Prehospital and First Health Facility Management of Patients with Severe Musculoskeletal Injuries in Uganda

Background: There is a dearth of evidence outlining the state of prehospital and first health facility care of the musculoskeletal injury patients in Uganda. Further documenting the current impediments in prehospital care may provide a basis for prioritizing interventions aimed at improving the system.
Methods: Cross-sectional descriptive analysis of prehospital and first health facility care of patients withmusculoskeletal injuries. Patients presenting for care at the Mulago Hospital Accident and Emergency Unit (MHAEU) within the first 24hrs post musculoskeletal injury were enrolled in the current study.
Results: 378 patients were enrolled from November 2006 to January 2007. Injury severity scores ranged from 2 to 45. 310 patients were "rescued" from the accident scene immediately after injury, 30 within 30 minutes, and the remaining 38 after 30 minutes. Ambulance personnel, police, and lay people, retrieved 2.4%, 12.4% and 85.2% from the injury scene respectively. 27.5% of patients arrived at MHAEU within one hour after injury. Haemostasis, splinting of injured limbs, and IVF resuscitation was carried out in 31.1%, 14.3% and 11.4% of patients respectively deemed on arrival to require such care. No patients had cervical spine precautions in place during extrication from the scene of injury and only 2/323 (0.6%) who required spine protection had c-collars at presentation. No treatment was provided in 99/157 of the patients seen in outside facilities prior to transfer to the MHAEU.
Conclusion: Minimal care is administered in the field to musculoskeletal injury patients. Inadequate resources and equipment along with unskilled responders create an informal prehospital system not prepared to offer appropriate care. Urgent need exists to improve this system in Uganda.