Factors influencing prehospital management of head injured patients in emergency medical service in Kigali.

Abstract

Background: Head injury has become a major concern to health globally. It is estimated that approximately 10 million people are victims of head injury annually in the world (Hyder et al. 2007). Many studies have shown that the major cause of head injuries is road traffic accidents and takes place at the prehospital stage (Maas et al., 2008). Objectives: This study was conducted to assess the factors influencing prehospital management in Kigali. It had two specific objectives; assessing the prehospital management of head injured patients in EMS, and identifying the factors affecting the prehospital management of head injured patients in Emergency Medical Service in Kigali. Methods: This retrospective and descriptive study covered a period of one month of data collection. Patients‘ records for cases that occurred during the period of 2014-2015 were reviewed using checklist and questionnaires were administered to 39 EMS personnel. Out of them, 37 filled and returned the questionnaires. Data were analyzed using SPSS version 20.0. Results: Findings have shown record of 1871 cases of head injury. Findings showed that 74.1% of head injuries were caused by road traffic crashes and 76.5% of all respondents were male. As regards to measure process, IV Fluid was given at 645 patients (94%, n=686), oxygen for hypoxia at 192 patients (99.4%, n=193). Pain Medication was given to 1 758 patients (94%, n=1871), C-Collar immobilization was given to 1 385 patients (74%, n=1 871). Resuscitation was administered to only 14% of patients who were eligible (n=71). Forty one percent (41.89%) of SAMU staff are not aware of the guidelines and protocols of head injury. Lack of functioning equipment was found as the major obstacle to performing procedures at 59.46%. Eight three percent (83%) of cases were rescued within 60 minutes. Traffic jams (86.4%) and limited facilities of receiving health facilities (67.56%) are the major hindrances to prehospital management. Conclusions and recommendation: The prehospital management in SAMU is moderate but there are factors that need improvement to make it better such as training of EMS personnel, restructuring of the requisition system and proper maintenance of medical equipment. MoH/SAMU should initiate trainings in specialized areas of prehospital care, encourage regular use of guidelines and protocols and strengthen their requisition systems.