Emergency preparedness: the case of management of road traffic accidents in three District Hospitals in the Ashanti Region of Ghana

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Worldwide, road traffic accidents (RTA) are leading cause of mortality and morbidity. In Ghana, RTA has been identified as a cause of preventable deaths and among the ten causes of outpatient attendance. Some RTA patients eventually end up in the hospitals. Outcome is determined by many factors, one of the most important being the emergency preparedness of the institution to manage such cases. Unacceptable levels of emergency preparedness by district hospitals situated along major highways in southern Ghana have been identified as a problem militating against provision of adequate and acceptable levels of care for victims of road traffic accidents (RTA). The Kumasi-Yeji trunk road has been identified as one of the most accident- prone. The Ashanti Regional Health Administration is not happy with the number of preventable deaths resulting from RTA in its hospitals. The Sekyere West, EjuraSekyedumasi and Afigya-Sekyere district health administrations, in whose districts this accident-prone road passes, have recorded accident as one of the five causes of outpatient attendance and are interested in knowing the state of emergency preparedness of their district hospitals to manage RTA patients. It was in the light of this that this hospital-based cross-sectional survey was designed and carried out in three district hospitals situated along the Kumasi-Ejura highway. The study was aimed at assessing the state of emergency preparedness of the three-selected district hospitals to manage cases of RTA. From the results of the study, recommendations were to be made to improve the state of emergency preparedness. The study was a cross-sectional one facilitated by the use of structured questionnaire and direct observation using a checklist. The availability of resources and processes that ensures emergency preparedness and the accessibility to these by RTA patients were looked at from the health managers and providers perspectives. It was conducted at the Mampong District Hospital (MDH), Ejura District Hospital (EDH) and the Abena Kwabena Seventh-day Adventist Hospital (SDA). Weaknesses were found in the area of key RTA management facilities, personnel, equipment, processes and inadequate accessibility to those available. This had made emergency preparedness in the three hospitals not to be in a state to help reduce adequately, the increasing preventable deaths and morbidity associated with RTA. It is recommended that, the three district hospitals prepare or review their disaster plans for RTA patients. Casualty should be established at EDH and SDA. Radiotelephone needs to be provided at SDA. Anaethetist is needed at EDH and surgical equipment for RTA-linked procedures and anaesthetic equipment need to be procured at EDH. Ambulances at MDH and EDH needs to be equipped appropriately and an ambulance service created out of these two ambulances for the three neighboring districts. A functional blood bank should be established at MDH and SDA. Policy to ensure daily inspection of emergency equipment must be instituted and operationalized. Support services for RTA management should operate on 24-hour basis. Strict adherence to government policy of providing service to RTA patient for the first forty-eight hours without asking for payment must be disseminated and implemented in the hospitals. Implementation of these recommendations should help improve on the emergency preparedness for managing RTA cases by the three hospitals.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of MSc.degree in Health Services Planning and Management, 2002