The coronavirus disease 2019 (COVID-19) pandemic had detrimental impacts across multiple sectors of the Mexican health care system. The prehospital care system, however, remains largely under-studied. The first objective of this study was to calculate the monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the early pandemic period (January 1 through June 30, 2020), while the second objective was to conduct these calculations at the borough-level for the same outcomes and time period. The third objective was to compare monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the pre-pandemic (January 1 through June 30, 2019), early pandemic (January 1 through June 30, 2020), and later pandemic periods (January 1 through June 30, 2021).

A retrospective analysis was conducted to examine injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) and borough-levels. Monthly per capita rates were calculated using four datasets, including Mexico City’s Public Release 9-1-1 Emergency Calls, National Institute of Statistics and Geography’s (INEGI) Traffic Accidents Micro-Dataset, Mexico City’s Attorney General’s Office Crime Dataset, and Projections of the Population of the Municipalities of Mexico, 2015 to 2030. All statistical analyses were conducted using STATA 17.0.

During the early pandemic period, injury-related 9-1-1 emergency calls, traffic accidents, and crime experienced similar trends in monthly per capita rates at the state-level and borough-levels. While the monthly per capita rates remained constant from January to March 2020, starting in March, there was a precipitous decrease across all three outcomes, although decline rates varied across boroughs. The monthly per capita rates across the three outcomes were higher during the pre-pandemic period compared to the early pandemic period. As the COVID-19 pandemic progressed, the monthly per capita rates during the later pandemic period increased across the three outcomes compared to the early pandemic period, although they did not reach pre-pandemic levels during the study period.

The precipitous decline in injury-related 9-1-1 calls, traffic accidents, and crime in Mexico City occurred at the same time as the issuance of the first wave of public health orders in March 2020. The largest decrease across the three outcomes occurred one to two months post-issuance of the orders.

Advanced Automatic Collision Notification (AACN) services in passenger vehicles capture crash data during collisions that could be transferred to Emergency Medical Services (EMS) providers. This study explored how EMS response times and other crash factors impacted the odds of fatality. The goal was to determine if information transmitted by AACN could help decrease mortality by allowing EMS providers to be better prepared upon arrival at the scene of a collision.

The Crash Injury Research and Engineering Network (CIREN) database of the US Department of Transportation/National Highway Traffic Safety Administration (USDOT/NHTSA; Washington DC, USA) was searched for all fatal crashes between 1996 and 2012. The CIREN database also was searched for illustrative cases. The NHTSA’s Fatal Analysis Reporting System (FARS) and National Automotive Sampling System Crashworthiness Data System (NASS CDS) databases were queried for all fatal crashes between 2000 and 2011 that involved a passenger vehicle. Detailed EMS time data were divided into prehospital time segments and analyzed descriptively as well as via multiple logistic regression models.

The CIREN data showed that longer times from the collision to notification of EMS providers were associated with more frequent invasive interventions within the first three hours of hospital admission and more transfers from a regional hospital to a trauma center. The NASS CDS and FARS data showed that rural collisions with crash-notification times >30 minutes were more likely to be fatal than collisions with similar crash-notification times occurring in urban environments. The majority of a patient’s prehospital time occurred between the arrival of EMS providers on-scene and arrival at a hospital. The need for extrication increased the on-scene time segment as well as total prehospital time.

An AACN may help decrease mortality following a motor vehicle collision (MVC) by alerting EMS providers earlier and helping them discern when specialized equipment will be necessary in order to quickly extricate patients from the collision site and facilitate expeditious transfer to an appropriate hospital or trauma center.

PlevinRE, KaufmanR, Fraade-BlanarL, BulgerEM. Evaluating the Potential Benefits of Advanced Automatic Crash Notification. Prehosp Disaster Med. 2017;32(2):156–164.

Road traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians.

This study examined the challenges associated with current first response practices in Malawi.

In April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer.

Access to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services.

Prehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals.

ChokothoL, MulwafuW, SinginiI, NjalaleY, Maliwichi-SenganimalunjeL, JacobsenKH. First Responders and Prehospital Care for Road Traffic Injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14–19.

The worldwide use of rail transport has increased, and the train speeds are escalating. Concurrently, the number of train disasters has been amplified globally. Consequently, railway safety has become an important issue for the future. High-velocity crashes increase the risk for injuries and mortality; nevertheless, there are relatively few studies on high-speed train crashes and the influencing factors on travelers’ injuries occurring in the crash phase. The aim of this study was to investigate the fatal and non-fatal injuries and the main interacting factors that contributed to the injury process in the crash phase of the 2013 high-velocity train crash that occurred at Angrois, outside Santiago de Compostela, Spain.

Hospital records (n=157) of all the injured who were admitted to the six hospitals in the region were reviewed and compiled by descriptive statistics. The instant fatalities (n=63) were collected on site. Influencing crash factors were observed on the crash site, by carriage inspections, and by reviewing official reports concerning the approximated train speed.

The main interacting factors that contributed in the injury process in the crash phase were, among other things, the train speed, the design of the concrete structure of the curve, the robustness of the carriage exterior, and the interior environment of the carriages. Of the 222 people on board (218 passengers and four crew), 99% (n=220) were fatally or non-fatally injured in the crash. Thirty-three percent (n=72) suffered fatal injuries, of which 88% (n=63) died at the crash site and 13% (n=9) at the hospital. Twenty-one percent (n=32) of those admitted to hospital suffered multi-trauma (ie, extensive, severe, and/or critical injuries). The head, face, and neck sustained 42% (n=123) of the injuries followed by the trunk (chest, abdomen, and pelvis; n=92; 32%). Fractures were the most frequent (n=200; 69%) injury.

A mass-casualty incident with an extensive amount of fatal, severe, and critical injuries is most probable with a high-velocity train; this presents prehospital challenges. This finding draws attention to the importance of more robust carriage exteriors and injury minimizing designs of both railway carriages and the surrounding environment to reduce injuries and fatalities in future high-speed crashes.

ForsbergR , VázquezJAI . A Case Study of the High-speed Train Crash Outside Santiago de Compostela, Galicia, Spain. Prehosp Disaster Med. 2016;31(2);163–168.

Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict.

Injuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce.

In a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence.

Seventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ2=46.8; P<.001).

People injured in traffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.

SchneiderM . War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries. Prehosp Disaster Med. 2015;30(6):618–620.