title: The prehospital burden of disease due to trauma in KwaZulu-Natal: the need for Afrocentric trauma systems.
abstract: BACKGROUND
  Trauma is one of the leading prehospital disease profiles in South Africa in general and in KwaZulu-Natal (KZN) in particular. The present study was designed to review the prehospital burden of injury in KZN, identify trauma burden to ambulance ratios, analyze system deficiencies, and propose a prehospital trauma system that is Afrocentric in nature.
  
  
  METHODS
  Approval from the relevant ethics authorities was obtained. Using a convenience data set all Emergency Medical Service (EMS) call data for the months of March and September 2010 were reviewed for the three main EMS providers in KZN. Data were extrapolated to annual data and placed in the context of population, ambulance service, and facility. The data were then mapped for area distribution and prehospital workload relative to the entire province. Questionnaire-based assessments of knowledge and deficiencies of the current system were completed by senior officers of the provincial system as part of the analysis of the current system.
  
  
  RESULTS
  The total annual call burden for trauma ranges between 94,840 and 101,420, or around 11.6 trauma calls per thousand of the population per year. Almost 70 % of calls were either for interpersonal intentional violence or vehicular collisions. Only 0.25 % of calls involved aeromedical resources. Some 80 % of patients were considered to be moderately to seriously injured, yet only 41 % of the patients were transported to a suitable level of care immediately, with many going to inappropriate lower level care facilities. Many rural calls are not attended within the time norms accepted nationally. Deficiencies noted by the questionnaire survey are the general lack of a bypass mechanism and the feeling among staff that most EMS bases do not have a bypass option or feel part of a system of care, despite large numbers of staff having been recently trained in triage and major trauma care.
  
  
  CONCLUSIONS
  The prehospital trauma burden in KZN is significant and consumes vital resources and gridlocks facilities. A prehospital trauma system that is financially sustainable and meets the needs of the trauma burden is proposed to enable Afrocentric emergency care planning for low and middle income regions.
authors.affiliation: Inkosi Albert Luthuli Central Hospital, Berea, South Africa. timothyhar@ialch.co.za
authors.forename: Timothy Craig
authors.initials: TC
authors.lastname: Hardcastle
authors.forename: Melissa
authors.initials: M
authors.lastname: Finlayson
authors.forename: Marc
authors.initials: M
authors.lastname: van Heerden
authors.forename: Ben
authors.initials: B
authors.lastname: Johnson
authors.forename: Candice
authors.initials: C
authors.lastname: Samuel
authors.forename: David J J
authors.initials: DJ
authors.lastname: Muckart
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data / Q000600:supply & distribution; D001291:Attitude of Health Personnel; D017281:Cost of Illness; D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D020380:Needs Assessment; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy