The city has only three TCs and travel times are over 30 min within a maximum distance of 10 km from the TC. For distant areas in the city (i.e., the remaining 97% of the area covered), travel times to these TCs will be much higher. The city has a poor road infrastructure and public transport vehicles are prone to frequent accidents [9].
The ambulances are staffed by drivers with no training in emergency trauma care or basic life support. The ambulances are typically equipped with a radio and a stretcher and in some cases with an oxygen tank, a suction machine, and a “first aid box” for wound dressing. The drivers maintain contact with the ambulance service control room. However, they have no communication with the hospital and do not follow any treatment protocols.
Usually, a bystander at the scene of the emergency calls the ambulance service. The dispatch center then instructs the ambulance service nearest to the site to send an ambulance. The ambulance then picks up the patient and transports him or her to the nearest TC [10].
Newspapers frequently report deaths of trauma victims due to delay in accessing emergency care. Our results, surprisingly, show travel times that are much lower than we expected at the outset of our study. The reason could be the variability in traffic at different times of the day. Our study was carried out between 1300 and 1700 hours on working days. It is very likely that the travel time will be different at other times of the day and on weekends.
The level of medical facilities is an important factor affecting the number of people killed in road traffic accidents, which cost Pakistan about £260 million per annum [11]. Until recently, trauma patients were exclusively taken to government-designated TCs with a medicolegal department. New legislation allows ECFs to provide services to RTI victims. This means that there are more hospitals available to cater to the needs of trauma patients and are on an average 4.5 min away from any given location. However, essential items such as cervical spine collar, spine board, and pain medications such as morphine are not universally available at the ECFs. In addition, most ECFs are privately owned and charge a fee for services. This becomes an important issue where more than 70% of the population earns less than $2 per day [12]. The true usefulness of ECFs will become apparent only after they become better equipped and receive incentives to provide trauma care. Efforts need to be made to upgrade trauma care services in the city.
There are a number of limitations in our exploratory study. We were able to determine timings only at one particular time of the day. We are therefore unable to comment on seasonal, monthly, off-peak, and peak hour variability.
We relied on the response of the doctors in the ECFs regarding the presence of supplies at all times and did not check and confirm the inventory of the ECFs at that time. Further studies need to be done to determine the differences in patient outcome depending on whether they use an ECF or TC and to establish guidelines for the appropriate referral, transfer, and management plans for different patients.