LFR International, Makeni, Sierra Leone; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
TraumaLink, Dhaka, Bangladesh; Harvard T.H. Chan School of Public Health, Boston, MA.
Surgery. 2024 Jul;176(1):220-222. doi: 10.1016/j.surg.2024.02.030. Epub 2024 Apr 9.
The lack of prehospital care access in low- and middle-income countries is one of the greatest unmet needs and, therefore, one of the most urgent priorities in global health. Establishing emergency medical services in low- and middle-income countries poses significant challenges and complexities, requiring solutions tailored to prevailing conditions, informed by needs assessments, and adapted to meet local demands in a culturally appropriate and sustainable manner. In areas without existing emergency medical services, patients must rely on informal networks of untrained bystanders and community members to provide first aid and transport to definitive care. Since 2005, training lay first responders has been recommended by the World Health Organization as the first step toward formal emergency medical services development. However, efforts to formalize lay first responders networks have not expanded with the increasing need for prehospital emergency care in low- and middle-income countries, despite their potential. The rapid expansion of communication technologies like mobile smartphones penetrating resource-limited settings offers effective and inexpensive options for dispatching and coordinating lay first responders that were not previously available. These technologies can also be used for more advanced emergency medical services, obviating expensive communications and dispatch infrastructure. Despite disproportionately bearing the global injury burden, lay first responders frequently lack accurate and comprehensive surveillance data secondary to widespread underreporting, especially for non-fatal events. Lay first responders expand surveillance, which may inform future targeted prevention efforts, assisting in the development of tailored countermeasures suited to local hazards and diseases. Emergency medical services development in low- and middle-income countries involves a strategic approach focused on understanding the unique needs of diverse communities, requiring broad stakeholder involvement to create a sense of ownership to maintain volunteer networks and enhance sustainability. By embracing these relatively low-cost, bottom-up strategies, low- and middle-income countries can develop more accessible, efficient, and community-oriented emergency medical systems, ultimately improving public health outcomes and averting preventable deaths to address the emergency burden.
在中低收入国家，缺乏院前医疗服务是未满足的最大需求之一，因此也是全球卫生领域最紧迫的优先事项之一。在中低收入国家建立紧急医疗服务面临着重大挑战和复杂性，需要根据需求评估制定针对现有情况的解决方案，并以文化上适当和可持续的方式适应满足当地需求。在没有现有紧急医疗服务的地区，患者必须依靠未经培训的旁观者和社区成员的非正式网络提供急救和转送至确定性治疗。自 2005 年以来，世界卫生组织建议培训非专业急救人员作为建立正式紧急医疗服务的第一步。然而，尽管存在潜力，将非专业急救人员网络正式化的努力并没有随着中低收入国家对院前紧急医疗服务需求的增加而扩大。像移动智能手机这样的通信技术的快速扩展，为在资源有限的环境中调度和协调非专业急救人员提供了有效且廉价的选择，这在以前是不可能的。这些技术还可用于更先进的紧急医疗服务，省去昂贵的通信和调度基础设施。尽管中低收入国家不成比例地承担着全球的伤害负担，但由于广泛的漏报，特别是对非致命事件的漏报，非专业急救人员往往缺乏准确和全面的监测数据。非专业急救人员扩大了监测范围，这可以为未来有针对性的预防工作提供信息，有助于制定适合当地危害和疾病的有针对性的对策。中低收入国家的紧急医疗服务发展需要采取一种战略方法，侧重于了解不同社区的独特需求，需要广泛的利益相关者参与，以建立一种归属感，维护志愿者网络并提高可持续性。通过采用这些相对低成本、自下而上的策略，中低收入国家可以开发出更易获得、更高效、更面向社区的紧急医疗系统，最终改善公共卫生结果，避免可预防的死亡，以应对紧急负担。
