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The State of Emergency Medical Services (EMS) Systems in Africa
- Nee-Kofi Mould-Millman, Julia M. Dixon, Nana Sefa, Arthur Yancey, Bonaventure G. Hollong, Mohamed Hagahmed, Adit A. Ginde, Lee A. Wallis
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 3 / June 2017
- Published online by Cambridge University Press:
- 23 February 2017, pp. 273-283
- Print publication:
- June 2017
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- Article
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Introduction
Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.
MethodsA survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems’ jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.
ResultsThe survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).
ConclusionEmergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service.
,Mould-Millman NK ,Dixon JM ,Sefa N ,Yancey A ,Hollong BG ,Hagahmed M ,Ginde AA .Wallis LA The State of Emergency Medical Services (EMS) Systems in Africa . Prehosp Disaster Med.2017 ;32 (3 ):273 –283 .
Barriers and Facilitators to Community CPR Education in San José, Costa Rica
- Kristin M. Schmid, Nee-Kofi Mould-Millman, Andrew Hammes, Miranda Kroehl, Raquel Quiros García, Manrique Umaña McDermott, Steven R. Lowenstein
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 5 / October 2016
- Published online by Cambridge University Press:
- 05 August 2016, pp. 509-515
- Print publication:
- October 2016
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- Article
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Background
Bystander cardiopulmonary resuscitation (CPR) improves survival after prehospital cardiac arrest. While community CPR training programs have been implemented across the US, little is known about their acceptability in non-US Latino populations.
ObjectivesThe purpose of this study was to identify barriers to enrolling in CPR training classes and performing CPR in San José, Costa Rica.
MethodsAfter consulting 10 San José residents, a survey was created, pilot-tested, and distributed to a convenience sample of community members in public gathering places in San José. Questions included demographics, CPR knowledge and beliefs, prior CPR training, having a family member with heart disease, and prior witnessing of a cardiac arrest. Questions also addressed barriers to enrolling in CPR classes (cost/competing priorities). The analysis focused on two main outcomes: likelihood of registering for a CPR class and willingness to perform CPR on an adult stranger. Odds ratios and 95% CIs were calculated to test for associations between patient characteristics and these outcomes.
ResultsAmong 371 participants, most were male (60%) and <40 years old (77%); 31% had a college degree. Many had family members with heart disease (36%), had witnessed a cardiac arrest (18%), were trained in CPR (36%), and knew the correct CPR steps (70%). Overall, 55% (95% CI, 50-60%) indicated they would “likely” enroll in a CPR class; 74% (95% CI, 70-78%) would perform CPR on an adult stranger. Cardiopulmonary resuscitation class enrollment was associated with prior CPR training (OR: 2.6; 95% CI, 1.6-4.3) and a prior witnessed cardiac arrest (OR: 2.0; 95% CI, 1.1-3.5). Willingness to perform CPR on a stranger was associated with a prior witnessed cardiac arrest (OR: 2.5; 95% CI, 1.2-5.4) and higher education (OR: 1.9; 95% CI, 1.1-3.2). Believing that CPR does not work was associated with a higher likelihood of not attending a CPR class (OR: 2.4; 95% CI, 1.7-7.9). Fear of performing mouth-mouth, believing CPR is against God’s will, and fear of legal risk were associated with a likelihood of not attending a CPR class and not performing CPR on a stranger (range of ORs: 2.4-3.9).
ConclusionMost San José residents are willing to take CPR classes and perform CPR on a stranger. To implement a community CPR program, barriers must be considered, including misgivings about CPR efficacy and legal risk. Hands-only CPR programs may alleviate hesitancy to perform mouth-to-mouth.
,Schmid KM ,Mould-Millman NK ,Hammes A ,Kroehl M ,Quiros García R ,Umaña McDermott M .Lowenstein SR Barriers and Facilitators to Community CPR Education in San José, Costa Rica . Prehosp Disaster Med.2016 ;31 (5 ):509 –515 .