Ambulance services for road traffic injury (RTI) victims in Bangladesh: a cross-sectional study on the ground realities and the way forward.

Abstract

Introduction: Swift and safe transport of road traffic injury patients for life-saving interventions requires a functioning ambulance system which is largely lacking in the low- and middle-income countries. This study explored the current situation of ambulance-based prehospital care services in Bangladesh to inform the development of an evidence-based national ambulance system.

Methods: A cross-sectional study conducted in five selected districts of Bangladesh, employing qualitative and quantitative approaches, elicited data on the 29 ambulances and the knowledge and skills of their operators. Findings were validated through 32 key informant interviews with relevant stakeholders on their experiences and insights towards developing a national ambulance system in the country.

Results: Most of the ambulances were 'makeshift ambulances' (converted microbus) and commonly lacked the necessary supplies and equipment, including a Global Positioning System tracker or location identifier system. Around 20 drivers had 10+years of work experience, but none were trained in first-aid. Some drivers developed a few life-saving skills like removing foreign bodies from the airway or immobilising fractured limbs, etc from work experiences. The public sector ambulances were mostly used for transporting referral patients and, quite frequently, for transporting staff. Public ambulances had government-determined fixed rates, whereas private ambulances did not. The responsible authority/operator for the public sector ambulances was ambiguous and not coordinated by any local/central authority.

Conclusion: The 'ambulance' service in the country is rudimentary, fragmented and poorly resourced, lacking any central/regional level coordination. A recommendation is made to develop a national ambulance service, integrating public and private sectors and operating under a central/regional authority.