TraumaLink

Road traffic injuries are a rapidly growing epidemic in low- and middle-income countries (LMICs). However, many countries, including Bangladesh, lack formal prehospital emergency medical services, often leaving victims without access to first aid when it can be most effective in preventing death or disability.

Last updated in January 2024

TraumaLink uses a dedicated emergency hotline number and a 24-hour call center staffed by paid full-time employees. A graphic user interface (GUI), developed specifically for the program, features interactive and searchable maps of the catchment areas, densely populated with local landmarks. Before beginning operations, community members help staff identify these landmarks and their various, sometimes multiple, local names commonly in use. Staff collect exact GPS coordinates for each site on a smartphone and enter them, along with the local names, into the GUI. This allows for easy identification of the crash location even when the caller is not familiar with the community.

Catchment areas are divided into operational zones roughly 1–2 km in length, based on local landmarks and the frequency of crashes in that area. All volunteer first responders (VFRs) are assigned to a specific zone based on where they live and/or work and are dispatched to crashes on a rotating basis. For larger mass casualty events, volunteers are also recruited from adjacent zones. TraumaLink provides and maintains locally sourced first aid supplies and stores them in locations that can be accessed 24 hours a day. Paid, full-time area coordinators supervise VFRs and provide local support and quality control; they also act as a vital link between the central office in Dhaka and local officials, volunteers, and community members.

At the request of the highway police, who have jurisdiction over the national highways, hotline operators routinely notify them of all crashes that might require their presence. The police provide scene management, protection, and legitimacy for the volunteers and transportation of victims to the hospital. Fire services are also activated as necessary to assist with rescue operations and ambulance transport.

Emergency hotline operators receiving a call first enter information on the crash location and number of injured patients. The GUI software then uses an embedded algorithm to generate text messages, dispatching an appropriate number of VFRs prioritized by their proximity to the crash scene. After patients are treated at the accident scene, hotline operators make a rough assessment of the severity of their injuries based on information from the VFRs, and using triage guidelines developed for the program. The call center software also contains a registry of public hospitals categorized by the severity of traumatic injuries they can manage, and operators use this information as needed to direct patients to the nearest appropriate facility. We default to sending patients to public hospitals to avoid potential delays in care resulting from private hospitals refusing them admission and to protect VFRs from having to make potentially financially consequential decisions for incapacitated patients.

Before each expansion of the program into a new community, we advertise our services and hotline number through community engagement events and various types of local media. Volunteers and staff also regularly spend time in the community, educating people about the service and encouraging them to program the hotline number into their phones. These campaigns are continued after the service launch.

Since the launch of formal operations in November 2014 we have expanded from a 14 km pilot to 227 km on 3 national highways, and free care has been provided to 5,363 patients involved in 2,902 crashes. All calls to the service have received a response, and in 90% of cases, first responders are at the scene within 5 minutes of the crash. We have found transportation to the hospital for all of the 3,099 patients who have required it, with almost 80% of victims arriving within 30 minutes of receiving their injuries. Almost 80% of our patients are men aged 21-50, most of whom are family breadwinners. Assessments of injury severity at the accident scene align closely with patient dispositions, reflecting the accuracy of these triage decisions.

For quality monitoring and evaluation of the program as well as to determine the program’s impact, after completion of each incident response, call center operators follow up by phone with volunteers and/or area coordinators to gather any missing information such as types of road users, victim demographics, and clinical information including patient dispositions. This allows us to collect uniquely detailed and comprehensive information on crashes in our catchment areas, and this information is already being used to drive more efficient and effective prevention measures.

Traumatic injuries are exquisitely time-sensitive and most traffic injury victims are otherwise young and healthy, so they are often salvageable with simple and inexpensive first aid measures if they are delivered quickly. Conversely, significant delays in care can result in unnecessary death or disability, often with profound and multigenerational impacts on families and the economy. TraumaLink was created to address the lack of formal prehospital services in Bangladesh by providing rapid access to free stabilizing care at the crash scene and transportation to the hospital.

TraumaLink streamlines and augments the process of mobilizing and organizing prehospital services for road traffic injury victims. Previously, police and fire services were notified of crashes through bystanders calling the stations, if they had the numbers available. We have instead instituted a hyperlocal emergency response system, with volunteer first responders positioned to quickly learn about and respond to incidents. The proximity of the volunteers and their dominant role in initiating emergency responses enables our rapid response times; in the middle of the night, it is often a volunteer who hears the crash, responds to the scene, and formally activates the call center.

The strong community support and rapid, reliable volunteer responses that characterize TraumaLink suggest that this model should be expanded throughout Bangladesh. While each setting offers unique challenges, many of the dangers Bangladeshi road users face are found throughout LMICs, and this simple, effective, and easily scalable model can be readily modified for other countries facing similar challenges.