M. A. Boeck1,3,4, T. E. Callese5, S. K. Nelson5, S. J. Schuetz2, C. G. Miller6, C. Fuentes Bazan7, J. R. Simons Gonzáles8, M. C. Vargas8, L. W. Ruderman8, J. L. Gallardo10, J. M. Laguna Saavedra11, N. M. Issa2, M. B. Shapiro2, M. Swaroop2 1Feinberg School Of Medicine – Northwestern University,Center For Global Health,Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University,Division Of Trauma And Critical Care,Chicago, IL, USA 3Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 4New York Presbyterian Hospital – Columbia,Department Of Surgery,New York, NY, USA 5Wake Forest University School Of Medicine,Winston-Salem, NC, USA 6Emory University School Of Medicine,Atlanta, GA, USA 7Arco Iris Hospital,La Paz, , Bolivia 8Centro De Medicina Familiar Yawisla SRL,Potosi, , Bolivia 9University Of Southern California,Los Angeles, CA, USA 10Hospital Obrero #5 Caja Nacional De Salud,Potosi, , Bolivia 11Bolivian National Police,La Paz, , Bolivia
Introduction: Globally, a person dies every five seconds due to a traumatic injury. Effective trauma systems, including pre-hospital, hospital and rehabilitative care, lead to decreased mortality and improved functional outcomes. Yet many low-resource settings like Bolivia lack in one or more of these areas. We sought to survey trauma first responder course (TFRC) participants in La Paz and Potosi, Bolivia regarding the current state of emergency training, trauma experience and healthcare facility access.
Methods: From March to May 2013 a nominally priced, eight-hour TFRC was offered in Bolivia. Nine sessions were held in the department of La Paz, a largely populated, urban setting; and ten courses took place in seven municipalities in the Potosi region, a more rural mining community. Participants completed a baseline survey on personal demographics, prior emergency experiences, first-aid training, and health facility access. Categorical and continuous variables were analyzed by Pearson’s chi squared and Wilcoxon rank sum tests, respectively.
Results: A total of 514 participants met criteria for study inclusion: n=355 in Potosi and n=159 in La Paz. There were higher proportions of medically trained (76.8% vs. 59.5%, p<0.001) and university-educated (81.1% vs. 61.4%, p<0.001) individuals in Potosi; while participants in La Paz had more prior trauma training (71.3% vs. 51.5%, p<0.001), emergency experiences in the past six months (68.6% vs. 43.9%, p<0.001) and higher numbers of emergencies seen per respondent (median 21.5 vs. 5, p<0.001). The most common injury mechanisms across both regions were road traffic crashes (median 5, IQR 2, 15) and falls (median 3, IQR 1, 8). Sixty-six percent of individuals in La Paz had provided assistance in an emergency versus 40% in Potosi (p<0.001), while most participants had access to first aid equipment in both locations (Potosi 77.9% vs. La Paz 83.1%, p=0.20). Health centers were considered the primary emergency care facility in Potosi (43.4%) versus hospitals in La Paz (51.6%, p=0.004), despite a majority of participants in both locales reporting an estimated 10 to 30 minute travel time to the closest hospital (p=0.015). On univariable analysis, there was no significant association between assisting in an emergency and pre-test score, prior training, self-reported baseline skill confidence level or profession.
Conclusion: The baseline TFRC survey captures fundamental information on existing local emergency response resources, workforce experiences and injury patterns. Participants reported a significant exposure to trauma cases, with variable access or ability to provide appropriate and timely medical care, highlighting a gap in basic emergency skills and supply availability in the community. This confirms the need for sustainable improvements in pre-hospital care in Bolivia, including additional training, resources and systems planning, to eventually decrease injury morbidity and mortality.