Scarf Injury: a qualitative examination of the emergency response and acute care pathway from a unique mechanism of road traffic injury in Bangladesh

BMC Emergency Medicine, 2022 · DOI: https://doi.org/10.1186/s12873-022-00698-2 · Published: August 1, 2022

Simple Explanation

Road traffic injuries are a major cause of death and injury worldwide. In Bangladesh, a specific type of injury called a 'scarf injury' has emerged, where a scarf gets caught in the driveshaft of autorickshaws, leading to strangulation-like trauma. This study aimed to understand how people respond in emergencies, the steps taken to provide acute care, and the resulting health outcomes for those who survive scarf injuries. The study found that many patients experience poor outcomes due to lack of awareness about scarf injuries, unsafe first aid practices, and the high cost of healthcare.

Study Duration

2013-2018 (Data Collection: June-July 2018)

Participants

12 scarf injury survivors, 6 caregivers, and 15 health care workers

Evidence Level

Not specified

Key Findings

1
Over half of the scarf injury patients were between the ages of 10 and 15, and almost all were tetraplegic, indicating severe spinal cord injuries.
2
A lack of awareness about scarf injuries and spinal cord injuries among the public and healthcare professionals contributes to less than optimal patient outcomes.
3
Unsafe and inefficient first aid practices by bystanders and the high costs of acute healthcare further worsen the outcomes for scarf injury patients.

Research Summary

This study examined the emergency response and acute care pathway for scarf injury survivors in Bangladesh, identifying gaps in care using the three-delay model. The study found that delays in seeking care, reaching care, and receiving adequate care all contribute to less-than-optimal patient outcomes, with mishandling during transport being a significant issue. The authors suggest interventions to increase awareness and knowledge of basic spinal cord injury care at the community and provider level to improve health and functional outcomes.

Practical Implications

Public Awareness Campaigns

Implement awareness campaigns to educate the public about scarf injuries, their prevention, and proper first aid techniques for spinal cord injuries.

Healthcare Provider Training

Provide training to healthcare professionals on the diagnosis, treatment, and management of spinal cord injuries, especially those resulting from scarf injuries.

Improved Emergency Response Systems

Enhance emergency response systems to ensure rapid and safe transportation of injured individuals to appropriate healthcare facilities, focusing on proper spinal stabilization techniques.

Study Limitations

1
Small patient and caregiver sample size, potentially underestimating the magnitude of challenges.
2
Sample limited to patients who survived and reached the rehabilitation center (CRP), introducing selection bias.
3
Healthcare worker sample primarily from CRP, lacking perspectives from professionals in pre-hospital and acute care settings.

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