Prehospital Emergency Care and the Global Road Safety CrisisPrehospital Emergency Care and the Global Road Safety Crisis

To the Editor: In his Medical News & Perspectives article, Dr Cole¹ highlights the increasing burden of years of life lost and long-term disability from road traffic injuries in developing countries as a result of poorly designed transportation systems. An adequate response of emergency medical services in settings with scarce resources is a challenge for research and planning of health services.

Most developing countries have insufficient prehospital emergency medical services.² Ground ambulances are available only in urban areas, if at all. Flight rescue is a luxury service for tourists but is inaccessible to local populations. In the absence of organized prehospital care, injured persons are often cared for by bystanders without any training in basic life support, and transported to the next medical facility in private or commercial vehicles.

In most regions with a sharp increase in traffic-related injuries, the response of the health sector does not keep pace. Even organized systems of trauma care need several years to become effective in reducing mortality from road traffic injuries.³

The organization of emergency medical services with regard to skills of staff and to medical interventions performed in the field differs across countries and continents. There is an ongoing debate about which medical interventions ought to be performed in the prehospital setting.⁴ For instance, it is unclear whether patients sustaining road traffic injuries benefit from tracheal intubation at the crash scene. Research on the effectiveness of medical interventions in prehospital and in-hospital emergency care must be strengthened in global efforts to reduce the social burden from road traffic injury.

Countries with scarce resources need cost-efficient solutions. Besides primary prevention, the recent World Report on Road Traffic Injury Prevention issued by the World Health Organization identifies trauma care as a target for interventions.⁵ Each year, many of the 1.2 million lives lost could be saved and much of the disability of the 50 million injured could be prevented if fast and competent prehospital care were available at the crash scene.