The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study.
OBJECTIVES
We sought to characterise the prehospital experience of Tanzanian trauma patients, and identify barriers and facilitators to implement community-based emergency medical systems (EMS).


SETTINGS
Our study was conducted in the emergency department of an urban national referral hospital in Tanzania.


PARTICIPANTS
A convenience sample of 34 adult trauma patients, or surrogate family members, presenting or referred to an urban referral emergency department in Tanzania for treatment of injury, participated in the study.


INTERVENTIONS
Participation in semistructured, iteratively developed interviews until saturation of responses was reached.


OUTCOMES
A grounded theory-based approach to qualitative analysis was used to identify recurrent themes.


RESULTS
We characterised numerous deficiencies within the existing clinic-to-hospital referral network, including missed/delayed diagnoses, limited management capabilities at pre-referral facilities and interfacility transfer delays. Potential barriers to EMS implementation include patient financial limitations and lack of insurance, limited public infrastructure and resources, and the credibility of potential first aid responders. Potential facilitators of EMS include communities' tendency to pool resources, individuals' trust of other community members to be first aid responders, and faith in community leaders to organise EMS response. Participants expressed a strong desire to learn first aid.


CONCLUSIONS
The composite themes generated by the data suggest that there are myriad structural, financial, institutional and cultural barriers to the implementation of a formal prehospital system. However, our analysis also revealed potential facilitators to a first-responder system that takes advantage of close-knit local communities and the trust of recognised leaders in society. The results suggest favourable acceptability for community-based response by trained lay people. There is significant opportunity for care improvements with short trainings and low-cost supply planning. Further research looking at the effects of delay on outcomes in this population is needed.
['Kuzma|Kristin|K|', 'Lim|Andrew George|AG|', 'Kepha|Bernard|B|', 'Nalitolela|Neema Evelyne|NE|', 'Reynolds|Teri A|TA|']
D000293:Adolescent D000328:Adult D000368:Aged D001294:Attitude to Health D004632:Emergency Medical Services D004636:Emergency Service, Hospital D005260:Female D005392:First Aid D006761:Hospitals D006801:Humans D007407:Interviews as Topic D008297:Male D008875:Middle Aged D036301:Qualitative Research D012017:Referral and Consultation D012106:Research D012111:Residence Characteristics D013636:Tanzania D014505:Urban Population D014947:Wounds and Injuries D055815:Young Adult
ACCIDENT & EMERGENCY MEDICINE TRAUMA MANAGEMENT