The research team, led by Jaclyn A. VanDerWal and Allison D. Dentice of the Medical College of Wisconsin’s Division of Trauma, Critical Care and Acute Care Surgery, together with Peruvian collaborators at Universidad Peruana Cayetano Heredia and four Lima trauma hospitals, conducted a multi-method needs assessment across the city’s emergency care infrastructure. Rather than measuring outcomes with statistics alone, the investigators used semi-structured qualitative interviews, a methodology that allows participants to describe their experiences, frustrations, and workarounds in their own words. The interviews were analyzed using thematic analysis, a rigorous coding process in which researchers identify recurring patterns across transcripts and refine them into overarching themes. This approach is particularly valuable in health systems research because the people operating a system often understand its failure points more precisely than any external audit can capture.

What emerged from the analysis was a taxonomy of six distinct prehospital entities, each with its own capabilities, educational requirements, and geographic coverage. The first is SAMU, the public emergency medical service, which operates as the government’s formal ambulance system. The second is EsSalud, the social security health network that serves formally employed workers, meaning coverage depends on a patient’s employment status. The third, and in many ways the most consequential, is the volunteer fire service, the Cuerpo General de Bomberos Voluntarios del Perú. Volunteer firefighters are the most geographically widespread responders in Lima, yet the study found they operate without formal medical training requirements, meaning the personnel most likely to reach an injured patient may have little or no structured education in trauma care.

The fourth and fifth actors are the national police and the municipal security units known as Serenazgo. According to the study, these security forces frequently function as impromptu ambulances, transporting injured patients to hospitals in vehicles that were never designed for medical transport and staffed by personnel without formal emergency medical training. The sixth category comprises private ambulance companies, which offer a higher standard of care but remain accessible only to those who can pay for the service. The practical consequence of this fragmentation is stark: many trauma patients in Lima rely on private transportation, hailing taxis or borrowing cars, to reach emergency departments, because the formal system is perceived as slow, unreliable, or simply unavailable.

The thematic analysis of the forty-nine interviews surfaced four recurring problems that cut across all six entities. The first is fragmented organizational structure: with no unified dispatch or command authority, responsibility for a given emergency can fall through the cracks between agencies, and responders from different organizations may arrive at the same scene without a clear chain of command. The second is inconsistent educational requirements, where the level of trauma training a responder receives depends less on the medical needs of the patient than on which agency happens to be dispatched. The third is limited resource availability, encompassing shortages of equipment, vehicles, and trained personnel. The fourth is poor inter-agency coordination, which undermines even the well-resourced actors because information about patients, road conditions, and hospital capacity does not flow smoothly between organizations.

These structural weaknesses have measurable clinical consequences. Prior research cited by the authors demonstrates that prehospital trauma systems reduce mortality in low- and middle-income countries, and that the treatment a patient receives before reaching a trauma center significantly affects survival from life-threatening injuries. Studies from Peru and elsewhere have documented associations between prehospital care time and hospital mortality in traffic accident victims, and systematic reviews have mapped the so-called Three Delays framework, the delays in seeking, reaching, and receiving care, onto injury outcomes in resource-limited settings. In Lima, where road traffic injuries are a leading burden on the trauma system, the interval between injury and definitive surgical care is precisely the window in which airway management, hemorrhage control, and rapid transport save lives. A system in which the first responder may be an untrained security officer in a police vehicle forfeits much of that window.

The study’s authors frame the findings as the foundation for targeted intervention. Because the needs assessment was designed explicitly to inform the implementation of innovations, the identified themes translate directly into priorities: standardized trauma training curricula that can be adapted across agencies, professional recognition frameworks that formalize the role of volunteer and security personnel who already function as de facto first responders, and coordination mechanisms that link the six entities into a coherent network. International evidence suggests such interventions are feasible and cost-effective. Trauma training programs modeled on low-cost alternatives to Advanced Trauma Life Support have been successfully implemented in Haiti, Ecuador, Kenya, and across East, Central, and Southern Africa, and studies of Prehospital Trauma Life Support training have shown measurable improvements in on-scene time intervals. Similar community-based programs in Bolivia, a neighboring country with comparable resource constraints, have demonstrated that empowering local trauma responders can transform care in underserved regions.

The Lima study also contributes a methodological lesson for global surgery research. By centering the perspectives of the system’s principal actors, the hospital and prehospital personnel who confront the system’s gaps daily, the researchers captured operational realities that administrative data cannot reveal, such as which agencies actually respond to which emergencies and how personnel improvise when equipment or training falls short. The work builds on the team’s earlier qualitative needs assessment of Lima’s prehospital trauma system published in Surgery in 2025, extending it with a focused examination of the educational standards and organizational dynamics of each responding entity. The interviews were conducted with ethical approval from the Medical College of Wisconsin and three Lima hospitals, and informed consent was obtained from all participants, underscoring the collaborative and locally grounded nature of the research.

For the millions of residents of Lima, and for urban populations across middle-income countries facing similar rapid urbanization, the study’s message is both a warning and a roadmap. The warning is that a prehospital system composed of many independent actors with inconsistent training, variable response times, unpredictable care quality, and minimal coordination effectively functions as no system at all, pushing patients toward dangerous self-transport decisions. The roadmap is the demonstration that rigorous qualitative assessment can identify exactly where targeted training interventions and professional education frameworks would yield the greatest benefit. As the authors conclude, the urgent need is not merely for more ambulances but for a coherent professional structure, shared standards, formal recognition, and inter-agency coordination, that turns Lima’s six parallel emergency networks into a single, reliable safety net for the injured.

Subject of Research: Prehospital trauma care education and emergency medical services organization in Lima, Peru

Article Title: Urban trauma education in a middle-income country: a qualitative review of Lima, Peru’s prehospital emergency system principal actors

Article References: VanDerWal, J. A., Dentice, A. D., Zavala-Wong, G., Chavarria, M., Agrawal, A., Blaser, M., Morales, C. E., Leal, B. R., LaGrone, L. N., Arredondo-Manrique, G., Betalleluz Pallardel, J. R., Aragon-Graneros, G., Rodríguez-Castro, M., Borda-Luque, G., Castro-Dolorier, A., Allagual, A., Huamán-Egoávil, E., & Iverson, K. R. (2026). Urban trauma education in a middle-income country: a qualitative review of Lima, Peru’s prehospital emergency system principal actors. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 139. https://doi.org/10.1007/s44186-026-00541-3

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00541-3

Keywords: prehospital care, trauma education, emergency medical services, Peru, global health, qualitative research, middle-income countries, trauma systems, medical training, urban emergency care, inter-agency coordination, Lima

The timing and the geography of this launch matter. The editors describe their belief as rooted in cumulative experience gained in a continent and a region they characterize as plagued by both natural and man-made disasters. North Africa, the Middle East, and the wider African continent have contended in recent decades with earthquakes, floods, conflicts, displacement crises, and public health emergencies that place enormous strain on health systems. In such settings, the editors argue, sharing field experience must go hand in hand with rigorous methodology, because anecdote without evidence rarely changes outcomes, and evidence locked behind paywalls rarely reaches the clinicians and officials working in low-resource or crisis-affected environments.

The problem the new journal identifies is a familiar one in global health research: a persistent disconnect between what is published and what is practiced. The founding editorial notes that on a global level, from sudden natural catastrophes to complex humanitarian emergencies, timely and reliable information has repeatedly proven critical, yet researchers, practitioners, and policymakers are often caught by surprise and struggle to access up-to-date findings precisely where the stakes are highest. Disaster-prone and crisis-affected regions frequently lack institutional subscriptions to major journals, meaning that the communities with the most direct experience of mass casualties, infrastructure collapse, and emergency response are often the least able to read the literature about them. The Journal of Emergency and Disaster Medicine is explicitly designed to fill that gap.

Open access sits at the center of that design. The editors state plainly that in many settings where emergencies strike, budgets are tight and institutional subscriptions may be out of reach, so all articles in the journal will be freely accessible to readers worldwide. They frame this as a matter of principle rather than mere convenience, holding that scientific progress and clinical excellence should serve humanity without restriction. The journal is published under a Creative Commons Attribution 4.0 International license, which permits use, sharing, adaptation, distribution, and reproduction in any medium or format, provided the original authors and source are credited and changes are indicated. For frontline workers in humanitarian operations, that licensing model means research can be downloaded, printed, translated, and circulated in the field without negotiating copyright barriers in the middle of a crisis.

The journal’s scope is broad by design, reflecting the reality that disaster medicine is not a narrow specialty but a systems-level discipline. The editors invite contributions spanning all dimensions of acute and disaster-related care, including prehospital and emergency department medicine, trauma systems, disaster risk reduction, mass casualty response, humanitarian health services, public health emergencies, and the use of technology and innovation in crisis contexts. That breadth mirrors the way disasters actually unfold: a single earthquake engages ambulance dispatch protocols, emergency department triage, surgical capacity, water and sanitation systems, disease surveillance, and long-term rehabilitation of survivors, all at once. A journal that addresses any one of those domains in isolation risks missing the interdependencies that determine how many people survive.

Notably, the editors are not limiting the journal to conventional research formats. Alongside original research, reviews, and policy analyses, they explicitly encourage field reports and case studies that reflect real-world challenges and innovations. This is a methodologically significant choice. Much of the practical knowledge in disaster response exists as institutional memory in the heads of emergency physicians, logisticians, and humanitarian coordinators, and it often evaporates when operations end. Formalizing a venue for such accounts, subject to the same editorial scrutiny as traditional papers, could help convert hard-won field experience into a reusable, citable body of knowledge. The editors emphasize that their focus is on work that not only advances theoretical knowledge but also produces actionable strategies for preparedness, response, and recovery.

Quality control will rest with an Editorial Board that the editors describe as a body of experts drawn from different corners of the world, a composition intended to position the publication as an efficient tool in the prevention and management of emergencies and disasters. Submitted manuscripts will be evaluated by independent reviewers for originality, methodological soundness, clarity, and relevance, the standard pillars of peer review. The journal’s publication workflow is designed to minimize the delay between acceptance and public availability: once a manuscript is accepted, it will be published online immediately after professional copyediting and typesetting. In a field where outbreak dynamics, aftershocks, and mass casualty events move faster than traditional publication cycles, that speed of dissemination is presented as a core feature rather than an afterthought.

The institutional provenance of the journal adds a distinctive dimension. Kasr Al-Ainy Faculty of Medicine, founded in the nineteenth century, is one of the oldest and largest medical schools in Africa and the Middle East, and Cairo University’s teaching hospital complex functions as a major referral center for Egypt. Its emergency departments absorb an enormous and varied caseload, from road traffic trauma to the aftermath of regional emergencies, giving the institution direct operational familiarity with the challenges the journal addresses. A publication anchored in a high-volume, resource-constrained health system, rather than in a wealthy institution insulated from such pressures, has the potential to set different priorities: questions about triage under scarcity, surge capacity, and supply chain resilience are not hypothetical there.

The launch also arrives amid growing international attention to health emergency preparedness. The COVID-19 pandemic, alongside repeated climate-linked disasters and ongoing conflicts, has exposed weaknesses in how evidence flows to decision-makers during crises, and global frameworks for disaster risk reduction have called for stronger science-to-policy linkages. A journal dedicated to converting evidence into actionable strategies speaks directly to that agenda, and its open-access model lowers the barrier for contributions from researchers in low- and middle-income countries, who are frequently underrepresented in high-impact emergency medicine literature.

The founding editorial closes with an invitation rather than a declaration of arrival. Kassem and Mourad write that they envision the Journal of Emergency and Disaster Medicine becoming a go-to reference for clinicians, researchers, humanitarian professionals, and policymakers committed to saving lives under difficult conditions, and they look forward to submissions, critiques, and shared experience as the venture begins. The editorial, published as Volume 1, article number 1 of the journal, is itself open access, and the first issue will reveal whether the publication can attract the rigorous field research and policy work its founders describe. What is already clear is the editorial wager behind it: that in emergencies and disasters, the distance between evidence and action is measured in lives, and that shortening that distance begins with making the evidence universally available.

Subject of Research: The launch of an open-access journal on emergency and disaster medicine

Article Title: From evidence to action: The launch of the Journal of Emergency and Disaster Medicine by Kasr Al-Ainy Faculty of Medicine, Cairo University

Article References: From evidence to action: The launch of the Journal of Emergency and Disaster Medicine by Kasr Al-Ainy Faculty of Medicine, Cairo University. (n.d.). https://doi.org/10.1007/s44467-025-00005-6

Image Credits: AI Generated

DOI: 10.1007/s44467-025-00005-6

Keywords: emergency medicine, disaster medicine, open access, Cairo University, Kasr Al-Ainy, mass casualty response, humanitarian health, public health emergencies, trauma systems, disaster risk reduction, editorial, Springer Nature