There were 41 traffic police officer, working from three districts in Dar es Salaam region who were interviewed for this study. The mean age of the participants was 37 years. Participants differed in terms of sex/gender where by 27 where men and 14 women. The working experience as a traffic police officer ranging from 3year to 32years, while about half (48.7%) of them aged between 30-39 years old.
It was found that traffic police officers are the first responders on the crash scene in most situations; as they step onto the scene, they experience the role of rescuer as well as that of a traffic police officer. A strong inner fear of touching individuals who are injured arises, the officers said, but they reported that they find courage, and calm themselves in order to fulfil their duties of clearing the scene, maintaining safety (their primary role), and meeting others’ expectations of transporting injured victims to the hospital and providing some initial help when possible. Doing work that is not easy even for professional rescuers, the officers are further challenged by limited access to training and technical equipment; this creates a difficult environment that puts their lives and those of the victims who receive care from them at increased risk. With the aim of reducing these challenges, traffic police officers raised suggestions about possible ways of reducing the challenges and ensuring that they would be safer while managing a crash scene. From analysis of descriptions of initial post-crash care of RTI victims from the injury scene to the hospital, three themes emerged: Maintaining safety while saving injured victims’ lives and facilitating access to the health facility refers to the officers’ perceived role of maintaining personal, bystander, and victim safety, as well as helping victims all the way from the scene to the hospital. Overwhelmed while working with limited resources and support illustrates how the traffic officers face challenges in fulfilling their role of providing post-crash care. Improving support system and empowering frontline personnel refers to the officers’ views on actions that should be taken to support their role of providing initial post-crash care of RTI victims.
Themes, Categories and Selected Codes That Emerged During Analysis
Theme
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Category
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Selected codes
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Maintain safety while saving injured victims’ lives and facilitate access to health facility
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Providing initial help to injured victim
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Remove victim from scene
Positioning victim
Fan serious victims
Provide first aid if possible
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Sorting out victims while ensuring safety
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Cordon the scene.
Prevent further injuries.
Identfy surviving victims and the dead
Notify citizen about incident
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Transporting RTI victims to the hospital
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Rush to hospital using police car
Request a private car for transport
Forcing car owner to rush victim to hospital
Paying car owner to rush victim to hospital
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Overwhelmed while working with limited resources and support
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Working with scarce resources for helping victims
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No first-aid kits and stretchers.
Use cloths to prevent blood contact
Use plastic bags
Caring for victim with bare hands
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Difficulty facilitating victims’ access to health facilities for care
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Use personal cars.
Private car owners’ resistance to carrying victims.
Unavailability of ambulances at scene.
Bad roads.
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Overwhelmed and exhausted with responsibilities without resting
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Heavy workload with little resting time
Working overtime over phone while at home
Becoming stressed while working with victim
Helping but being blamed by civilians
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Lacking support system at the scene and at health facilities
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Overcrowding at the scene with no help
Onlooker stealing victims’ property
Bureaucracy delays admission of patient to emergency department
Delays in receiving victim/dead body at emergency department
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Improving the support system and empowering frontline personnel
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Need for strong emergency care system
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Available standby ambulance along major roads
Special number to call ambulances
Special emergency number to call hospital
Preparedness of emergency care provider
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Availability of resources and emergency medical support system
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Distribution of first-aid material
Increased number of police patrol cars
Specified police patrol car for victim
Employing more staff in police posts
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Training for police and drivers on victims’ first aid and road safety
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First-aid training for police and other drivers
Training on road rules and regulations for drivers
Workshop on care for different types of injured patients
Not being rough while caring for the victim
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Theme 1: Maintaining Safety While Saving Injured Victims’ Lives and Facilitating Access to the Health Facility
The traffic police officers said that in addition to their primary role of maintaining safety, they also provided some initial management and helped injured victims reach the health facility for proper care.
Providing initial help to the injured victim
The participants reported several initial actions they took to help RTI victims. Once they arrive at the scene, the first thing the police officers do is to remove the injured victim(s) from the vehicle and crash scene and place them out of harm’s way under a shady tree or at the side of the road. Although it was described that participants placed the victims on their back, the officers could not explain clearly why they did so. However, one participant described that this position helps the victim to breathe, and in case of respiratory difficulty the victim’s face can be fanned easily to increase ventilation. Despite mentioning the provision of first aid to victims, the participants were not clear about what type of first aid they normally provided. They further noted that they did not know what to do for first aid; most of time they rushed victims to the hospital for such services.
“I am supposed to provide first aid to injured victims, but it always depends because you might be busy doing something to a victim, thinking that you are helping; instead, you are worsening the victim’s condition..... That is why I always rush them to the hospital, which I believe is a safe place for them”. (FGD2, Participant 4)
Sorting out victims while ensuring safety
Apart from providing initial help to injured victims, participants reported that they ensured safety at the crash scene by cordoning off the scene area to alert other road users that there had been a crash and that they should not themselves become victims (or worsen the state of already-injured persons) by intruding onto the scene, whether in a vehicle or on foot. Personal safety was mentioned as the top priority before helping the victims and the main reason they cordoned off the scene. Participants also reported that upon arrival at the scene they sorted out victims, identifying them by name for official records, whether the victims were dead or alive, and took the surviving victims immediately to the hospital. Those who died would be taken to the mortuary later.
“I have to identify quickly who died and who is still alive. This helps to know who needs quick transport to the hospital and who can wait”. (Participant 8)
It was also noted that traffic police officers are responsible for notifying next of kin, either personally, by phone, or through social media, to make it easier for relatives to visit their loved ones at the hospital or to confirm the identity of a deceased relative’s body at the mortuary.
Transporting RTI victims to the hospital
The officers reported that transporting RTI victims to the hospital was a crucial responsibility. This responsibility was taken as a priority regardless of the condition of the injured person; private cars and sometime police patrol cars were mentioned as means of transport used to take victims to the hospital. Police officers reported using different approaches, including begging Good Samaritans who owned a car to take victims to hospitals, or forcing a private car owner to take victims to the hospital, especially when nobody agreed to help.
“Most times, drivers do not want to carry injured victims at all, especially if an injured person is profusely bleeding. That is why we normally apply a little bit of force”. (Participant 5)
Additionally, some participants reported using their own money to pay a taxi driver in order to take a victim to the hospital, especially if others refused to do so.
“I always hate begging behaviour. This is because you might ask for help in the first car and the driver comes up with a lot of excuses.... In that case I take my own money, hire a taxi, and ask the driver to rush the victims to the hospital”. (Participant 9)
Theme 2: Overwhelmed While Working with Limited Resources and Support
Participants reported experiencing challenges in providing care to injured victims. These challenges were related to resources, infrastructure, and lack of support.
Working with scarce resources for helping victims
Participants claimed to have no first-aid kit or other first-aid materials like stretchers in the police cars or at the police posts that could be used for initial care. The officers reported using victims’ or bystanders’ clothes to prevent direct blood contact when helping victims. Others reported using plastic bags as protection against direct blood contact, especially in the presence of profuse bleeding. Although this method was mentioned by several participants, some declared that the method was not effective and that it did little to prevent cross-infection. Some participants reported helping bleeding victims with bare hands due to a lack of protective gear, which created the possibility of exposure to blood-borne infections such as HIV and hepatitis.
“We are using plastic bags; however, they don’t even fit the hand and you find you are busy caring for a victim and the plastic bag has dropped off or even if it is there, you have already contacted the victim’s blood; we are really working in a difficult environment, and sometime it’s even a shame to tell a person that we use plastic bags”. (Participant 2)
Difficulty facilitating victims’access to health facilities
Concern was expressed that even if a traffic police officer arrived early at the scene, the injured victim would still be unable to get to the hospital quickly. The situation is even worse if a crash happens at night because many motorists do not even stop when police officers try to pull them over, and if they stop, most of them do not agree to carry injured victims, especially those who are bleeding. Badly potholed roads, sometimes filled with water, were also mentioned as a cause of delay in getting an RTI victim to the hospital.
“There is no system which enables an ambulance to take injured people from the scene, though from what I believe this is what it supposed to happen; taking injured people from the scene to the hospital… It’s really painful, whereby you have toiled enough using other means to make sure the injured person reaches the hospital, just to find that there are three ambulances parked at the hospital. This is unfair and a misuse of resources”. (Participant 3)
Overwhelmed and exhausted by responsibilities
Some participants, especially those with high rank in their working area, reported having a lot of responsibility, which overwhelmed them and kept them from having any resting time at all. It was noted that the workload increased when a crash happened because during that time traffic police officers were required to continue fulfilling their legal responsibilities while dealing with newly emerged caring and transporting responsibilities.
“When I receive a call about an accident, that is where the stress starts exactly…. It reminds me of other accidents that I don’t even want to remember at all. It also increases stress because I know that even after my arrival, I have nothing to do apart from taking them to hospital”. (Participant 7)
Participants further reported feeling demoralized because they received so little recognition for their efforts to help RTI victims, especially from bystanders who ended up blaming the traffic police officer for not arriving at the scene on time and not delivering care at the scene the way they thought it should be done.
Lack of a support system at the scene and at health facilities
The officers related that once a crash occurs, bystanders crowd the scene without offering any assistance to the police in helping the victims. Instead, they take photos of the victims or steal their property Another challenge the officers reported was the experience of arriving with victims at the hospital and waiting a long time before care was given.
“I don’t know what is wrong with our hospital’s admission system. It’s normal to arrive with an injured victim and you are asked to go and open a patient file and do all the other procedures which are required for admission. This can take up to three hours, and I consider it as a waste of time with no reason because that is not my work. I was just a rescuer”. (FGD 3, Participant 2)
Theme 3: Improving the Support System and Empowering Frontline Personnel
Participants expressed their views on strategies that could be employed to address challenges encountered as they provide initial post-crash care to injured victims.
Strengthening the emergency care system
Almost all participants expressed the need to have an established emergency care system in Tanzania. Moreover, they suggested having ambulances parked in hot spots along main roads where crashes commonly occur. Participants also suggested that once such an emergency care system was in place, both traffic police and community members around hot spots should be given an emergency telephone number to call in case of a crash or any other road emergency. It was proposed that all hospitals have a special number, as the police do, that would be known by community members and used to call for help when an emergency occurred or to request an ambulance from a nearby health facility. Moreover, participants suggested that having good communication between the on-scene rescuer and the hospital would help hospital staff prepare for emergency arrivals and reduce unnecessary delays.
“Hospitals should have an emergency number to call as one of their services, as police do.... Anybody who has an emergency should be encouraged to call that number, and that will help to release ambulances stationed in the hospital to the scene and save lives”. (Participant, 1)
Availability of resources and emergency medical support system
The participants proposed that first-aid materials be distributed to their police posts and their patrol cars. They argued that if first-aid materials could become available, they could even ask bystanders to help with rescuing injured victims, as opposed to what is currently happening, because no one is ready to work without protection. It was also noted that, as police patrol cars are few and ambulances are not in place, increasing the number of patrol cars would mitigate the problem of transporting victims to the hospital. They also suggested that once the number of police patrol cars was increased, a few could be specifically identified and reserved for transporting victims. The need to employ more police officers who would be trained in first aid and who would be specifically available for caring for injured victims was also expressed.
“ Our patrol cars need to be specified, which one is for injured victims and which one should do the rest of activities…. I remember one day we arrested a person with illegal dirty car oil and we put them in the patrol car and when we were on our way to the police station, we found an accident and we had no way other than to take the injured victim in an oil-dirty car”. (Participant 10)
Training for police and drivers on victims’ first-aid care and road safety
First-aid training would help both police and drivers, especially bus and taxi drivers, deliver better care to RTI victims. The officers mentioned training as an important issue because most of them declared that when they arrived at a crash scene, their main role was to facilitate transport of the victim to the hospital. This often-meant recruiting taxi drivers or using their own patrols cars; in either case, little or no first aid could be given to the victim. Based on the expression of the need for training, suggestions for workshops on how to initiate care of ill and injured victims were highlighted. Participants were of the view that such training would improve how they provided care and reduce needless fatalities. Furthermore, most of them reported being influenced by the command-driven nature of their work, which is opposite to what care need. Finally, participants pointed out that some drivers ignored road rules and regulations, causing crashes. Therefore, they suggested mandatory refresher courses on road rules and regulations as a way to reduce the number of RTIs. Some police officers liked the idea of the proposed training, while others were against it, as they perceived post-crash care as an extra activity that was not their responsibility.
“You know everybody has specialized in a certain work. My work is not to care for injured victims, you [the interviewer] are the people who are trained about that. Asking me to initiate care to injured victim is like increasing extra work to me, but I have no way out”. (FDG 3, Participant 10)