Seriously Injured Patients in Global South Countries Miss 'Golden Hour' Care

A new international study, led by the University of Birmingham and Stellenbosch University, has revealed a critical gap in emergency medical care: a significant number of seriously injured patients in Global South countries do not receive medical care within the vital 'golden hour'. Published in BMJ Global Health, the findings indicate that in Ghana, Pakistan, Rwanda, and South Africa, over half of patients with serious injuries failed to reach medical care within an hour.

Key Findings on Delays

The 'golden hour' is a crucial guiding principle for patients with moderate or serious injuries, with strong evidence suggesting that delayed arrival is associated with increased risks of death and disability.

The study found that 57% of all patients arrived more than one hour after being injured, and 34% arrived more than two hours later.

While ambulances transported 46% of patients across the four countries (with usage varying from 20% in Ghana to 65% in Rwanda), paradoxically, ambulances were associated with reaching care after the golden hour. Patients using informal transport methods, such as private cars, taxis, or motorbikes, arrived for treatment more quickly than those traveling by ambulance.

Contributing Factors and Expert Insights

More than 50% of patients did not go directly to a facility capable of providing definitive treatment, with approximately 20% initially seeking care at primary care centers. This highlights a lack of awareness regarding injury severity and inadequate referral pathways, even for patients transported by ambulance.

Delays were more frequently observed in poorer, less-educated, and older patients, underscoring significant inequities. Despite these measured delays, only 19% of patients believed they had experienced a delay.

Professor Justine Davies from the University of Birmingham emphasized the gravity of the situation:

"In low-resource settings, understanding healthcare failures is crucial for saving lives and optimizing resource investment. Investing in expensive ambulance services alone may not reduce deaths after injuries; the entire pre-hospital system, including trained staff, referral pathways, and coordinated solutions, needs strengthening."

Dr. Leila Ghalichi, also from the University of Birmingham, added that these delays begin even before patients reach hospital doors and are "exacerbated by fragmented pre-hospital systems." She stressed that improving early access to the appropriate hospital could significantly reduce preventable disability and deaths.

Recommendations and Future Initiatives

The study provides actionable recommendations for policymakers:

• Strengthening pre-hospital care systems beyond just ambulance services.
• Improving transport options and considering alternatives to ambulances.
• Streamlining and enhancing referral pathways.
• Addressing inequities affecting vulnerable patient populations.
• Integrating injury care improvement with urban planning and congestion solutions.
• Increasing public awareness about the urgency of seeking prompt medical care.
• Developing national public health messaging to encourage direct attendance at capable facilities while avoiding overwhelming tertiary centers.

Injuries represent a growing health crisis in low- and middle-income countries (LMICs), predominantly affecting young people. Annually, over 4 million deaths are caused by injuries, with 90% occurring in LMICs, and 40% of these deaths are considered avoidable.

Professor Davies is actively working on a solution: the 912Rwanda software. This initiative, funded by the National Institute for Health and Care Research (NIHR) and the United States National Institute of Health, aims to improve coordination between ambulance crews and hospitals by automatically recommending the nearest available facility that can provide the necessary patient care. This software seeks to reduce serious disabilities for an estimated 250 million people who suffer injuries each year in LMICs, as well as mitigate deaths and disability from other emergency medical conditions.