Poor access to acute care resources to treat major trauma in low- and middle-income settings: A self-reported survey of acute care providers

Introduction: Injury and violence are neglected global health concerns, despite being largely predictable and therefor preventable. We conducted a small study to indirectly describe and compare the perception of availability of resources to manage major trauma in high-income, and low- and middle-income countries using evidence-based guidance (as per the 2016 National Institute of Clinical Excellence guidelines), as self-reported by delegates attending the 2016 International Conference on Emergency Medicine held in South Africa. Methods: A survey was distributed to delegates at the International Conference on Emergency Medicine 2016. The survey instrument captured responses from participants working in both pre- and in-hospital settings. Responses were grouped according to income group (either high-income, or low- and middle-income) based on the respondent’s nationality (using the World Bank definition for income group). A Fisher’s Exact test was conducted to compare responses between different income groups. Results: The survey was distributed to 980 delegates, and 392 (40%) responded. A total of 206 (53%) respondents were from high-income countries and 186 (47%) were from low- to middle-income countries. Respondents described significantly less access to resources and services for low- and middle-income countries to adequately care for major trauma patients both pre- and in-hospital when compared to high-income countries. Shortages ranged from consumables to analgesia, imaging to specialist services, and pre-hospital to in-hospital care. Conclusion: Major trauma care requires a chain of successful, evidence-based events for outcomes to benefit. This small study suggests that many of the links of this chain are either missing or broken within low- and middle-income countries. These settings simply do not benefit from the currently available evidence-base in major trauma care. It is important that this evidence-base also be evaluated within low- and middle-income countries. The capacity of low- and middle-income country emergency care systems also needs better describing. Keywords: Self-report, Specialization, Global health, Income, Emergency medicine, Developed countries