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Delaney PG, Eisner ZJ, Thullah AH, Turay P, Sandy K, Boonstra PS, Raghavendran K. Evaluating feasibility of a novel mobile emergency medical dispatch tool for lay first responder prehospital response coordination in Sierra Leone: A simulation-based study. Injury 2023; 54:5-14. [PMID: 36266111 DOI: 10.1016/j.injury.2022.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The global injury burden, driven by road traffic injuries, disproportionately affects low- and middle-income countries, which lack robust emergency medical services (EMS) to address injury. The WHO recommends training lay first responders (LFRs) as the first step toward formal EMS development. Emergency medical dispatch (EMD) systems are the recognized next step but whether small groups of LFRs equipped with mobile dispatch infrastructure can efficiently respond to geographically-dispersed emergencies in a timely fashion and the quality of prehospital care provided is unknown. MATERIALS AND METHODS We piloted an EMD system utilizing a mobile phone application in Sierra Leone. Ten LFRs were randomly selected from a pool of 61 highly-active LFRs trained in 2019 and recruited to participate in an emergency simulation-based study. Ten simulation scenarios were created matching proportions of injury conditions across 1,850 previous incidents (June-December 2019). Fifty total simulations were launched in randomized order over 3 months, randomized along 10 km of highway in Makeni. Replicating real-world conditions, highly-active LFR participants were blinded to randomized dispatch timing/scenario to assess response time and skill performance under direct observation with a checklist using standardized patient actors. We used novel cost data tracked during EMD pilot implementation to inform the calculation of a new cost-effectiveness ratio ($USD cost per disability-adjusted life year averted (DALY)) for LFR programs equipped with dispatch, following WHOCHOICE guidelines, which state cost-effectiveness ratios less than gross domestic product (GDP) per capita are considered "very cost-effective." RESULTS Median total response interval (notification to arrival) was 5 min 39 s (IQR:0:03:51, 0:09:18). LFRs initially trained with a 5-hour curriculum and refresher training provide high-quality prehospital care during simulated emergencies. Median first aid skill checklist completion was 89% (IQR: 78%, 90%). Cost-effectiveness equals $179.02USD per DALY averted per 100,000 people, less than Sierra Leonean GDP per capita ($484.52USD). CONCLUSION LFRs equipped with mobile dispatch demonstrate appropriate response times and effective basic initial management of simulated emergencies. Training smaller cohorts of highly-active LFRs equipped with mobile dispatch appears highly cost-effective and may be a feasible model to facilitate efficient dispatch to expand emergency coverage while conserving valuable training resources in resource-limited settings.
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Affiliation(s)
- Peter G Delaney
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI 48109, United States; LFR International, 4835 Oak Park Ave, Encino, California, United States; Michigan Center for Global Surgery, Ann Arbor, Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, United States.
| | - Zachary J Eisner
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI 48109, United States; LFR International, 4835 Oak Park Ave, Encino, California, United States; Michigan Center for Global Surgery, Ann Arbor, Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, United States
| | - Alfred H Thullah
- LFR International - Sierra Leone, Plot 4, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | | | - Kpawuru Sandy
- Sierra Leone Red Cross Society, 6, Liverpool St., Freetown, Sierra Leone
| | - Philip S Boonstra
- University of Michigan Department of Biostatistics, 1415 Washington Heights, Ann Arbor, MI, United States
| | - Krishnan Raghavendran
- Michigan Center for Global Surgery, Ann Arbor, Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, United States; University of Michigan Health System Department of Surgery, 1500 E Medical Center Dr, Ann Arbor, MI, United States
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Hendrie D, Lyle G, Cameron M. Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111185. [PMID: 34769702 PMCID: PMC8583449 DOI: 10.3390/ijerph182111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007–2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.
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Affiliation(s)
- Delia Hendrie
- School of Population Health, Curtin University, Bentley, Perth 6102, Australia;
- Correspondence: ; Tel.: +61-8-9266-9068
| | - Greg Lyle
- School of Population Health, Curtin University, Bentley, Perth 6102, Australia;
| | - Max Cameron
- Monash University Accident Research Centre (MUARC), Clayton, Melbourne 3800, Australia;
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Scott-Parker B, Oviedo-Trespalacios O. Young driver risky behaviour and predictors of crash risk in Australia, New Zealand and Colombia: Same but different? ACCIDENT; ANALYSIS AND PREVENTION 2017; 99:30-38. [PMID: 27865138 DOI: 10.1016/j.aap.2016.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/21/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
Young drivers remain overrepresented in road crashes around the world, with road injury the leading cause of death among adolescents. In addition, the majority of road traffic crashes, fatalities and injuries occur in low- and middle-income countries. All young drivers are at risk due to a breadth of age- and inexperience-related factors; however it is well recognised that young drivers may also intentionally engage in risky driving behaviours which increase their crash risk. The aim of this paper is to examine the self-reported risky driving behaviour of young drivers in Australia, New Zealand (high-income countries), and Colombia (middle-income country), and to explore the utility of a crash risk assessment model in these three countries. Young drivers aged 16-25 years completed the Behaviour of Young Novice Drivers Scale (BYNDS), in addition to self-reporting crash involvement and driving offences. A hierarchical segmentation analysis via decision trees was used to study the relationship between self-reported crashes and risky driving. Young drivers in Colombia reported more risky driving than young drivers in New Zealand, and considerably more risky driving than young drivers in Australia. Significant differences among and across countries in individual BYNDS items were found, and 23.5% of all participants reported they had been involved in a road crash. Handheld mobile phone usage was the strongest predictor of crashes, followed by driving after drinking alcohol, and carrying friends as passengers. Country of origin predicted mobile phone usage, with New Zealand and Colombia grouped in the same decision tree branch which implies no significant differences in the behaviour between these countries. Despite cultural differences in licensing programs and enforcement, young drivers reported engaging in a similar breadth of risky behaviours. Road crashes were explained by mobile phone usage, drink driving and driving with passengers, suggesting interventions should target these three risk factors. Whilst New Zealand and Australia have implemented graduated driver licensing programs, are geographical neighbours, and are high-income countries, the finding that behaviours of young drivers in New Zealand and Colombia were more similar than those of young drivers in New Zealand and Australia merits further investigation.
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Affiliation(s)
- Bridie Scott-Parker
- Adolescent Risk Research Unit (ARRU), Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast (USC), Australia; Sustainability Research Centre (SRC), Faculty of Arts, Business and Law, University of the Sunshine Coast (USC), Australia; School of Social Sciences, Faculty of Arts, Business and Law, University of the Sunshine Coast (USC), Australia; Consortium of Adolescent Road Safety (CADROSA), Australia.
| | - Oscar Oviedo-Trespalacios
- Consortium of Adolescent Road Safety (CADROSA), Australia; Queensland University of Technology (QUT), Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Australia; Queensland University of Technology (QUT), Institute of Health and Biomedical innovation (IHBI), Australia; Department of Industrial Engineering, Universidad del Norte, Colombia
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