Box 6.3Improving Trauma Care in the Absence of a Formal Ambulance System

Background: The efficacy of a program that builds upon the existing, although informal, system of prehospital transport in Ghana was assessed. In Ghana, the majority of injured persons are transported to the hospital by some type of commercial vehicle, such as a taxi or bus.

Methods: A total of 335 commercial drivers were trained using a six-hour basic first aid course. The efficacy of this course was assessed by comparing the process of prehospital trauma care provided before and after the course, as determined by self-reporting from the drivers.

Results: Follow-up interviews were conducted on 71 of the drivers, a mean of 10.6 months after the course. Sixty-one percent indicated that they had provided first aid since taking the course. There was considerable improvement in the provision of the components of first aid in comparison to what was reported prior to the course (see table 1).

Table 1Provision of Emergency Medical Care Before and After First Aid Course

Type of careProvided before course (%)Provided after course (%)
Crash scene management735
Airway management235
Bleeding control442
Splint application116


The course was conducted with moderate amounts of volunteer labor and gifts-in-kind, such as transportation to the course. The actual cost of the course amounted to US$3 per participant.

Conclusions: Even in the absence of formal emergency medical services, improvements in the process of prehospital trauma care are possible by building upon existing, although informal, prehospital transport.

Source: DCP2, chapter 68, box 68.1.

From: Chapter 6, Providing Interventions

Cover of Priorities in Health
Priorities in Health.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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