Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-24T19:39:22.749Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Characteristics in the North East Department of Haiti: A Cross-sectional Study from a Low-income Setting Without Prehospital Systems

Published online by Cambridge University Press:  12 May 2014

Adam R. Aluisio ,
Robert Gore ,
Isnelle Decome ,
Annelies De Wulf  and
Christina Bloem
Adam R. Aluisio*
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York USA
Robert Gore
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York USA
Isnelle Decome
Affiliation:
Fort Liberté Hospital, Fort Liberté, North East Department, Haiti
Annelies De Wulf
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York USA
Christina Bloem
Affiliation:
Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York USA
*
Correspondence: Adam R. Aluisio, MD, MSc Department of Emergency Medicine SUNY Downstate Medical Center 450 Clarkson Ave Brooklyn, NY 11203 USA E-mail adam.aluisio@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Although prehospital care is recognized as key in health systems development, it has been largely neglected in Haiti. The North East Department is one of the poorest areas of Haiti, and is a region where no data on out-of-hospital health care exists. This research assessed prehospital characteristics in the North East Department with the aim of providing baseline data to inform prehospital systems development.

Methods

In this observational study, data were collected from patients presenting at the Fort Liberté Hospital, the public regional referral health center in the North East Department. Data were accrued from April 2, 2012 through June 5, 2012. All patients accessing acute care at the hospital were eligible for enrollment. After obtaining consent, data on demographics, health needs, and prehospital information were gathered via a standardized questionnaire administered by hospital staff trained in study protocols.

Results

Data were collected from 441 patient visits. The median age was 24 years, with 62% of the population being female. Medical complaints comprised 75% of visits, with fever and gastrointestinal complaints being the most common reasons for presentation. Traumatic injuries accounted for 25% of encounters, with an equal distribution of blunt and penetrating events. Extremity injuries were the most common traumatic subclassification. The majority of patients (67.2%) were transported by motorcycle taxi and paid transport fees. Trauma patients were more likely to be transported without charge (OR = 9.10; 95% CI, 2.19-37.76; P < .001). Medical patients were most commonly brought from home (78.5%) and trauma patients from a road/street setting (42.9%). Median time to presentation was 240 minutes (IQR = 120-500) and 65 minutes (IQR = 30-150) for medical and trauma complaints, respectively (P < .001). Eleven percent of patients reported receiving care prior to arrival. As compared with medical patients, trauma victims were less likely to have received prehospital care.

Conclusions

Assessing prehospital care in this low-income setting that lacks surveillance systems was feasible and required minimal resources. Motorcycle taxi drivers function as the primary emergency transport mechanism and may represent an access point for prehospital interventions in the North East Department of Haiti. Out-of-hospital care is nearly nonexistent in the region and its development has the potential to yield public health benefits.

AluisioAR, GoreR, DecomeI, De WulfA, BloemC. Prehospital Characteristics in the North East Department of Haiti: A Cross-sectional Study from a Low-income Setting Without Prehospital Systems. Prehosp Disaster Med. 2014;29(3):1-7.

Keywords

emergency careHaitiprehospital care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 3 , June 2014 , pp. 230 - 236
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Central Intelligence Agency. The Wold Factbook 2012. The CIA Website. https://www.cia.gov/library/publications/download/download-2012/index.html. Accessed April 21, 2013.Google Scholar
2. Pan American Health Organization: Health Situation in the Americas Basic Indicators 2012. The PAHO Website. http://new.paho.org/hq/index.php?option=com_content&view=article&id=7170&Itemid=2395&lang=en. Accessed April 21, 2013.Google Scholar
3. World Health Organization. World Health Statistics 2012. The WHO Website. http://www.who.int/gho/publications/world_health_statistics/2012/en/index.html. Accessed April 21, 2013.Google Scholar
4. UNICEF: Levels & Trends in Child Mortality, Report 2012. The United Nations Children's Fund Website. http://reliefweb.int/sites/reliefweb.int/files/resources/Levels%2520and%2520Trends%2520in%2520Child%2520Mortality%2520Report%25202012.pdf. Accessed March 23, 2013.Google Scholar
5. Worl Health Organization. Haiti: Health profile: 2010. The WHO Website. http://www.who.int/gho/countries/hti.pdf. Accessed December 3, 2012.Google Scholar
6. Husum, H, Gilbert, M, Wisborg, T, Van Heng, Y, Murad, M. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma. 2003;54(6):1188-1196.Google Scholar
7. Wisborg, T, Murad, MK, Edvardsen, O, Husum, H. Prehospital trauma system in a low-income country: system maturation and adaptation during 8 years. J Trauma. 2008;64(5):1342-1348.Google Scholar
8. Murad, MK, Issa, DB, Mustafa, FM, Hassan, HO, Husum, H. Prehospital trauma system reduces mortality in severe trauma: a controlled study of road traffic casualties in Iraq. Prehosp Disaster Med. 2012;27(1):36-41.CrossRefGoogle ScholarPubMed
9. Kobusingye, OC, Hyder, AA, Bishai, D, Hicks, ER, Mock, C, Joshipura, M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626-631.Google Scholar
10. Nielsen, K, Mock, C, Joshipura, M, Rubiano, AM, Zakariah, A, Rivara, F. Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehosp Emerg Care. 2012;16(3):381-389.CrossRefGoogle ScholarPubMed
11. Anderson, PD, Suter, RE, Mulligan, T, Bodiwala, G, Razzak, JA, Mock, C. World Health Assembly Resolution 60.22 and its importance as a health care policy tool for improving emergency care access and availability globally. Ann Emerg Med. 2012;60(1):35-44; e3.CrossRefGoogle ScholarPubMed
12. Launching a National Surveillance System after an earthquake --- Haiti, 2010. MMWR Morb Mortal Wkly Rep. 2010;59(30):933-938.Google Scholar
13. Rapid establishment of an internally displaced persons disease surveillance system after an earthquake --- Haiti, 2010. MMWR Morb Mortal Wkly Rep. 2010;59(30):939-945.Google Scholar
14. Barzilay, EJ, Schaad, N, Magloire, R, et al. Cholera surveillance during the Haiti epidemic--the first 2 years. N Engl J Med. 2013;368(7):599-609.Google Scholar
15. Sletten P, Egset W. Poverty in Haiti. 2004;Fafo-paper 2004:31.Google Scholar
16. Mtonga, RE, Zavala, DE. Implementing a hospital based injury surveillance system in Zambia: a preliminary report. Med Confl Surviv. 2008;24(4):280-284.CrossRefGoogle ScholarPubMed
17. Hyder, AA, Sugerman, DE, Puvanachandra, P, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. 2009;87(5):345-352.Google Scholar
18. Omoke, NI, Chukwu, CO, Madubueze, CC, Oyakhiolme, OP. Outcome of road traffic injuries received in the emergency room of a teaching hospital, Southeast Nigeria. Trop Doct. 2012;42(1):18-22.CrossRefGoogle ScholarPubMed
19. Mathers, CD, Boerma, T, Ma Fat, D. Global and regional causes of death. Br Med Bull. 2009;92:7-32.Google Scholar
20. Patton, GC, Coffey, C, Sawyer, SM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374(9693):881-892.CrossRefGoogle ScholarPubMed
21. Mutasingwa, DR, Aaro, LE. Injury registration in a developing country. A study based on patients' records from four hospitals in Dar es Salaam, Tanzania. Cent Afr J Med. 2001;47(8):203-209.Google Scholar
22. Kobusingye, OC, Guwatudde, D, Owor, G, Lett, RR. Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev. 2002;8(2):133-136.Google Scholar
23. World Health Organization. The global burden of disease: 2004. WHO Website. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/. Accessed April 21, 2013.Google Scholar
24. Hyder, AA, Wunderlich, CA, Puvanachandra, P, Gururaj, G, Kobusingye, OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation. 2007;22(5):341-353.CrossRefGoogle ScholarPubMed
25. Mock, CN, Jurkovich, GJ, nii-Amon-Kotei, D, Arreola-Risa, C, Maier, RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-812; discussion 812-814.CrossRefGoogle ScholarPubMed
26. Henry, JA, Reingold, AL. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2012;73(1):261-268.Google Scholar
27. Mock, CN, Tiska, M, Adu-Ampofo, M, Boakye, G. Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma. 2002;53(1):90-97.CrossRefGoogle Scholar
28. Jayaraman, S, Mabweijano, JR, Lipnick, MS, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg. 2009;33(12):2512-2521.Google Scholar
29. Jayaraman, S, Mabweijano, JR, Lipnick, MS, et al. First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS One. 2009;4(9):e6955.CrossRefGoogle ScholarPubMed
30. Prue, CS, Shannon, KL, Khyang, J, et al. Mobile phones improve case detection and management of malaria in rural Bangladesh. Malar J. 2013;12:48.Google Scholar
31. Zurovac, D, Sudoi, RK, Akhwale, WS, et al. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. Lancet. 2011;378(9793):795-803.Google Scholar
32. John, IA, Mohammed, AZ, Lawoko, S, et al. Implementing a hospital based injury surveillance system: a case study in Nigeria. Med Confl Surviv. 2008;24(4):273-279.CrossRefGoogle ScholarPubMed
33. Zavalaa, DE, Bokongo, S, John, IA, et al. Implementing a hospital based injury surveillance system in Africa: lessons learned. Med Confl Surviv. 2008;24(4):260-272.CrossRefGoogle ScholarPubMed
34. Fisman, DN. Seasonality of infectious diseases. Annu Rev Public Health. 2007;28:127-143.CrossRefGoogle ScholarPubMed
35. Friede, KA, Osborne, MC, Erickson, DJ, et al. Predicting trauma admissions: the effect of weather, weekday, and other variables. Minn Med. 2009;92(11):47-49.Google Scholar
36. Ameratunga, S, Hijar, M, Norton, R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367(9521):1533-1540.Google Scholar
Supplementary material: PDF

Aluisio Supplementary Material

Supplementary Material

Download Aluisio Supplementary Material(PDF)
PDF 59.8 KB