**4. Emergency services following trauma in the rural and semi-urban regions of the LMICs**

There is evidence that prehospital mortality can be reduced significantly by good emergency services following trauma which includes first aid and timely and safe transport to health facility [56]. In most LMICs reporting and life supporting systems to sustain the injured person and transportation to health facility are unreliable and indeterminate [3, 57]. It is common for injured person in rural and semi-urban regions of LMICs to be handled haphazardly at the trauma scene and transported by laypersons to the health facility by any means possible. For example, in Zambia, a report showed that the majority of injured persons were transported to the hospital by private cars and it was less than 6% who were transported by ambulance after trauma [3]. In this way, there is a significant delay to get to a health facility and increased risk of secondary trauma and mortality. In most cases, an injured person is given what is regarded as "first aid" by laypersons who happened to be at the incident scene. While such effort to save life is with good intention, this could be of more harm than helpful especially when handling delicate cases such as severe visceral, chest, head, and spinal cord injuries. Noting this danger, some programs to train laypersons on assisting and transporting a trauma victim have yielded convincing results [3, 58].

While training civilians to help trauma victims seems to be the best option for countries where emergency services are immature or unavailable, there are still issues on the package of training and the population coverage. Trauma varies in type, severity, and complexity of management. Even with good training on basic life support to laypersons, it would be difficult to major life threatening injuries such as those involving head, pelvis, and multiple viscera. Another limitation is that such training of skills requires practical session which may not be that feasible to a big group of learners (population). Furthermore, basic tools and equipment necessary for evacuation, first aid, and transportation of injured person are normally not readily available to complement the acquired knowledge and skills. For this reason, there ought to be a political will to facilitate not only the acquisition of basic knowledge and skills to manage a trauma victim, but also sustainable provision of basic tools for such a task. One useful approach would be inclusion of such information and skills training in school curriculums simultaneously with provision of practical tools. This will to create awareness and orient children with skills for safe handling of an injured person at basic level. This also means that elementary school teachers and school environment will be equipped to deliver such education and skills. There are other opportunities in LMICs to train laypersons on this regard. For example, women cell groups, village community banking (VICOBA) meetings, and faith based gatherings such as churches and mosques. However, as civilian services are hardly standardized and rarely sustainable, LMIC governments should be encouraged to plan for paramedic services which will ensure that a seriously injured person is handled by a well trained personnel from incident scene.
