The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study

Area of Science:

• Emergency Medicine
• Public Health
• Health Systems Research

Background:

• Prehospital care in low-resource settings like Tanzania is often fragmented.
• Existing referral networks have significant deficiencies, impacting trauma patient outcomes.

Purpose of the Study:

• To characterize the prehospital experiences of Tanzanian trauma patients.
• To identify barriers and facilitators for implementing community-based emergency medical systems (EMS).

Main Methods:

• Qualitative study using semistructured interviews with 34 adult trauma patients or their surrogates.
• Grounded theory approach for data analysis to identify recurrent themes.

Main Results:

• Identified deficiencies in the referral network: missed/delayed diagnoses, limited pre-referral capabilities, and transfer delays.
• Barriers to EMS include patient finances, lack of insurance, limited infrastructure, and responder credibility.
• Facilitators include community resource pooling, trust in local responders, and faith in leaders; strong interest in first aid training.

Conclusions:

• Significant structural, financial, institutional, and cultural barriers exist for formal prehospital systems.
• Community-based first-responder systems leveraging local trust and leadership are feasible.
• Trained lay responders show favorable acceptability, offering opportunities for care improvement with basic training and low-cost supplies.