Can a volunteer-based service create an effective, locally appropriate and scalable model of prehospital care for traffic injury victims on the national highways of Bangladesh? Operational outcomes after 10 years of TraumaLink.

Introduction: Road traffic injuries continue to be a leading killer worldwide, but many developing countries lack formal prehospital services. This leaves victims without access to care when it can be most effective in preventing death and disability and contributes to the disproportionate burden of deaths and injuries on the roads in low-income and middle-income countries. Methods: To address the lack of prehospital care in Bangladesh, we developed TraumaLink. The service uses an emergency hotline number and 24-hour call centre with local first responders trained in basic trauma first aid, provided with essential medical supplies and dispatched through mobile phone text messages to provide free care at the crash scene. We retrospectively examined key performance indicators from the first 10 years of operations to better understand the programme's impact and its effectiveness as a locally appropriate and scalable model for prehospital care in this resource-limited setting. Results: During its first 10 years, the service expanded to 249 km on 3 national highways, with 988 volunteer first responders. Free care was provided to 5966 patients involved in 3330 crashes. All calls to the service received a response, and in 90% of cases, first responders were at the scene in 5 min or less. Most patients were young adult men, and 80% of victims transported to the hospital arrived there within 30 min of the crash. Assessments of injury severity at the scene aligned closely with patient dispositions, reflecting the accuracy of these triage decisions. Conclusions: TraumaLink's key performance indicators suggest that it is an effective, locally appropriate and scalable model for providing prehospital care in Bangladesh. The service model has now been adopted to create an official government post-crash response programme, providing an example that could be followed by other developing nations.