The care and transport of trauma victims by layperson emergency medical systems: a qualitative study in Delhi, India
The care and transport of trauma victims by layperson emergency medical systems: a qualitative study in Delhi, India
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DOI：
10.1136/bmjgh-2019-001963
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发表时间：
2019-11-01
影响因子：
8.1
通讯作者：
Mohan, Dinesh
中科院分区：
文献类型：
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作者：
Bhalla, Kavi;Sriram, Veena;Mohan, Dinesh
简介基于救护车的紧急医疗系统(EMS)价格昂贵，在低收入和中等收入国家仍然很少见，在这些国家，创伤受害者通常由过往车辆运送到医院。交通网络技术的最新发展可能会打破这一现状，因为它允许非专业人员网络进行协调的应急响应。我们试图了解旁观者援助印度德里创伤受害者的障碍，以及对外行EMS的影响。方法采用定性分析的方法，对50名一线利益相关者(包括出租车司机、医疗专业人员、法律专家和警察)的访谈、一名利益相关者咨询和文件审查的数据进行分析。结果受访者指出，德里的大多数创伤受害者很快就会被旁观者、出租车和警察送往医院。虽然救护车很常见，但它们主要用于设施间的转运。根深蒂固的法医做法导致大量警察出现在医院，这是骚扰好心人的主要来源，并干扰病人护理。创伤受害者经常因为无力支付费用而被营利性医院拒之门外，导致治疗延误。最近限制警察和营利性医院稳定患者的角色的政策努力似乎没有成功。结论印度现有的医疗保健和法医实践对改善创伤预后造成了巨大的系统性障碍。在印度正在进行的卫生和运输部门改革成功确保营利性医院可靠地提供护理之前，好心人和外行EMS提供者应该把经济能力不确定的受害者送到公共设施。为了避免与警方的麻烦，非专业EMS的提供者可能需要得到警方的正式批准，并携带他们提供紧急交通工具的权力的明显象征。德里已经有了EMS的几个关键组成部分(包括调度员协调的警察反应，大型救护车车队)，可以整合和扩展成一个完整的紧急护理系统。
Introduction Ambulance-based emergency medical systems (EMS) are expensive and remain rare in low-and middle-income countries, where trauma victims are usually transported to hospital by passing vehicles. Recent developments in transportation network technologies could potentially disrupt this status quo by allowing coordinated emergency response from layperson networks. We sought to understand the barriers to bystander assistance for trauma victims in Delhi, India, and implications for a layperson-EMS.Methods We used qualitative methods to analyse data from 50 interviews with frontline stakeholders (including taxi drivers, medical professionals, legal experts and police), one stakeholder consultation and a review of documents.Results Respondents noted that most trauma victims in Delhi are rapidly brought to hospital by bystanders, taxis and police. While ambulances are common, they are primarily used for interfacility transfers. Entrenched medico-legal practices result in substantial police presence at the hospital, which is a major source of harassment of good Samaritans and interferes with patient care. Trauma victims are often turned away by for-profit hospitals due to their inability to pay, leading to delays in treatment. Recent policy efforts to circumscribe the role of police and force for-profit hospitals to stabilise patients appear to have been unsuccessful.Conclusions Existing healthcare and medico-legal practices in India create large systemic impediments to improving trauma outcomes. Until India's ongoing health and transport sector reforms succeed in ensuring that for-profit hospitals reliably provide care, good Samaritans and layperson-EMS providers should take victims with uncertain financial means to public facilities. To avoid difficulties with police, providers of a layperson-EMS would likely need official police sanction and carry visible symbols of their authority to provide emergency transport. Delhi already has several key components of an EMS (including dispatcher coordinated police response, large ambulance fleet) that could be integrated and expanded into a complete system of emergency care.