Journal of Angiotherapy
Integrative Biomedical Research | Online ISSN  2207-872X
  1. You are here:
  2. Home
  3. Journals
  4. Biological Sciences
REVIEWS   (Open Access)
Contents Vol 7 (2)

Challenges and Strategies for Strengthening Emergency Care Systems in Post-Conflict Settings: A Comprehensive Review

Salmuhaylib, Abdulaziz Mohammed 1, Afnan Mohammed Bin Jabal 1, Naif Ruwaydhan Al Ruwaydhan 1, Ali Mutlaq Ali Alsubaie 1, Hamad Dafalh Alrakhimy 1, Abdulaziz Shayim Alsharari 1, Salman Ghazi Al-Faridi 1, Ali Jamal Alanazi 1, ‏Abdulrahman Abdullah Alorf 1, ‏Ahmed Turki Alotaibi 1, ‏Abdulrahman Munawir Alanazi 1, ‏Rayid Mohammed Alanazi 1, ‏Yousef Mansour Aloudah 1, Moteb Roshaid Al-Shamari 1, Sultan Fares Alshamari 1, ‏Zaid Helal Alanazi 1, Talal Fares Awadh Almutairi 1, Bassam Mohammed Al-Rashid 1*

+ Author Affiliations

Journal of Angiotherapy 7 (2) 1-8 https://doi.org/10.25163/angiotherapy.7210147

Submitted: 10 October 2023 Revised: 28 December 2023  Published: 29 December 2023 

Abstract

Emergency care services (ECS) are vital for reducing mortality and morbidity in post-conflict regions, where fragile healthcare infrastructures and limited resources exacerbate health challenges. This review synthesizes current literature on ECS in post-conflict settings, employing the World Health Organization's Emergency Care System Framework to identify systemic deficiencies and context-specific needs. The findings highlight pervasive barriers, including inadequate infrastructure, insufficient medical supplies, limited formal emergency medical education, and societal mistrust. Restricted access to care, damaged transportation and communication networks, and disrupted referral systems further hinder ECS effectiveness. In many cases, triage systems are deficient, leading to resource misallocation and suboptimal patient outcomes. Despite these challenges, targeted interventions such as community education, standardized triage implementation, and capacity-building initiatives have shown promise. However, a lack of quantitative evaluations limits the ability to assess their efficacy comprehensively. Addressing these gaps requires integrating robust training programs, enhancing resource allocation, and fostering community trust to build resilient ECS. The review underscores the need for standardized frameworks and increased donor engagement to optimize emergency care delivery and contribute to broader post-conflict recovery efforts.

Keywords: Emergency care systems, Post-conflict healthcare, Prehospital care, Healthcare infrastructure, Trauma systems

References

Acerra, J. R., Iskyan, K., Qureshi, Z. A., & Sharma, R. K. (2009). Rebuilding the healthcare system in Afghanistan: An overview of primary care and emergency services. International Journal of Emergency Medicine, 2, 77–82.

Adini, B., Cohen, R., Laor, D., & Israeli, A. (2011). Can patient flow be effectively controlled? Health Policy and Planning, 26, 518–525.

Alobo, G., Ochola, E., Bayo, P., Muhereza, A., Nahurira, V., & Byamugisha, J. (2021). Why women die after reaching the hospital: A qualitative critical incident analysis of the ‘third delay’ in post-conflict North Uganda. Maternal and Child Health Journal, Md, 1–11.

Alruwaili, A., Khorram-Manesh, A., Ratnayake, A., Robinson, Y., & Goniewicz, K. (2023). The use of prehospital intensive care units in emergencies—A scoping review. Healthcare, 11(21), 2892.

Bhaumik, S., Hannun, M., Dymond, C., DeSanto, K., Barrett, W., Wallis, L. A., & Mould-Millman, N. K. (2022). Prehospital triage tools across the world: A scoping review of the published literature. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), 32.

Boeck, M. A., Callese, T. E., Nelson, S. K., Schuetz, S. J., Fuentes, C., Mauricio, J., et al. (2018). The development and implementation of a layperson trauma first responder course in La Paz, Bolivia: A pilot study. Injury, 49, 885–896.

Broccoli, M. C., Dixon, J., Skarpiak, B., Phiri, G., Muck, A. E., & Calvello, E. J. (2021). Application of the World Health Organization’s basic emergency care course in Zambia. African Journal of Emergency Medicine, 11, 140–143.

Carlson, L. C., Reynolds, T. A., Wallis, L. A., & Calvello Hynes, E. J. (2019). Reconceptualizing the role of emergency care in the context of global healthcare delivery. Health Policy and Planning, 34, 78–82.

Charlson, F., Van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394, 240–248.

Chi, P. C., Bulage, P., Urdal, H., & Sundby, J. (2015). Barriers in the delivery of emergency obstetric and neonatal care in post-conflict Africa: Qualitative case studies of Burundi and Northern Uganda. PLoS One, 10, e0139120.

Epps, L., Ramachandran, A., Yi, S., Mayah, A., Burkholder, T., Jaung, M., Haider, A., Wesseh, P., Shakpeh, J., Bills, C., & Enriquez, K. (2023). Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit. PLoS One, 18(3), e0282690.

Erickson, T. B., Vanrooyen, M. J., Werbiski, P., Mycyk, M., & Levy, P. (1996). Emergency medicine education intervention in Rwanda. Annals of Emergency Medicine, 28, 648–651.

Fernández-Niño, J. A., Chavarro, L. M., Vásquez-Rodríguez, A. B., Rojas-Botero, M. L., Hernández-Neuta, G. E., & Peñuela-Poveda, A. M., et al. (2020). Perception of effective access to health services in territorial spaces for training and reincorporation, one year after the peace accords in Colombia: A cross-sectional study.

Gashi, M., Bajraktari, G., Gashi, S. L., Ahmeti, H. R., & Degoricija, V. (2022). Correlates of in-hospital mortality in patients with acute coronary syndrome in Kosovo. Acta Clinica Croatica, 61(1), 19–28.

Goosen, J., Bowley, D. M., Degiannis, E., & Plani, F. (2003). Trauma care systems in South Africa. South African Medical Journal, 34, 704–708.

Henry, J., & Reingold, A. (2012). Prehospital trauma systems reduce mortality in developing countries: A systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery, 73, 261–268.

Hong, Q., Fabregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., et al. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34, 285–291.

Kennedy, K., Aghababian, R. V., Gans, L., & Lewis, C. P. (1996). Triage: Techniques and applications in decision making. Annals of Emergency Medicine, 28, 136–144.

Khan, A., Mahadevan, S. V., Dreyfuss, A., Quinn, J., Woods, J., Somontha, K., et al. (2016). One-two-triage: Validation and reliability of a novel triage system for low-resource settings. Emergency Medicine Journal, 33, 709–715.

Kivlehan, S., Dixon, J., Kalanzi, J., Sawe, H., Chien, E., Robert, J., et al. (2019). Impact of the World Health Organization basic emergency care course in Tanzania and Uganda. PLoS One, 14, e0224257.

Kruk, M. E., Freedman, L. P., Anglin, G. A., & Waldman, R. J. (2010). Rebuilding health systems to improve health and promote state-building in post-conflict countries: A theoretical framework and research agenda. Social Science & Medicine, 70, 89–97.

Kruk, M. E., Rockers, P. C., Williams, E. H., Varpilah, S. T., Macauley, R., & Galea, S. (2010). Availability of essential health services in post-conflict Liberia. Bulletin of the World Health Organization, 88, 527–534.

Lashoher, A., Schneider, E. B., Juillard, C., Stevens, K., Colantuoni, E., Berry, W. R., et al. (2017). Implementation of the World Health Organization trauma care checklist program in 11 centers across multiple economic strata: Effect on care process measures. World Journal of Surgery, 41, 954–962.

Lecky, F. E., Reynolds, T., Otesile, O., Hollis, S., Turner, J., Fuller, G., et al. (2020). Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): Results of research prioritization setting exercise. BMC Emergency Medicine, 20, 68.

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., et al. (2009). The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. PLoS Medicine, 6, e1000100.

McGarry, K., Redmill, D., Edwards, M., Byrne, A., Brady, A., & Taylor, M. (2017). Punishment attacks in post-ceasefire Northern Ireland: An emergency department perspective. Ulster Medical Journal, 86, 90–93.

McGready, R., Rijken, M. J., Turner, C., Than, H. H., Tun, N. W., Min, A. M., et al. (2021). A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Research, 6, 94.

Molyneux, E., Ahmad, S., & Robertson, A. (2006). Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bulletin of the World Health Organization, 84, 314–319.

Nelson, B. D., Dierberg, K., Ågren, M., Mitrovic, M., Vuksanovic, M., Milic, L., et al. (2005). Integrating quantitative and qualitative methodologies for the post-conflict Serbia. BMC Health Services Research, 11, 1–11.

Nelson, B. D., Fernandez, W. G., Galea, S., Sisco, S., Dierberg, K., Gorgieva, G. S., et al. (2004). War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia. BMC Medicine, 10, 1–10.

O’Hanlon, K., & Lerner, E. (2007). Post-war development of emergency medicine in Kosovo. Emergency Medicine Journal, 24, 18–21.

O’Meara, M., Porter, K., & Greaves, I. (2007). Triage. Trauma, 9, 111–118.

Orkin, A. M., Venugopal, J., Curran, J. D., Fortune, M. K., McArthur, A., Mew, E., et al. (2021). Emergency care with lay responders in underserved populations: A systematic review. Bulletin of the World Health Organization, 99, 514–528.

Ramsden, S., & Cresswell, R. (2019). First aid and voluntarism in England, 1945–85. Twentieth Century British History, 30, 504–530.

Razzak, J. A., Bhatti, J., Wright, K., Nyirenda, M., Tahir, M. R., & Hyder, A. A. (2022). Improvement in trauma care for road traffic injuries: An assessment of the effect on mortality in low-income and middle-income countries. The Lancet, 400(10348), 329–336.

Razzak, J., Usmani, M. F., & Bhutta, Z. A. (2019). Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: Analysis of the 2015 global burden of disease study. BMJ Global Health, 4, 733.

Reynolds, T. A., Sawe, H., Rubiano, A. M., Shin, S. D., Wallis, L., & Mock, C. N. (2017). Strengthening health systems to provide emergency care. In D. T. Jamison, H. Gelband, S. Horton, P. Jha, R. Laxminarayan, C. N. Mock, & R. Nugent (Eds.), Disease Control Priorities: Improving Health and Reducing Poverty (3rd ed., Chapter 13). Washington, DC: The International Bank for Reconstruction and Development / The World Bank.

Samuel, N., Hirschhorn, G., Chen, J., Steiner, I. P., & Shavit, I. (2013). Prehospital injury severity of children evacuated by helicopters from combat zones: A retrospective report. Journal of Emergency Medicine, 44, 641–645.

Shustak, A., Uwitonze, J. M., Kabagema, J., Wojick, M., Asay, B., Louka, A., Wolfe, L., Dushime, T., & Jayaraman, S. (2023). Managing medical emergencies: Sustainable pre-hospital medical education in Rwanda. Rwanda Medical Journal, 80(3), 34–41.

Sunyoto, T., Bergh, R. D., Valles, P., Gutierrez, R., Ayada, L., Zachariah, R., et al. (2014). Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: A cross-sectional study. BMC Health Services Research, 14, 531.

Tenner, A. G., Sawe, H. R., Amato, S., Kalanzi, J., Kafwamfwa, M., Geduld, H., et al. (2019). Results from a World Health Organization pilot of the basic emergency care course in Sub-Saharan Africa. PLoS One, 14, e0224257.

The United Nations. (2022). Peacebuilding and sustaining peace: Report of the Secretary-General.

Thompson, M. E., Harutyunyan, T. L., & Dorian, A. H. (2012). First aid training course for primary health care providers in Nagorno Karabagh: Assessing knowledge retention. Prehospital and Disaster Medicine, 27, 509–514.

Vanier, V. K., Vanrooyen, M. J., Lis, J., & Eliades, M. J. (2001). Post-war Kosovo: Part I assessment of prehospital emergency services. Prehospital and Disaster Medicine, 16, 263.

Wen, L. S., & Char, D. M. (2011). Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study. African Journal of Emergency Medicine, 1, 57–61.

Werner, K., Kak, M., Herbst, C. H., & Lin, T. K. (2023). Emergency care in post-conflict settings: A systematic literature review. BMC Emergency Medicine, 23(1), 37.

World Health Organization. (2019). Emergency care systems for universal health coverage: Ensuring timely care for the acutely ill and injured (WHA72.16).

World Health Organization. (2019). Emergency care systems for universal health coverage: Ensuring timely care for the acutely ill and injured (WHA72.16). Seventy-second World Health Assembly, Geneva.

World Health Organization. (2019). Global Spending on Health: A World in Transition. Geneva.

World Health Organization. (2019). WHO Emergency Care System Framework infographic.

 

PDF
Abstract
Export Citation

View Dimensions


View Plumx


View Altmetric



0
Save
0
Citation
210
View
2
Share