Developing clinical criteria for aeromedical inter-facility transfers of adult trauma patients in Namibia

Abstract

Introduction: Trauma is a major contributor to morbidity and mortality in Namibia. The country’s vast distances, centralised specialist care and constrained resources make aeromedical Interfacility Transfers (IFTs) essential for timely access to definitive trauma care. There are, however, no standardised clinical criteria to guide practitioners with decision-making regarding the initiation of aeromedical IFT for adult trauma patients. This study aimed to develop context-specific clinical criteria for aeromedical IFT of adult trauma patients in Namibia using a systematic, consensus-based approach driven by evidence. The specific objectives were to conduct a comprehensive scoping review of literature on aeromedical IFTs of adult trauma patients to develop a clinical criteria framework to elicit expert opinion, to utilise expert opinion to obtain consensus on the components of the clinical criteria and to construct clinical criteria for aeromedical IFTs in Namibia for distribution to relevant stakeholders to implement. Methods: A scoping review of literature was conducted to elicit a framework of clinical criteria relevant to aeromedical IFTs of adult trauma patients. This framework was further refined through the stewardship of an appointed steering committee (SC). The SC completed a pilot survey to further refine the framework. The next phase of the study was informed by the framework and involved a structured consensus-building process through a modified Delphi, which entailed anonymous voting on criteria using a Likert Scale, receiving feedback on results from previous rounds and further consideration of subsequent rounds. Expert Panellists (EPs) opinions were elicited throughout the Delphi rounds to establish consensus on essential clinical criteria for the consideration of aeromedical IFTs of adult trauma patients in the Namibian setting. The final phase utilised the consensus-derived criteria to construct a Clinical Decision Support Tool (CDST), suggested for evaluation, validation, and then implementation into the National Referral Policy to support consistent, evidence-based decision making for aeromedical IFTs of adult trauma patients in Namibia. Results: The scoping review identified eight thematic areas from a broad scope of literature. Regional dominance was noted in the literature, with most studies originating from developed countries, particularly the United States of America, albeit being retrospective studies. The Steering Committee members were from both the public and private sectors, in-hospital and prehospital settings, ensuring a balanced representation whilst ensuring contextual relevance. There were two Delphi rounds conducted: expert participation dropped from 29 in the first round to 14 in the second round. However, consensus on 28 out of 32 clinical criteria statements was achieved. The consensus-based clinical criteria informed the final CDST, thus reflecting locally adapted, evidence-based clinical criteria for aeromedical IFT of adult trauma patients in Namibia. vi Conclusions and Recommendations: The study demonstrates the structured, sequential phase approach of integrating evidence synthesis and expert consensus as effective in standardised clinical criteria development for aeromedical IFTs of adult trauma patients in a setting with limited resources. The CDST offers a practical context-specific decision tool aimed at improving decision-making consistency, optimising aeromedical resources and timely access to the advanced Namibian trauma care system. It is recommended that the CDST be evaluated for suitability and, thereafter, considered for adoption into the National Referral Policy and emergency frameworks in both the public and private sectors, under the tutelage of the Ministry of Health and Social Services. Prospective studies are, however, needed to confirm the validity of the CDST in real-world practice, evaluating its efficiency and direct impact on patient outcomes. Continuous refinement of the CDST is essential in the evolving Namibian trauma care system.