Machona Penelope Kantu, Zulu Joseph Mumba, Makasa Mpundu, Meland Eivind, Mildestvedt Thomas
Department of Surgery, University of Zambia, School of Medicine, Lusaka, Zambia.
Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia.
PLOS Glob Public Health. 2025 May 9;5(5):e0004382. doi: 10.1371/journal.pgph.0004382. eCollection 2025.
The increasing burden of road traffic injuries (RTIs) has become a public health concern in Zambia for the last five years. Little is known about the capacity and determinants of emergency care at the point of first contact in a country without coordinated pre-hospital and emergency medical services (EMS). Evaluation of the in-hospital emergency trauma care for RTIs is critical. This study sought to assess the emergency care at the district level hospitals to effectively manage RTIs, using the WHO Hospital Emergency Assessment Tool (HEAT), and identify the barriers and facilitators. A mixed-methods approach was employed at ten facilities in Lusaka Province between May 2023 and September 2023. Quantitative data were collected using the WHO HEAT instrument on facility matrices, infrastructure and equipment, human resources, diagnostic and clinical services, and signal functions. Thirty-five interviews were conducted with emergency unit healthcare providers at these facilities to identify the barriers and facilitators to care. The WHO tool guided inductive and deductive thematic analysis. Emergency care services were available 24 hours a day, with a mean bed capacity of 4.7 for the ten (10) facilities sampled. Eight hospitals had a designated emergency unit and three had no triage area. Only four hospitals had a core emergency trauma team. The key barriers to care were shortage of equipment and consumables, a lack of skills and specialist services to perform signal functions, and inadequate ambulance services. However, supportive and committed leadership, team cohesiveness, interdepartmental collaboration, motivated staff, and skills transfer from seniors emerged as the facilitators to care. Lusaka Province is moderately prepared for the increasing number of emergency trauma cases. To strengthen emergency trauma care; capacity building for human resource in triage, resuscitation, and trauma interventions for the initial care is integral. Deliberate action through budgetary support for infrastructure development, emergency equipment procurement, increased ambulance service availability, and recruitment of skilled human resources is timely.
在过去五年中，道路交通伤害（RTIs）负担的不断增加已成为赞比亚的一个公共卫生问题。在一个没有协调的院前和紧急医疗服务（EMS）的国家，对于首次接触时的急诊护理能力和决定因素知之甚少。评估医院内对道路交通伤害的急诊创伤护理至关重要。本研究旨在使用世界卫生组织医院急诊评估工具（HEAT）评估地区级医院对道路交通伤害的急诊护理，以有效管理此类伤害，并确定障碍和促进因素。2023年5月至2023年9月期间，在卢萨卡省的十个机构采用了混合方法。使用世界卫生组织HEAT工具收集了关于机构矩阵、基础设施和设备、人力资源、诊断和临床服务以及信号功能的定量数据。对这些机构的急诊室医护人员进行了35次访谈，以确定护理的障碍和促进因素。世界卫生组织的工具指导了归纳和演绎主题分析。急诊护理服务每天24小时提供，抽样的十（10）个机构的平均床位容量为4.7张。八家医院设有指定的急诊室，三家没有分诊区。只有四家医院有核心急诊创伤团队。护理的主要障碍是设备和消耗品短缺、缺乏执行信号功能的技能和专科服务以及救护车服务不足。然而，支持性和坚定的领导、团队凝聚力、部门间协作、积极主动的员工以及上级的技能传授成为了护理的促进因素。卢萨卡省对不断增加的急诊创伤病例有一定程度的准备。为加强急诊创伤护理，对分诊、复苏和初始护理的创伤干预方面的人力资源进行能力建设不可或缺。通过预算支持进行基础设施建设、采购应急设备、增加救护车服务可用性以及招聘技术熟练的人力资源等有意为之的行动刻不容缓。
