A Retrospective study of the pre-hospital trauma burden managed by the Western Cape Government Emergency Medical Services

  • Naseef Abdullah None
  • Colleen Saunders
  • Michael McCaul
  • Peter Nyasulu


Background: Trauma is one of the leading causes of premature death and disability in South Africa. There is a lack of data describing the pre-hospital trauma burden in sub-Saharan Africa. This study aimed to describe the epidemiology of common trauma emergencies managed by the Western Cape Government (WCG) emergency medical services (EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this Is the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these, 168 980 (34.3%), or 25.5 per 1000 population, were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were men between the socio-economically active ages of 21–40 years (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS caseload. The patient acuity was categorised as urgent in 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report on the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the World Health Organization (WHO) or any other low- and middle-income countries (LMICs). It also provides the foundation for further research on emergency care needs in South Africa and support for Afrocentric health care solutions to address this public health crisis.

Author Biography

Naseef Abdullah, None
Operational paramedic


World Health Organization. Injuries and Violence:The Facts. 2014.

Haagsma J, Graetz N, Bolliger I, et al. The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Inj Prev. 2015;22(1):3–18.

WHO. Global status report on road safety. World Health Organization; 2018.

Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification. Statistical Release P0309.3. 2018.

Gosselin RA. The Increasing Burden of Injuries in Developing Countries. Tech Orthop. 2009;24(4):230–2.

Mould-Millman N-K, Dixon JM, Sefa N, et al. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(03):273–83.

WHO. The burden of injuries in South Africa. WHO. World Health Organization; 2011.

Paniker J, Graham SM, Harrison JW. Global trauma: the great divide. Sicot-J. 2015;1:19.

Matzopoulos R, Prinsloo M, Pillay-Van Wyk V, Gwebushe N, Mathews S, Martin LJ, et al. Injury-related mortality in south africa: A retrospective descriptive study of postmortem investigations. Bull World Health Organ. 2015;93(5):303–13.

Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Guidelines for Essential Trauma Care.Geneva. Vol. 58, World Health Organisation. 2004.

Mock C, Jurkovich G, Nii-Amon-Kotei D, Al E. Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development. J Trauma - Inj Infect Crit Care. 1998 May;44(5):804–14.

Mould-Millman N-K, Rominski SD, Bogus J, et al. Barriers to accessing emergency medical services in Accra, Ghana: development of a survey instrument and initial application in Ghana. Glob Heal Sci Pract. 2015;3(4):577–590.

Beck B, Smith K, Mercier E, Cameron P. Reviewing prehospital trauma deaths. Resuscitation. 2018 Nov 1;130(Suppl 2):e140.

Mould-Millman NK, Naidoo R, De Vries S, Stein C, Wallis LA. AFEM consensus conference, 2013. AFEM out-of-hospital emergency care workgroup consensus paper: Advancing out-of-hospital emergency care in Africa-advocacy and development. African J Emerg Med. 2014;4(2):90–5.

Kobusingye OC, Hyder A a., Bishai D, Joshipura M, Hicks ER, Mock C. Disease Control Priorities in Developing Countries,second edition. Disease Control Priorities in Developing Countries. 2006. 1261-1279 p.

Paravar M, Hosseinpour M, Mohammadzadeh M, Mirzadeh AS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):473–7.

Statistics SA. Mid-year population estimates 2018 - 2020.

Department of Health. Western Cape Government,Department of Health Annual Report. 2017.

Twomey M, De Sá A, Wallis LA, Myers JE. Inter-rater reliability of the South African Triage Scale: Assessing two different cadres of health care workers in a real time environment. African J Emerg Med. 2011;1(3):113–8.

Wallis LA, Twomey M. Workload and casemix in Cape Town emergency departments. South African Med J. 2007;97(12 I):1276–80.

Hardcastle TC, Finlayson M, Van Heerden M, Al E. The prehospital burden of disease due to trauma in KwaZulu-Natal: The need for afrocentric trauma systems. World J Surg. 2013;37(7):1513–25.

Hardcastle TC, Oosthuizen G, Clarke D, et al. Trauma, a preventable burden of disease in South Africa: review of the evidence, with a focus on KwaZulu-Natal. South African Health Review 2016. 2016. p. 179–89.

Chiara O, Mazzali C, Lelli S, Mariani A, Cimbanassi S. A population based study of hospitalised seriously injured in a region of Northern Italy. World J Emerg Surg. 2013;8(1):1.

Black JJM, Ward ME, Lockey DJ. Appropriate use of helicopters to transport trauma patients from incident scene to hospital in the United Kingdom: An algorithm. Emerg Med J. 2004;21(3):355–61.

Zakariassen E, Burman RA, Hunskaar S. The epidemiology of medical emergency contacts outside hospitals in Norway - a prospective population based study. Scand J Trauma Resusc Emerg Med. 2010;18(1):1–9.

Norman R, Matzopoulos R, Groenewald P, Bradshawa D. The high burden of injuries in South Africa. Bull World Health Organ. 2007;85(9):695–702.

World Health Organization. Global status report on violence prevention 2014. 2014.

Sawe HR, Mfinanga JA, Mbaya KR, Koka PM, Kilindimo SS, Runyon MS, et al. Trauma burden in Tanzania: A one-day survey of all district and regional public hospitals. BMC Emerg Med. 2017;17(1):6–11.

Moodley NB, Clarke DL. Current trauma patterns in Pietermaritzburg. South African J Surg. 2015;53(3–4):37–9.

Mbanjumucyo G, George N, Kearney A, Karim N, Aluisio AR, Mutabazi Z, et al. Epidemiology of injuries and outcomes among trauma patients receiving prehospital care at a tertiary teaching hospital in Kigali, Rwanda. African J Emerg Med. 2016;6(4):191–7.

Seidenberg P, Cerwensky K, Brown RO, Hammond E, Mofu Y, Lungu J, et al. Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hospital in Lusaka, Zambia. African J Emerg Med. 2014;4(3):115–22.

Fararoei M, Sadat SJ, Zoladl M. Epidemiology of trauma in patients admitted to an emergencyward in Yasuj. Trauma Mon. 2017;22(3):1–5.

DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C MG er. a. Traumatic Injury In the United States:In-patient epidemiology 2000-2011. Injury. 2016;47((7):1393–403.

Radebe. Decade of Action and Arrive Alive.South Africa National Road Safety Strategy 2011-2020. 2011.

Van Niekerk A, Laubscher R, Laflamme L. Demographic and circumstantial accounts of burn mortality in Cape Town, South Africa, 2001-2004: An observational register based study. BMC Public Health. 2009;9:1–10.

Tyler MD, Richards DB, Reske-Nielsen C, et al. The epidemiology of drowning in low- and middle-income countries: a systematic review. BMC Public Health. 2017;17(1):1–7.

Burrows S, van Niekerk A, Laflamme L. Fatal injuries amoung urban children in South Africa: risk distribution and potential for reduction. Bull World Heal Organ. 2010;88(4):267–72.

Nzaumvila D, Govender I, Kramer EB. Glass injuries seen in the emergency department of a South African district hospital. African J Prim Heal Care Fam Med. 2015;7(1):1–8.

Hunter LD, Lahri S, van Hoving DJ. Case mix of patients managed in the resuscitation area of a district-level public hospital in Cape Town. African J Emerg Med. 2017;7(1):19–23.

Abrahams N, Jewkes R, Mathews S. Guns and gender-based violence in South Africa. South African Med J. 2010;100(9):586–8.

East African experts deliberate on gender based violence | WHO | Regional Office for Africa [Internet]. [cited 2019 Apr 19]. Available from: https://afro.who.int/news/east-african-experts-deliberate-gender-based-violence?country=879&name=Uganda

Original Research