Road traffic injuries are an important and rapidly growing epidemic throughout the developing world. Bangladesh is one of the nations hardest hit by this epidemic, with a recent large-scale national survey estimating over 23,000 deaths and more than 3.4 million injuries on the nation’s roads every year. Despite the significant and growing need for these services, Bangladesh lacks any type of national pre-hospital emergency medical system to provide them. As a consequence, the majority of traffic injury victims have little or no access to skilled first aid at the time when it can be most effective. Rapid access to skilled medical care at the crash scene plays an important role in reducing deaths and permanent injuries. Without a national hotline number for people to call when there has been a crash with injuries there are often significant delays in bringing necessary resources to crash scenes and in patients receiving treatment for their injuries. Most traffic injury victims are currently receiving care from untrained bystanders, and this lack of training carries very real risks. An excellent example of this is preventable spinal cord injuries caused by improper handling and transportation of patients. Most bystanders are also working without proper equipment, further impairing their ability to provide good care. Furthermore, there is often confusion about where to send badly injured patients. This creates additional delays when patients are initially taken to medical facilities that are not properly equipped to care for them, and then require transfer elsewhere for definitive treatment. There are also significant barriers to the transportation of injured patients in Bangladesh. Purchasing and maintaining ambulances is very resource intensive and the country’s incredible traffic congestion creates enormous delays in getting vehicles to and from the scene. Public ambulances are often not functional and private ambulances fees can be prohibitively high for poorer patients. Even if families are able to collect these funds, the process may sometimes takes hours.
Thoughout the widespread and rapidly growing use of mobile technology in Bangladesh give a powerful tool for organizing volunteer emergency services,to provide guidance, education, and first aid supplies in particular.
Prior to launching the service in a community, TraumaLink organize multiple local events to raise awareness about RTI’s, foster discussions about possible solutions to the problem, and recruit potential volunteers. They conclued that education on basic trauma first aid, guidance on where to take injured patients, and a single emergency hotline number would all be helpful in case of a traffic crash with injuries. Participants interested in becoming volunteers are interviewed by TraumaLink staff, who make the final decisions on who will move on to receive training. Recruits are all local community members, most of whom live and/or work close to the highway. Potential volunteers receive two days of intensive training on basic trauma first aid from a Bangladeshi physician-trainer employed by TraumaLink. The curriculum is based on materials originally developed by the PI to teach community health workers in Uganda and was later refined with the assistance of Bangladeshi physicians to assure that the content was relevant and understandable to a local audience. It focuses on the basics of trauma first aid with an emphasis on skills that are easy to teach, learn, and perform. The classes combine didactics with hands-on training and class size is limited to 15 students to ensure individual attention for all participants. Those who successfully graduate from the course are registered to serve as TraumaLink Volunteer First Responders. In addition to printed lecture materials, volunteers have access to a professional quality training video that was developed in Bengali to assist them in reviewing and improving their first aid skills. This is available in a high definition version as well as a condensed file that can be downloaded and viewed on a mobile phone. Volunteers are given personal photo ID badges as well as reflective fluorescent vests decorated with the TraumaLink logo to make them readily identifiable at crash scenes and to improve their visibility during nighttime responses. In order to stay active in the program, volunteers are required to undergo retraining every 6-12 months. The service utilizes a dedicated 24/7 emergency hotline number and a call center staffed by full time paid TraumaLink employees. A graphic user interface (GUI) was developed specifically for the service and features an interactive map of the service areas populated with geo-tagged local landmarks to allow for easy identification of the crash location even if the caller is not familiar with the area. When operators receive a call they collect information on where the crash occurred and how many patients have been injured. As soon as this information is entered into the call center GUI, the software program automatically generates SMS messages that dispatch an appropriate number of volunteers to the crash scene. Catchment areas are divided into different geographic zones along the highways. All volunteer first responders are assigned to a specific zone and summoned to crash scenes on a rotating basis to assure a more even call distribution. For larger mass casualty events, the system recruits volunteers from adjacent zones as needed. First aid supplies including stretchers, cervical collars, and bandages are supplied by TraumaLink and stored throughout the catchment areas in locations that can be accessed 24 hours a day. These include fuel stations and other prominent businesses as well as local Police and Fire Brigade Stations. After patients are treated at the crash scene, first responders make an assessment of the severity of their injuries. The call center software contains a registry of hospitals categorized by their location and the severity of traumatic injuries they have the capacity to manage. Call center operators use this information to provide guidance in directing patients to the nearest appropriate medical facility. With the support of community leaders, TraumaLink is able to provide transportation for patients through a combination of Fire and Police vehicles, free CNG service, and private vehicles, as this had been a common practice prior to the establishment of the service. Volunteers are supervised by paid TraumaLink field level staff who provide local support and quality control in crash scene responses and take call on a rotating basis to assure that every call will have a response if volunteers are unavailable. They also provide a vital link between the central team in Dhaka and local officials and community members. Following completion of an emergency response, the operator follows up by phone with the responding volunteer and/or field staff to collect additional demographic and operational information related to the call.