O'Connor Kathleen, Driban Matthew, Oke Rasheedat, Dissak-Delon Fanny Nadia, Tanjong Signe Mary Magdalene, Mirene Tchekep, Dieudonne Mbeya, Kinge Thompson, Njock Richard L, Nkusu Daniel N, Tsiagadigui Jean-Gustave, Edouka Cyrille, Wonja Catherine, Eisner Zachary, Delaney Peter, Julliard Catherine, Chichom-Mefire Alain, Christie S Ariane
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, United States of America.
PLOS Glob Public Health. 2024 Jul 11;4(7):e0002875. doi: 10.1371/journal.pgph.0002875. eCollection 2024.
Despite high injury mortality rates, Cameroon currently lacks a formal prehospital care system. In other sub-Saharan African low and middle-income countries, Lay First Responder (LFR) programs have trained non-medical professionals with high work-related exposure to injury in principles of basic trauma care. To develop a context-appropriate LFR program in Cameroon, we used trauma registry data to understand current layperson bystander involvement in prehospital care and explore associations between current non-formally trained bystander-provided prehospital care and clinical outcomes. The Cameroon Trauma Registry (CTR) is a longitudinal, prospective, multisite trauma registry cohort capturing data on injured patients presenting to four hospitals in Cameroon. We assessed prevalence and patterns of prehospital scene care among all patients enrolled the CTR in 2020. Associations between scene care, clinical status at presentation, and outcomes were tested using univariate and multivariate logistic regression. Injury severity was measured using the abbreviated injury score. Data were analyzed using Stata17. Of 2212 injured patients, 455 (21%) received prehospital care (PC) and 1699 (77%) did not receive care (NPC). Over 90% (424) of prehospital care was provided by persons without formal medical training. PC patients were more severely injured (p<0.001), had markers of increased socioeconomic status (p = 0.01), and longer transport distances (p<0.001) compared to NPC patients. Despite increased severity of injury, patients who received PC were more likely to present with a palpable pulse (OR = 6.2, p = 0.02). Multivariate logistic regression adjusted for injury severity, socioeconomic status and travel distance found PC to be associated with reduced emergency department mortality (OR = 0.14, p<0.0001). Although prehospital injury care in Cameroon is rarely performed and is provided almost entirely by persons without formal medical training, prehospital intervention is associated with increased early survival after injury. Implementation of LFR training to strengthen the frequency and quality of prehospital care has considerable potential to improve trauma survival.
尽管受伤死亡率很高，但喀麦隆目前缺乏正式的院前护理系统。在撒哈拉以南非洲的其他低收入和中等收入国家，现场急救员（LFR）项目已对工作中高暴露于受伤风险的非医学专业人员进行了基本创伤护理原则培训。为在喀麦隆制定适合当地情况的LFR项目，我们利用创伤登记数据了解当前非专业旁观者参与院前护理的情况，并探讨当前未经正规培训的旁观者提供的院前护理与临床结果之间的关联。喀麦隆创伤登记处（CTR）是一个纵向、前瞻性、多地点的创伤登记队列，收集喀麦隆四家医院收治的受伤患者的数据。我们评估了2020年CTR登记的所有患者院前现场护理的患病率和模式。使用单变量和多变量逻辑回归测试现场护理、就诊时临床状况和结果之间的关联。损伤严重程度使用简明损伤评分进行测量。数据使用Stata17进行分析。在2212名受伤患者中，455名（21%）接受了院前护理（PC），1699名（77%）未接受护理（NPC）。超过90%（424名）的院前护理由未接受过正规医学培训的人员提供。与NPC患者相比，PC患者受伤更严重（p<0.001），具有社会经济地位提高的标志（p = 0.01），且转运距离更长（p<0.001）。尽管损伤严重程度增加，但接受PC的患者更有可能出现可触及的脉搏（OR = 6.2，p = 0.02）。对损伤严重程度、社会经济地位和出行距离进行多变量逻辑回归调整后发现，PC与急诊科死亡率降低相关（OR = 0.14，p<0.0001）。尽管喀麦隆的院前损伤护理很少实施，且几乎完全由未接受过正规医学培训的人员提供，但院前干预与受伤后早期生存率提高相关。实施LFR培训以加强院前护理的频率和质量，对于提高创伤存活率具有相当大的潜力。
