Prehospital Transportation and Care of Externally-Caused Injuries Admitted to Karapitiya Teaching Hospital in Galle, Sri Lanka

Background: Injuries account for about 13% of all registered deaths in Sri Lanka, and are the leading cause of admission to public hospitals. Each year, about 62,377 people with injuries require inpatient care in the Galle district. The prehospital trauma care system is new to Sri Lanka and a free ambulance service was launched about two years ago, with most ambulances concentrated in the larger cities around major hospitals.

Objective: The objective of this study was to describe the prehospital transportation and care of people with externally-caused, acute injuries and examine factors associated with ambulance transport the first health facility.

Methods: A cross-sectional survey, with a small longitudinal component was administered to 405 patients that were admitted the emergency trauma center at Teaching Hospital Karapitiya in Galle, Sri Lanka. Information on patients’ medical treatment and length of stay were extracted from the medical records. Descriptive statistics were tabulated to summarize prehospital transportation and care variables. Logistic regression was used to examine predictors of ambulance transport, and negative binomial regression was used to examine transport time, mode of transport, and prior medical care as effect modifiers of injury event and length of stay relationship.

Results: Over 50% of people used a tuk-tuk to get to the first health facility, and 20.5% used an ambulance to get to the first health facility. Factors that were significantly associated with ambulance use were age, injury mechanism, alcohol, location type, open wound, abrasion, and chest/abdomen injury. Ambulance transport and prior medical treatment were significant effect modifiers for open wound and fractures.

Conclusion: Ambulance transport and prior medical treatment of fractures and open wounds were associated with a reduced length of stay which could help alleviate the burden on already constrained resources at tertiary care facilities.