Qualitative evaluation of trauma delays in road traffic injury patients in Maringá, Brazil

Background Road traffic injuries (RTIs) are the 8th leading cause of death worldwide, with 90% occurring in low- and middle-income countries (LMICs). In Brazil, more than 43,800 people are killed by RTI annually. There is limited research evaluating RTI transport delays to trauma centres in LMICs. The objective of this study is to determine specific causes of prehospital transport delays in RTI patients to trauma centres in Maringa, Brazil. Methods We qualitatively evaluated the regional public prehospital system, Servicos de Atendimento Movel de Urgencia (SAMU), with a catchment area of 500,000 people, one Advanced and 4 Basic Life Support teams. We used a qualitative approach and interviewed providers. Inclusion criteria were: healthcare professionals working with SAMU or the regional trauma hospital Metropolitano for at least 6 months. Interviews focused on primary causes and measures to reduce delays in care of RTI patients. Results We interviewed 11 providers: 2 physicians and 2 nurses from Metropolitano and 7 SAMU employees (1 nurse, 3 physicians, 3 drivers). Primary causes of delays fell into the following categories: 1) lack of public education, 2) traffic, 3) insufficient personnel/ambulances, 4) bureaucracy, and 5) poor location of stations. Traffic was the most common response, with a total of 7 responses, including nearly all SAMU providers. Suggested measures to reduce delays were: 1) improving public education, 2) increasing personnel, 3) increasing ambulances, 4) proper extrication/need for rapid treatment, and 5) need for a centralised station to avoid traffic. The most common response was the need for public education, primarily teaching drivers about ambulance right-of-way. Conclusions Most providers, particularly SAMU providers, believe traffic is the primary cause of delay in presentation of RTI patients to a tertiary care centre. Rapid economic growth and increased road traffic are primary factors leading to the overall increased rates of RTIs in LMICs. The same traffic causing RTIs may also be a significant cause of delay in the treatment these patients. Offered solutions to reduce delays focused mostly on public education and the need for increased resources. A public education campaign for driver education in response to RTIs could be an initial step towards reducing delays in the care of RTI patients.