Prehospital Staffing and Road Traffic Accidents

232 Pages·2015·1.94 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2015
Prehospital Staffing and Road Traffic Accidents:
Physician Versus Trained Nonphysician
Responders
Timothy A. Grant
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Timothy A. Grant

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Bernice Kennedy, Committee Chairperson, Public Health Faculty
Dr. Chester Jones, Committee Member, Public Health Faculty
Dr. Dorothy Browne, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
Prehospital Staffing and Road Traffic Accidents:
Physician Versus Trained Nonphysician Responders
by
Timothy A. Grant

MSW, University at Albany, 1994
BA, Russell Sage, 1992

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
February 2015
Abstract
Road traffic deaths, which affect people in their productive years, are projected to be the
third leading cause of death by the year 2030. While most studies have focused on road
infrastructure and vehicle safety, this study examined something new: the impact of
prehospital response to road traffic accidents on the rate of death. Some countries send
physicians to the scene of an accident; some send paramedics or registered nurses. The
question this research sought to answer was whether the use of physician responders
resulted in a lower rate of death compared to the use of nonphysician responders. The
literature makes it clear that rate of road traffic death is related to country income and
governance indicators, so first those variables needed to be equalized. My conceptual
framework for this cross-sectional correlation study was the Haddon matrix, which
organizes injuries by temporal (pre-event, event, and postevent) and epidemiological
(host, agent, and environment) factors. Using World Health Organization data on road
traffic injury and country income, World Bank data on governance indicators, and a
literature search of 67 countries’ prehospital response profiles, significant negative
correlations (p > 0.001) were found for road traffic deaths and income, r (65) = –0.68,
and governance indicators, r (65) = –0.646. No significant difference in the rate of road
traffic death was found between physician and nonphysician prehospital staffing.
Because increasing countries’ income and improving governance are long-term,
ambitious goals for developing countries, training nonphysician prehospital responders
appears to be the most effective social change to decrease the burden of road traffic
deaths.
Prehospital Staffing and Road Traffic Accidents:
Physicians Versus Trained Nonphysician Responders
by
Timothy A. Grant

MSW, University at Albany, 1994
BA, Russell Sage, 1992

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
February 2015
Dedication
Copyeditors do more than fix grammar, spelling, and punctuation.
They solve problems every hour of every day and plant the flag for good
English and clear writing—a worthy goal in the age of emoticons and
Twitter shorthand. They save writers and the publications they work for
from embarrassment.
A copyeditor asks questions and makes suggestions that, for
whatever reason during the editing process, no matter how good the
assigning editors are, never got asked or suggested: What do you mean?
Who is this person ID’d by only a last name? That last sentence doesn’t
add much—it might be stronger to end with the previous one. This sounds
choppy. Oh, and nice lede.
The best copyeditors are born, not made. You can be decent at the
job with training and hard work, but it helps if you take pleasure in tasks
many people would find mind-numbing. (O’Sullivan, 2013)

This dissertation is dedicated to the unsung heroes of publishing.
Acknowledgments
People benefit from those who support and encourage them. I would like to thank
some of those who have help me achieve this goal. I thank my committee members, Dr.
Bernice Kennedy, Dr. Chester Jones, and Dr. Dorothy Browne, without whom I could not
have finished this project. I also thank Dr. Annie Pezalla, Dr. Nancy Rea, Dr. Tammy
Root, Dr. Jorg Westerman, Robert Brandt, Robert Vansco, Maria Jaworski, Lou
Milanesi, Martha King, and the administration of Walden University. I would be remiss if
I did not thank my form and style reviewer, Dayna Herrington, and the members of my
dissertation cohort for their support: Sharon Muff, Victoria Stewart, Regina Watson,
Bernadette Lonchke, Nalini Narotam, Ebony Gafferey, Catrena Burivck, and Tiffany
Simmons.
The person who deserves the greatest thanks is the person to whom I have
incurred a debt I can never repay, who for 25 years supported me through three degrees,
editing my work while striving to make the work of hundreds of other authors more
understandable and to keep our family together. I wish to thank Judith Hoover, my wife
and the mother of our child, Sophia. Judith is the person who deserves the reward from
my completing this program.
Table of Contents
List of Tables ..................................................................................................................... vi 
List of Figures ................................................................................................................... vii 
Chapter 1: Introduction to the Study ....................................................................................1 
Background ....................................................................................................................3 
Prehospital Emergency Medical Care ..................................................................... 3 
Road Traffic Death ................................................................................................. 8 
Injury by Type of Road Use.................................................................................. 10 
Governance and Income ....................................................................................... 11 
Framework for Studying Prehospital Response to Road Traffic Death ......................12 
Purpose of the Study ....................................................................................................16 
Research Questions ......................................................................................................17 
Definitions....................................................................................................................19 
Nature of the Study ......................................................................................................20 
Assumptions .................................................................................................................21 
Scope and Delimitations ..............................................................................................21 
Generalizability and Internal and External Validity ....................................................22 
Limitations ...................................................................................................................23 
Significance..................................................................................................................23 
Summary ......................................................................................................................24 
Chapter 2: Literature Review .............................................................................................26 
Introduction ..................................................................................................................26 
i
Literature Review.........................................................................................................27 
Theoretical Foundations...............................................................................................27 
Rationale for Theory Choice ................................................................................. 35 
Approaches to the Study of Prehospital Services and Road Traffic Fatalities ............37 
Factors Influencing Road Traffic Injury ......................................................................40 
Vehicle Safety ....................................................................................................... 40 
Seat Belt Use and Child Restraints ....................................................................... 41 
Helmet Laws for Motorcycle and Bicycle Riding ................................................ 41 
Speed as a Factor .................................................................................................. 42 
Alcohol, Drugs, and Distracted Driving ................................................................43 
Age as a Factor.......................................................................................................43 
Other Factors ......................................................................................................... 44 
The Social and Economic Costs of Road Traffic Injury ..............................................48 
Key Variables and Concepts ........................................................................................49 
Income and Road Traffic Injury ..................................................................................49 
Governance ..................................................................................................................53 
Governance and Income ........................................................................................69 
Governance, Income, and Road Traffic Fatalities .................................................72 
Governance, Income, and Prehospital Services .................................................... 73 
Prehospital Services .....................................................................................................74 
Prehospital Responder Training .............................................................................75 
Prehospital Service and Health ..............................................................................77 
ii
Prehospital Response and Road Traffic Fatalities .................................................80 
Physician Versus Nonphysician Prehospital Providers ........................................ 83 
Governance, Income, Prehospital Staffing, and Road Traffic Death ..........................87 
Rationale for Selection of the Variables or Concepts ..................................................87 
Summary and Conclusions ..........................................................................................89 
Chapter 3: Research Method ..............................................................................................91 
Introduction ..................................................................................................................91 
Research Design ...........................................................................................................91 
Methodology ..........................................................................................................92 
Target Population ...................................................................................................92 
Sampling ................................................................................................................92 
Databases ...............................................................................................................93 
Power Analysis ......................................................................................................94 
Ethics of the Study .......................................................................................................95 
Instrumentation and Operational Definitions...............................................................95 
Operational Definitions ................................................................................................96 
Prehospital Care System ........................................................................................96 
Road Traffic Fatality ..............................................................................................96 
Data Manipulation .......................................................................................................97 
Research Questions ......................................................................................................98 
Threats to Validity .....................................................................................................101 
Ethical Procedures .....................................................................................................101 
iii