WHO Bulletin: Improving emergency care in Uganda

2 May, 2019

'Around the world, acutely ill and injured people die every day because they lack access to effective, timely prehospital and emergency care. Many countries have no emergency access telephone number to call for an ambulance, and many countries have no ambulances to call.' Application of WHO guidelines in Uganda has halved in-hospital mortality related to emergency conditions. Extracts and a comment from me below. Full text here: https://www.who.int/bulletin/volumes/97/5/19-020519/en/


Improving emergency care in Uganda

A low-cost emergency care initiative has halved deaths due to emergency conditions in two district hospitals in Uganda. The intervention is being scaled up nationally. Gary Humphreys reports.

Bulletin of the World Health Organization 2019;97:314-315. doi: http://dx.doi.org/10.2471/BLT.19.020519

Around the world, acutely ill and injured people die every day because they lack access to effective, timely prehospital and emergency care. Many countries have no emergency access telephone number to call for an ambulance, and many countries have no ambulances to call. Hospitals lack dedicated emergency units and have few providers trained in the recognition and management of emergency conditions.

“Over half of deaths in low- and middle-income countries are caused by conditions that could be addressed by effective emergency care,” says Dr Teri Reynolds, an expert in emergency, trauma and acute care at the World Health Organization (WHO). “Despite its enormous potential contribution, emergency care has been neglected in health system strengthening. It’s a real blind spot.”...

“We talk a lot about effectiveness and quality,” says Reynolds, “but we neglect timeliness as a critical component of both. Many ‘proven’ interventions only save lives if given in time in the right situation.”...

“Uganda has one of the highest incidences of road traffic trauma and deaths on the African continent,” says Joseph Kalanzi, Senior House Officer, Emergency Medicine, Makerere University College of Health Sciences. “We are faced with multiple road traffic crashes daily and have barely any dedicated emergency response.”

According to WHO’s Global status report on road safety 2018, road traffic crashes resulted in 12 036 deaths in 2016 in Uganda...

After a meeting convened in Kampala in July 2016, the actions identified included the training and equipping of frontline prehospital and hospital providers, increasing the coverage and quality of ambulance services and improving processes in hospital emergency units. The focus was on the provision of emergency ca for hospital staff, creating dedicated resuscitation areas and basic emergency unit protocols.

“An intervention was designed based on four WHO tools,” explains Reynolds, “our Basic Emergency Care course, two checklist protocols, a triage protocol, and resuscitation area guidance.”....

With no new input of resources, the nurses, supported by their colleagues, adapted the WHO guidance to their settings in several creative ways, including organizing emergency unit beds by triage colour category, and using the course content to create protocol posters and checklists for equipment and supplies....

The results were remarkable. “In the first year of the intervention they roughly halved in-hospital mortality related to emergency conditions,” says Reynolds. “The impact was seen across conditions, ranging from road traffic injury deaths to deaths from pneumonia and diarrhoea in children.”...

WHO launched the Global Emergency and Trauma Care Initiative in December 2018 to support capacity development for the provision of quality emergency care in countries around the world, and to foster awareness through a global advocacy campaign.


COMMENT (NPW): This is a clear example of the importance of *timely* life-saving interventions supported by WHO checklists and guidelines. But reducing in-hospital mortality is only part of the picture. More research is needed on how to reduce avoidable deaths before reaching hospital. The importance of the actions of the general public should not be underestimated, especially in rural areas where they may be the only people present. The Red Cross First Aid app should be available on every mobile phone app. Currently the app is available free in multiple languages, but penetration is minuscule so their impact is severely limited. The HIFA Mobile Healthcare Information For All project is working to address this anomaly. Can it be addressed by preloading essential healthcare information onto mobile phones before point of sale, or does it require a more gradual approach of better publicity and marketing to encourage more people to download such information.

Best wishes, Neil

Coordinator, mHIFA Project (Mobile Healthcare Information For All)


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org