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December 12 , 2005
Sasser works to improve emergency care in Mozambique

BY lailee mendelson

When a person is seriously injured in the United States, the first response is usually to dial 911 and wait for help. But in developing countries, which often lack such organized emergency medical services (EMS) systems, injuries frequently are not treated quickly enough, contributing to the high rates of injury-related death and disability found in low-income countries.

In fact, developing nations carry the overwhelming burden of such deaths and disabilities worldwide, according to Scott Sasser, assistant professor of emergency medicine. Ninety percent of global fatalities due to traffic accidents occur in the developing world. In Africa, injury mortality rates among males are higher than anywhere in the world, and drowning, war and traffic accident injuries rank among the top five causes of death in children ages 5 to 14.

Sasser is helping one African nation in particular—Mozambique—overcome these challenges. Using the recently published World Health Organization (WHO) document Prehospital Trauma Care Systems (of which Sasser is the lead editor) as a guide, he and several Emory colleagues work with Mozambican officials to strengthen emergency medical care in the capital city of Maputo.

“EMS systems like the United States’—with firefighters as ‘first responders’ followed by paramedics trained and equipped to provide advanced life-support interventions—are extremely expensive,” said Sasser. “Such costly EMS systems are far beyond the reach of most low-income countries.”

But that does not mean countries like Mozambique cannot provide good care, he said. Studies have shown that properly trained villagers, bystanders or primary health care workers can achieve many of the benefits of sophisticated prehospital trauma systems.

“We know some things work,” Sasser said, “such as putting pressure on bleeding and opening obstructed airways. These are techniques that can be easily taught and remembered, and they don’t require a country to overhaul its health care system or spend enormous amounts of money. What we need are simple, sustainable, flexible, locally and culturally relevant strategies for improving prehospital care.”

In August, Sasser led a team from Emory’s Department of Emergency Medicine to conduct a technical-assistance visit to Mozambique. The team, joined by representatives of the WHO and experts from South Africa, analyzed the current status of prehospital trauma care in Maputo and proposed activities to be conducted for system development.

Three months earlier, Sasser also received a National Institutes of Health Fogarty International Center grant to develop a training and injury-research program that will assist Mozambique in developing essential academic and clinical faculty in the principles of public health, research methods, ethical principles, injury prevention and control, and safety promotion.

The initiative is a collaborative effort between Emory’s Center for Injury Control (jointly sponsored by the Department of Emergency Medicine and the Rollins School of Public Health, and a WHO-designated collaborating center for injury control, violence prevention, and emergency health services) and the medical school of the Universidade Eduardo Mondlane in Maputo. The grant will assist with the creation of an injury-research infrastructure for Mozambique and will lay the foundation for a new trauma and injury-control center.

The Fogarty grant also will support a five-year training program for two fellows per year from Mozambique. Fellows (mostly clinicians) will spend their first year in Africa completing coursework, followed by three-to-six-month stints at Emory’s schools of medicine and public health. Sasser hopes the program will prove a model to expand trauma and injury-control research capacity throughout sub-Saharan Africa.

This article first appeared in International Emory, the newsletter of the Office of International Affairs, and is reprinted with permission.

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