All you need to know about emergency care in Kenya

Kakamega County Referral Hospital Emergency Department

The Ministry of Health in Kenya reported that in 2016, about 13,159 people were seriously injured on the road. It is not just road traffic accidents, but also tens of thousands others lose their lives due to other emergencies such as heart attacks, stroke, maternity cases such as the killer pregnancy-induced blood pressure and falls from buildings.

New WHO report highlights insufficient progress to tackle lack of safety on the world’s roads


7 DECEMBER 2018 | Geneva, Switzerland – A new report by the World Health Organization (WHO) indicates road traffic deaths continue to rise, with an annual 1.35 million fatalities. The WHO Global status report on road safety 2018 highlights that road traffic injuries are now the leading killer of children and young people aged 5-29 years.   

“These deaths are an unacceptable price to pay for mobility,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “There is no excuse for inaction. This is a problem with proven solutions. This report is a call for governments and partners to take much greater action to implement these measures.”  

The WHO Global status report on road safety 2018 documents that despite an increase in the overall number of deaths, the rates of death relative to the size of the world population have stabilized in recent years. This suggests that existing road safety efforts in some middle- and high-income countries have mitigated the situation.   

“Road safety is an issue that does not receive anywhere near the attention it deserves – and it really is one of our great opportunities to save lives around the world,” said Michael R Bloomberg, Founder and CEO of Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries. “We know which interventions work. Strong policies and enforcement, smart road design, and powerful public awareness campaigns can save millions of lives over the coming decades.”      

In the settings where progress has been made, it is largely attributed to better legislation around key risks such as speeding, drinking and driving, and failing to use seat-belts, motorcycle helmets and child restraints; safer infrastructure like sidewalks and dedicated lanes for cyclists and motorcyclists; improved vehicle standards such as those that mandate electronic stability control and advanced braking; and enhanced post-crash care.   

The report documents that these measures have contributed to reductions in road traffic deaths in 48 middle- and high-income countries. However, not a single low-income country has demonstrated a reduction in overall deaths, in large part because these measures are lacking.   

In fact, the risk of a road traffic death remains three times higher in low-income countries than in high-income countries. The rates are highest in Africa (26.6 per 100 000 population) and lowest in Europe (9.3 per 100 000 population). On the other hand, since the previous edition of the report, three regions of the world have reported a decline in road traffic death rates: Americas
, Europe and the Western Pacific.   

Variations in road traffic deaths are also reflected by type
 of road user. Globally, pedestrians and cyclists account for 26% of all road traffic deaths, with that figure as high as 44% in Africa and 36% in the Eastern Mediterranean. Motorcycle riders and passengers account for 28% of all road traffic deaths, but the proportion is higher in some regions, e.g. 43% in South-East Asia and 36% in the Western Pacific.   

RELATED LINKS:   

Global status report on road safety 2018 http://www.who.int/violence_injury_prevention/road_safety_status/2018/en    

WHO fact sheet on road traffic injuries http://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries    

WHO website on road traffic injuries http://www.who.int/violence_injury_prevention/road_traffic/en/    

SaveLIVES: a road safety technical package http://www.who.int/violence_injury_prevention/publications/road_traffic/save-lives-package/en/ 

What does the law say about emergency medical treatment in Kenya?

  • Medical institutions that fail to provide health care services necessary to prevent and manage the damaging health effects due to an emergency situation are culpable.
  • Facilities that have systems that are inappropriately designed and invariably cause a patient deserving of emergency medical treatment not to receive such treatment, are also culpable.
  • Hospitals that prioritize monetary security prior to admission can also be held in violation of the Constitution as well as the Kenya National Patients’ Rights Charter.
  • The liability of the government arises from its duties as stipulated in the Constitution as well as sections 15 and 112 of the Health Act. Where the government thus fails to enact policies; mobilize financial resources, regulate, train and accredit emergency care providers or ensure compliance with already existing guidelines by medical institutions, then it is liable in law. This, must, of course, be done in consultation with county governments and other stakeholders in the health sector acknowledging that health is now a devolved function.

 

David Rudisha campaigns for Emergency Care in Kenya

Today David Rudisha (2012 and 2016 Olympic champion, 2-time World Champion (2011 and 2015), and world record holder in the 800 metres) joined us to make a statement about emergency care in Kenya…he didn’t have to and definitely didn’t gain anything from it but he understood that we need to address the problem and dedicated his evening to play his part…so to all those who play their part every day saving lives…Thank You! You are our Everyday Hero!

 

Assessment of Emergency Medical Services (EMS) Training Curricula in Kenya

 

This assessment, conducted by external EMS experts with expertise in African and international EMS systems and EMS education, reports several key findings and offers important recommendations to help standardise and enhance the quality of training in Kenyan prehospital care.

In brief, the key recommendations are as follows:

  1. A standard Kenyan EMS scope of practice (document and policy) is needed that defines levels (i.e. tiers or cadres) of EMS providers and delineates all knowledge and skills required to practice as a prehospital provider at the given level.
  2. A standard for EMS training should be developed and implemented to help ensure high quality and uniformity in EMS training across institutions, and alignment with the Kenyan EMS scope of practice.
  3. There should be a transition from over-reliance on non-Kenyan curricula and training content, to more Kenya-specific materials and content targeted to the local burden of disease, healthcare system, and available resources. External reference texts/material can function as a guide for initial training initiatives and provide coarse structure, but training content should be edited as much as possible to reflect local needs.
  4. The EMS training culture should shift away from diagnosis-based training to syndrome or
    symptom-based training.
  5. EMS trainees could greatly benefit from stronger foundational didactic classroom-based education (classroom education) at the Basic (EMT) level with a specific focus on clinically relevant basic anatomy and physiology. This should be limited to the knowledge and basics directly relevant to their scope of practice.
  6. To improve foundational clinical training in emergency care, all trainees should first achieve competencies and attain adequate field experience at a basic (EMT) provider level, before receiving additional training to higher qualifications (e.g. Intermediate Life Support (ILS) or Advanced Life Support (ALS).
  7. Higher-order and critical thinking skills need to be developed, by integrating basic knowledge and skills into real-world clinical scenarios, which should be heavily woven into all aspects of EMS training programs.