1. Systems Expansion in Global Surgery: Needs Assessment and Feasibility of
Prospective Data Registry Development for Prehospital Care in Cali, Colombia
Zina Model, BA1 & Dhaval Mehta, BA1; Paul Truche, MD2; Gregory Peck, DO3
1Rutgers Robert Wood Johnson Medical School Piscataway, NJ Department of General Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ Department of Acute Care Surgery, Robert Wood Johnson University Hospital New Brunswick, NJ 08901
Purpose
Establish the groundwork for longitudinal needs assessment and quality improvement of prehospital care in Cali, Colombia.
Implement prospective study to evaluate timely access to essential surgery with prehospital inspection.
Build capacity for prehospital and hospital data integration for regional trauma system inclusivity.
Methods
Three medical students collectively spent three months in Cali between April and July The students identified prehospital stakeholders through a needs assessment to determine strengths and weaknesses in the prehospital system.
Information acquisition led to the development of a prospective clinical project on the status of two-hour access to care after trauma that will be continued longitudinally over 4 years. We report on the first year’s accomplishments: a prospective clinical research protocol for both the private and public sector: Hospital Universitario del Valle (a public hospital) and Fundación Valle del Lili (a private hospital).
The public hospital, Hospital Universitario del Valle
The private hospital, Fundación Valle del Lili
Discussion and Conclusions
This project laid the foundation for a longitudinal collaborative project by utilizing students in the Global Scholars program to forge a relationship with the Cali trauma system.
This infrastructure is vital to the project’s longitudinal nature, allowing for meaningful data to be collected in the long term dedicated to improving the prehospital system.
Challenges included understanding and fulfilling the different requirements for ethics board approval at each institution, as well as establishing consistent domestic capacity because of limited system resources for quality improvement.
Students gained an appreciation for collaborative work and the importance of ensuring continued success by setting up their peers in developing a longitudinal project.
The creation of the data collection form was a key step for this initial phase of the longitudinal project and a direct result of the needs assessment portion of this work, with input from local EMS, physicians, and research staff.
Moving forward, efforts for data collection in LMICs warrants database formation that links prehospital care with existing hospital data for trauma outcomes assessment.
Background
Access to timely surgical care (less than two hours) is essential for universal health care.1 Prehospital care impacts access to surgical care within a trauma system.2,3 Determining local prehospital practices and expanding data metrics can improve and standardize triage. In Cali, Colombia, prehospital care is non-standardized, non-inclusive, and a complex system of public and private ambulances provides variable pre-hospital care. Objective data of current EMS practices in low resource settings is necessary to optimize local and national systems of care.
Data Collection Form
To the left is the English translation of the Data Collection Form that is stored in the Emergency Department triage area of both hospitals. Paramedics are required to fill out this form upon patient arrival detailing travel times, vital signs, and other information that will be useful in the prospective study relating patient outcomes data to prehospital care. It was designed via collaboration between local medical and research staff, the RWJ medical students, and additional stakeholders.
Results
1) Data collection is minimal for prehospital variables and poorly links to the existing hospital database.
2) Two prospective data collection protocols were created.
3) Local officials helped to better understand domestic goals for the research project. Significant revisions were based on local input to modify protocol and data collection and proposal adherence to hospital requirements. Collection and submission of documentation for all co-investigators was completed. Written approval was obtained from the director of clinical research and documents were submitted in-person to the ethics committee at the private institution. Approval by the public institution is more challenging due to committee changes.  
4) Research process to include domestic student participation and data collection, Redcap database initiation, and reciprocal analysis and interpretation from epidemiologic and surgical faculty is underway.
5) The Chancellors students collaborated significantly with domestic medical students (building local student investment) who will oversee day-to-day implementation of the data collection as part of a continued effort. Data analysis points are set for two months and one year post-initiation of data collection. Global Scholars program will continue to return to Cali for longitudinal collaboration and project completion.
Funding
Funding was provided by a grant from the United States Agency for International Development (USAID) awarded to each of the Rutgers medical students, in conjunction with the Rutgers Chancellors Global Health Scholars program
References
Meara, J.G. and S.L. Greenberg, The Lancet Commission on Global Surgery Global surgery 2030: Evidence and solutions for achieving health, welfare and economic development. Surgery, (5): p
Callese, T.E., et al., Trauma system development in low- and middle-income countries: a review. J Surg Res, (1): p
Henry, J.A. and A.L. Reingold, Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg, (1): p