International Emergency Medicine
William Bruno, MD
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Division of Global Emergency Medicine
Disclosure Relationship(s): Nothing to disclose
Background: Recent escalations of violence forced over 900,000 Rohingya out of Myanmar and into Cox’s Bazar, creating the world’s largest refugee camps. Field hospitals aim to mitigate the crisis, yet no structured prehospital care system exists. Given unreliable communication networks and lack of resources for on-scene and online medical control, we seek to implement a protocol driven system. Here, we describe the development and methods for implementation of prehospital care protocols for use among a local Non Government Organization, Hope Foundation (HF)’s ambulance workers servicing the refugee community in Cox’s Bazar.
Methods: Patient demographics, reason for transport, transport destination, and location were retrospectively collected from March-October 2018 and descriptive statistics were collected. This data was used to develop Standing Field Treatment Protocols (SFTPs), which were adapted from the Los Angeles County Prehospital Care Manual. The protocols will be implemented in a stepwise manner, starting with those pertaining to the most common chief complaints. Subject matter experts will train the ambulance staff (ambulance drivers, medical assistants, and nurse midwifes) in SFTP adherence through classroom instruction and ambulance ride-alongs. Provider run sheets will be completed at the conclusion of each transport and will be reviewed to assess provider compliance with SFTPs.
Results: HF transported 366 unique patients to 38 facilities. Obstetric emergencies were the most common (10.4%) reason for transport, followed by musculoskeletal problems (9.6%), abdominal pain (9.6%), fever (8.2%), trauma (7.1%) and neonatal distress (4.8%). Acute watery diarrhea and malnutrition together accounted for 3.8%. Seventeen SFTPs (12 adult, 3 pediatric, 1 maternal, 1 miscellaneous) were developed based on the most common presenting chief complaints and further subcategorized as trauma (4), medical (9), and environmental exposure (3). Finally, a protocol for determination of death was developed and categorized as miscellaneous.
Conclusions: Our study is the first attempt to develop and implement an evidence-based, protocol-driven, prehospital system in a large complex refugee camp. Retrospective data guided the development of SFTPs that will be utilized to improve prehospital care in a complex refugee setting.