Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study

IntroductionSierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.MethodsWe collected prehospital data of 6387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data.ResultsAt the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%.ConclusionNEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.

EP.WE.82Positive impact of COVID-19 pandemic on future of Surgery in the NHS

Aim To assess how surgical units innovated and adapted to meet the Lockdown challenges and highlight best practice development Methods Look at the Royal Surgical Colleges and national surgical society Guidelines during the pandemic and recovery phase of the Lockdowns. To assess how to local trust level modifications made in the first lockdown were reinforced during the second lockdown. Results During the first lockdown all elective surgical activity was suspended from 14th March. Day case urgent elective work restarted after 6 weeks, during this period only life and limb saving emergencies were performed on CEPOD theatres. Full PPE, aerosol generating precautions and thorough cleaning between cases ensured that no healthcare worker developed COVID-19 from occupational exposure in Theatres. Remote access from home has been a boon. The outpatients rapidly moved to online appointments. No routine follow up scans were done. Endovascular interventions increased. The telephonic clinics have reduced footfall, allowed routine follow-ups to be permanently put on telephonic clinics and patients too seem to be satisfied that they do not have to waste a day for a 10 minute appointment to come and be told that we will see you again in 12months time. Non-essential surgery has stopped, Conclusion Pandemic has been a time for surgeons to reflect on their practice. Instead of going back to old ways-outpatient clinics, day surgery units and main theatres have seen rapid adaptation of newer ideas. Pandemic has fast forwarded innovation in the NHS.