Presentation delivered at the second annual William G. Barsan Emergency Medicine Research Forum, Ann Arbor, April 12, 2017.

1. Global Emergency Medicine
Building Leadership and Research Capacity
through Clinical Training

2. • At least 90% of road traffic injury-related deaths occur in low- and
middle-income countries (LMICs)
• The highest road traffic injury death rates in the African region.
• Road traffic injuries accounted for 1.24 million deaths in 2015 and
ranked as the tenth leading cause of death.
• In disability-adjusted life years, road traffic accidents were the tenth
leading contributor worldwide and are increasing over time (WHO).
• Although these numbers or alarming are they accurate?
Anatomy of the “problem”
Department of Emergency Medicine

3. • Formed a partnership with Ghana to create a cadre of specialty trained
acute and emergency care providers.
• Kwame Nkrumah University for Science and Technology/Ministry of
Health/ Komfo Anokye Teaching Hospital/ Ghana College of Physicians
and Surgeons/ Ghana National Ambulance Service.
• Pilot funding from the (NIH) Medical Education Partnership Initiative
(Cunningham/ Donkor). Match 1:1 by UM department of EM
• Creation of training programs for Physicians, nurses and
exposure to EM for medical students and EMT’s.
The role of Emergency Medicine
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4. • “Skills and educational needs of accident and emergency nurses in
Ghana: An initial needs analysis”.
• “Non-fatal injuries among pediatric patients seeking care in an urban
Ghanaian emergency department”
• “Bypassing proximal health care facilities for acute care: a survey of
patients in a Ghanaian Accident and Emergency Centre.”
• “Assessment of Emergency Medical Services in the Ashanti Region of
Ghana”
• “Individual and Medical Characteristics of Adults Presenting to an Urban
Emergency Department in Ghana”
More than 20 resident led papers; More than 20 international presentations
What does ED population in Kumasi look like?
Department of Emergency Medicine

5. (NIH) Fogarty Global Health Research Fellowship Project:
“Evaluating the emergency care for the acutely injured patient in Kumasi,
Ghana”
Mentors: Ronald Maio, Peter Donkor, Cheryl Moyer, Charles Mock
•Conduct a multidisciplinary panel review, using a structured implicit review
process, to compare the preventability of death and appropriateness of
care for trauma patients at KATH hospital before and after the introduction
of emergency medicine.
“Learning the language of clinical research”
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6. • There is no unified identification system for a patient:
Unable to track a patient through the system
• Roughly 300 hundred trauma related deaths/year.
only 45 records could be found for the years 2012 and 2013
• Five of those 45 when we reviewed the chart did not die.
• Documentation of care is incomplete
• Paper records inaccurate and difficult to trace
• Autopsy infrequently performed and results are often unavailable.
• Although these numbers or alarming are they accurate?
Insufficient accurate data
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7. Findings and Outcomes
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8. • Establish a clinical research database at KATH that mirrors the American
College of Surgeons Trauma registry.
• Prehospital/initial hospital/ED care/procedures/outcomes/Severity
scoring
• Adapted for Ghana: vehicle seat type
• Includes Injury severity scoring; ED outcomes; Interventions
• Contains 10,000+ patients of all ages:
• Led to the submission of two R21 grants: Under review
• “The characteristics and outcomes of traumatic brain injuries in the
Ashanti region of Ghana”
• “Post-acute management of injuries in Ghana: Partnership and
capacity building to support needs identification, definition, and co-creative design”
Initial approach to finding answers
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9. • Establishing three more departments in Ghana
• Each with the clinical research database
• Include all the referral hospitals and the road commission
• Program graduates now are visiting faculty for a new EM residency in Addis
Ababa Ethiopia.
• Database expansion towards an EMR
• To explore our critical care population and care
• Cardiovascular emergencies
Provide accurate data for Policy recommendation and implementation
through in-country partners and funders: EMS, Ministry of Health,
WHO and World Bank
Next Steps:
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10. • Dr’s. Cunningham, Barsan, Carter, Wachter
• Mentorship Team:
• Drs. Maio, Kolars, Donkor, Kowalenko, Lozon, Nypaver, Moyer
• The department leadership: Dr. Neumar, Mr. Maxwell
• Hurley Leadership: for always supporting and understanding my absences
• All the partners in Ghana, especially the folks at KATH and in our research office.
• My Admin support: Nancy, Rusty, Deb
Acknowledgements/ Thanks
Department of Emergency Medicine