title: The readiness of emergency and trauma care in low- and middle-income countries: a cross-sectional descriptive study of 42 public hospitals in Albania.
abstract: BACKGROUND
  Traumatic injuries have become a substantial but neglected epidemic in low- and middle-income countries (LMICs), but emergency rooms (ERs) in these countries are often staffed with healthcare providers who have minimal emergency training and experience. The aim of this paper was to describe the specialized training, available interventions, and the patient management strategies in the ERs in Albanian public hospitals.
  
  
  METHODS
  A cross-sectional descriptive study of 42 ERs in the Republic of Albania between September 5, 2014, and December 29, 2014 was performed. Assessment subcategories included the following: (1) specialized training and/or certifications possessed by healthcare providers, (2) interventions performed in the ER, and (3) patient management strategies.
  
  
  RESULTS
  Across the 42 ERs surveyed, less than half (37.1-42.5 %) of physicians and one third of nurses (7.1-26.0 %) working in the ERs received specialized trauma training. About half (47.9-57.1 %) of the ER physicians and one fifth of the nurses (18.3-22.9 %) possessed basic life support certification. This survey demonstrated some significant differences in the emergency medical care provided between primary, secondary, and tertiary hospitals across Albania (the significance level was set at 0.05). Specifically, these differences involved spinal immobilization (p = 0.01), FAST scan (p = 0.04), splinting (p = 0.01), closed reduction of displaced fractures (p = 0.02), and nurses performing cardiopulmonary resuscitation (CPR) (p = 0.01). Between 50.0 and 71.4 % of the facilities cited a combined lack of training and supplies as the reason for not offering interventions such as rapid sequence induction, needle thoracotomy, chest tube insertion, and thrombolysis. Mass casualty triage was utilized among 39.1 % primary hospitals, 41.7 % of secondary, and 28.6 % of tertiary.
  
  
  CONCLUSIONS
  The emergency services in Albania are currently staffed with inadequately trained personnel, who lack the equipment and protocols to meet the needs of the population.
authors.affiliation: Department of Surgery, Westchester Medical Center Health, 100 Woods Road, Valhalla, New York, 10595, USA. Latifi@surgery.arizona.edu.|International Virtual e-Hospital (IVeH) Foundation, Hope, USA. Latifi@surgery.arizona.edu.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: International Virtual e-Hospital (IVeH) Foundation, Hope, USA.|Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, 85721, USA.
authors.forename: Jayleen K L
authors.initials: JK
authors.lastname: Gunn
authors.affiliation: Department of Surgery, Westchester Medical Center Health, 100 Woods Road, Valhalla, New York, 10595, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Stroster
authors.affiliation: TUHC "Mother Teresa" Hospital, Tirana, Albania.
authors.forename: Edmond
authors.initials: E
authors.lastname: Zaimi
authors.affiliation: Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania.
authors.forename: Fatos
authors.initials: F
authors.lastname: Olldashi
authors.affiliation: University Trauma Hospital, Tirana, Albania.
authors.forename: Agron
authors.initials: A
authors.lastname: Dogjani
authors.affiliation: Anesthesiology and Intensive Care, University Hospital of Trauma, Tirana, Albania.
authors.forename: Mihal
authors.initials: M
authors.lastname: Kerci
authors.affiliation: Faculty of Medicine & Surgery, University of Tirana, Tirana, Albania.
authors.forename: Xheladin
authors.initials: X
authors.lastname: Draçini
authors.affiliation: International Virtual e-Hospital (IVeH) Foundation, Hope, USA.
authors.forename: Julian
authors.initials: J
authors.lastname: Kuçani
authors.affiliation: The United States Agency for International Development (USAID)/Albania, Tirana, Albania.
authors.forename: Zhaneta
authors.initials: Z
authors.lastname: Shatri
authors.affiliation: The United States Agency for International Development (USAID)/Albania, Tirana, Albania.
authors.forename: Agim
authors.initials: A
authors.lastname: Kociraj
authors.affiliation: International Virtual e-Hospital (IVeH) Foundation, Hope, USA.
authors.forename: Arian
authors.initials: A
authors.lastname: Boci
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
authors.forename: Ross I
authors.initials: RI
authors.lastname: Donaldson
keywords: Emergency medical care; Guidelines for Essential Trauma Care; International Association for Trauma and Surgical Intensive Care; Low and middle-income countries (LMICs); Trauma care; World Health Organization