Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA, San Francisco, USA.
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
BMC Emerg Med. 2023 Apr 1;23(1):37. doi: 10.1186/s12873-023-00775-0.
Emergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning.
We searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care.
We identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies.
To our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.
紧急医疗救援系统（ECS）在转运和医疗机构中组织并提供救命医疗服务。在冲突后环境等不确定情况下，对 ECS 的了解还不够。本综述旨在系统地确定和总结发表的关于冲突后环境中紧急医疗救援的证据，并为卫生部门规划提供指导。
我们于 2021 年 9 月在五个数据库（PubMed MEDLINE、Web of Science、Embase、Scopus 和 Cochrane）中搜索了有关冲突后环境中 ECS 的相关文章。纳入的研究（1）描述了冲突后、受冲突影响或受战争或危机影响的环境；（2）检查了紧急医疗救援系统功能的实施情况；（3）提供英语、西班牙语或法语版本；（4）发表时间在 1900 年 1 月至 2021 年 9 月 9 日之间。使用世界卫生组织（WHO）ECS 框架中确定的基本系统功能提取和映射数据，以获取关于伤病现场、转运期间以及急诊和早期住院治疗期间基本紧急医疗功能的发现。
我们确定了描述这些国家人口疾病负担和提供医疗服务的独特挑战的研究，这些研究指出了院前医疗服务提供方面的特定差距（包括现场响应和转运期间）。常见障碍包括基础设施差、社会信任度低、正规紧急医疗救援培训稀缺以及资源和物资匮乏。
据我们所知，这是第一项系统地确定脆弱和受冲突影响环境中 ECS 证据的研究。使 ECS 与现有的全球卫生重点保持一致，将确保获得这些关键的救命干预措施，但人们对前线紧急医疗服务投资不足表示担忧。对冲突后环境中 ECS 的状况有了初步了解，尽管与最佳实践和干预措施相关的现有证据极其有限。应谨慎关注 ECS 中的常见障碍和与背景相关的优先事项，例如加强院前医疗服务提供、分诊和转诊系统以及对紧急医疗原则进行卫生工作人员培训。
