“A pre-hospital
emergency service should be implemented, as this study suggests that
salvageable patients are dying before reaching hospital. Injury management requires
coordination, so that the large volume of minor injuries receive care without
impeding the care of the seriously injured, who should be rapidly triaged to
tertiary centers. This is particularly crucial for head injuries.”
Kobusingye et al. 2002
“The goal of an effective emergency
medical system should be to provide universal emergency care — that is, emergency
care should be available to all who need it. However, there are many unfounded
myths about emergency medical care, and these are often used as a rationale for
giving it a low priority in the health sector, especially in low- and
middle-income countries.
These myths include equating
emergency care to ambulances and focusing on transport alone while neglecting
the role of care that can be provided in the community and at a health-care facility.
Perhaps most common is the perception that emergency care is inherently
expensive; this myth focuses attention on the high-technology end of clinical
care as opposed to the strategies that are simple and effective. Efforts to
improve emergency care, however, need not lead to increased costs.”
Kobusingye et al. 2005
Uganda’s emergency service is still very much in its early infancy
but it is important to begin somewhere in helping it develop and grow. This is significantly
important, an emergency perhaps for Uganda, given that many salvageable
patients die before getting to the hospital (Kobusingye et al. 2002). However,
the challenges are numerous, including myths which make building an emergency care
system seem like climbing Mount Elgon (all of 4320 metres), or Mount Rwenzori (just
about 5100 metres) without climbing gear
– not worth the hustle.
However, the need is great and this hasn’t changed, with or
without emergency care services.
Pre-hospital services:
Pre-hospital services – provided in the community until the patient gets to a
health facility – may have an impact in improving outcomes. In the context of
resource limitation, building the capacity of these tier-one systems i.e. volunteers
and bystanders may be reasonable to form a group of first responders who will
contribute to improving outcomes.
EMU and Pre-Hospital Care
Beginning 9th April 2016, EMU started its
contribution to building these tier-one systems. In partnership with Namirembe
Diocese, we embarked on training members of this Diocese in First Aid and cardiopulmonary
resuscitation (CPR). A group of 20 teachers including Sunday school teachers
gathered in a classroom at Kazo, a Kampala suburb to learn what it means to
provide simple, yet life-saving interventions in different situations. We hope
that we can slowly but surely, within the context of limited resources, begin
the process of shifting outcomes through improved pre-hospital care. We hope
they will form a nucleus of First Aid first responders that will spread throughout
the country.
We also aim to use these experiences to develop a manual
that is tailor-made for the needs of our communities.
We will keep you updated as we continue these efforts, as they snowball into a vibrant community first aid service that feeds directly into enhanced emergency pre-hospital services.
Below is a pictorial:
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| The tier-one system taking shape |
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| Interaction Between Trainers and Trainees |
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| Practicing Adult Compression-only CPR |
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| Infant CPR |
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| More Infant CPR whilst referring to the manual in the making |
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| Infant Choking |
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| Learning with the manual in the making |
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| Heimlich Manoeuvre |
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| More of Heimlich Manoeuvre |
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| More of Heimlich Manoeuvre |
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| Choking in the Infant |
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| The Manual In its Infancy |
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| A Peek Inside The Manual |
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| Learning from a "Real Patient" |
References
Kobusingye, C. O., Guwatudde, D., Owor, G. & Lett, R. R.
2002. Citywide trauma experience in Kampala, Uganda: a call for intervention. Injury Prevention. 8:133-136
Kobusingye, C. O., Hyder, A. A., Bishai, D., Mock, C. &
Joshipura, M. 2005. Emergency medical systems in low- and middle-income
countries: recommendations for action. Bulletin
of the World Health Organization. 83:626-631.
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