65 Emergency Care

Jess Meagher, Joseph Kalanzi, Tony Luggya, Omona Alfonse 22/10/18

Injury = 10% global burden of diseasee

6x more likely to die of survivable injury here than you are in a high income country. Resulting in 2 million “avoidable deaths” a year.

6 English speaking SubSaharan African countries involved in establishing Emergency Care Systems with the WHO.

This is an emergency care system as the WHO sees it, also what the ECSA are using:

• Care at scene
• Care at transport
• Care at hospital

System: Relies on systems, governance, as well as health care workers, and kit.

Scene/Transport: Relies on bystander involvement, a dispatcher and system, and a health care provider to come to patient.

Uganda currently lacks any good samaritan laws to protect bystanders (so people are reluctant to), or a single number to phone, or coordinated dispatch of providers. There’s a lack of providers, provider skill, and physical infrastructure.

Hospital: No structure for transfer of care. Majority of people working in ED are not “emergency trained”, or fixed to the ED. There’s a lack of kit. Private hospitals are currently not mandated to give emergency care, so people get delays, sent off to public hospitals.

Uganda has recently introduced emergency medicine training program.

30% global burden of disease can be attributed to surgically treatable conditions.

How do you deal with the fact that most of SSA has less than 10% of the trained surgeons it needs? You bring in the idea of Task Shifting. People taking on roles traditionally thought of as a “surgeon’s role”.

In rural areas of Uganda, a median surgical admission may cost ~$250. This can be more than someone’s yearly income.