始文章，排除病例报告、小病例系列、社论、摘要和临床前研究；那些数据不一致、妨碍数据提取的文章；以及研究人群少于十人的文章。
文献检索共确定了 2128 篇文章，其中 29 篇被纳入本综述，研究对象来自 27848 名 LMICs 国家的患者。研究确定了四个主要的重点领域：（1）探索紧急服务系统、框架和院前创伤救护背景下的互联网络；（2）将患者从响应地点转运到医院治疗；（3）医疗教育和第一反应者培训在 LMICs 的效果；（4）影响院前创伤救护寻求行为的文化和社会因素。由于社会和医疗保健系统的总体差距，LMICs 在提供院前创伤救护的各个阶段都存在重大障碍，特别是在伤害识别、寻求治疗、运往医院以及及时接受治疗和干预后支持方面。
LMICs 院前创伤救护的提供在多个层面上都面临重大障碍，主要取决于更广泛的社会、地理、经济和政治因素，这些因素阻碍了医疗保健领域更高功能系统的发展。然而，在某些 LMICs 的院前创伤救护的不同方面都取得了许多突破，这些突破在不同程度上得到了国际倡议的支持，为广泛实施和目标提供了案例研究。由于 LMICs 的景观千差万别，因此这种经验学习是必不可少的。
