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Prehospital Airway Management for Trauma Patients by First Responders in Six Sub-Saharan African Countries and Five Other Low- and Middle-Income Countries: A Scoping Review

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Abstract

The global injury burden disproportionately affecting low- and middle-income countries (LMICs) is exacerbated by a lack of robust emergency medical services. Though airway management (AM) is an essential component of prehospital emergency care, the current standard of prehospital AM training and resources for first responders in LMICs is unknown. This scoping review includes articles published between January 2000 and June 2021, identified using PMC, MEDLINE, and SCOPUS databases, following PRISMA-ScR guidelines. Inclusion criteria spanned programs training formal or informal prehospital first responders. Included articles were assessed for quality using the Newcastle–Ottawa scale. Relevant characteristics were extracted by multiple authors to assess prehospital AM training. Of the initial 713 articles, 17 met inclusion criteria, representing 11 countries. Basic AM curricula were found in 11 studies and advanced AM curricula were found in nine studies. 35.3% (n = 6) of first responder programs provided no equipment to basic life support (BLS) AM training participants, reporting a median cost of $7.00USD per responder trained. Median frequency of prehospital AM intervention was reported in 31.0% (IQR: 6.0, 50.0) of patient encounters (advanced life support trainees: 12.1%, BLS trainees: 32.0%). In three studies, adverse event frequencies during intubation occurred with a median frequency of 22.0% (IQR: 21.0, 22.0). The training deficit in advanced AM interventions in LMICs suggests BLS AM courses should be prioritized, especially in sub-Saharan Africa. Prehospital AM resources are sparse and should be a priority for future development.

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The authors received no funding for this work.

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Authors and Affiliations

  1. Washington University in St. Louis McKelvey School of Engineering, 1 Brookings Drive, St. Louis, MO, 63130, USA

    Haleigh Pine

  2. LFR International, Los Angeles, CA, USA

    Haleigh Pine, Zachary J. Eisner & Peter G. Delaney

  3. University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA

    Zachary J. Eisner & Peter G. Delaney

  4. Michigan Center for Global Surgery, 1301 Catherine St, Ann Arbor, MI, 48109, USA

    Zachary J. Eisner, Peter G. Delaney & Krishnan Raghavendran

  5. Masinde Muliro University of Science and Technology, Kakamega Webuye Highway, P.O. Box 190-50100, Kakamega, Kenya

    Simon Ochieng Ogana & Dinnah Akosa Okwiri

  6. University of Michigan Medicine Department of Surgery, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Krishnan Raghavendran

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  1. Haleigh Pine
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Contributions

HP contributed to study design, literature search, data collection, writing, and critical revision; ZJE contributed to study design, literature search, data collection, data analysis, data interpretation, writing, and critical revision; PGD contributed to writing and critical revision; SO, DO, and KR contributed to critical revision.

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Correspondence to Haleigh Pine.

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Pine, H., Eisner, Z.J., Delaney, P.G. et al. Prehospital Airway Management for Trauma Patients by First Responders in Six Sub-Saharan African Countries and Five Other Low- and Middle-Income Countries: A Scoping Review. World J Surg 46, 1396–1407 (2022). https://doi.org/10.1007/s00268-022-06481-5

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