Settings with no formal EMS

Most of the above issues of pre-hospital triage and radio communication pertain to systems for trauma management as organized in high-income countries. Many of these issues may also pertain to some middle-income environments in which EMS and a better telecommunications infrastructure exist. Nevertheless, some of the above principles apply to organization of trauma care systems even in low-income countries. This may apply even in settings where there is no formal EMS. For example, in Ghana a pilot programme assessed the potential utility of basic first-aid training for commercial drivers. These commercial drivers were already the ones transporting most of the severely injured patients who did make it to a hospital. The pilot programme demonstrated an improvement in basic first-aid manoeuvres performed by these drivers. Among these was the use of triage. Such triage was not related to the concept of bypass of facilities as mentioned above, but rather to identifying which of many casualties (e.g. in bus crashes) might benefit most from being transported first to nearby hospitals (80, 8/).

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