Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-04-30T17:25:43.319Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda

Published online by Cambridge University Press:  16 April 2014

Sarah Stewart de Ramirez ,
Jacob Doll ,
Sarah Carle ,
Trisha Anest ,
Maya Arii ,
Yu-Hsiang Hsieh ,
Martins Okongo ,
Rachel Moresky ,
Sonia Ehrlich Sachs  and
Michael Millin
Sarah Stewart de Ramirez*
Affiliation:
Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland USA
Jacob Doll
Affiliation:
University of Chicago, Department of Internal Medicine, Chicago, Illinois USA
Sarah Carle
Affiliation:
Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland USA
Trisha Anest
Affiliation:
Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland USA
Maya Arii
Affiliation:
Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts USA
Yu-Hsiang Hsieh
Affiliation:
Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland USA
Martins Okongo
Affiliation:
The Millennium Villages Project Field Office, Ruhiira, Uganda
Rachel Moresky
Affiliation:
Columbia University, Mailman School of Public Health, New York, New York USA
Sonia Ehrlich Sachs
Affiliation:
The Earth Institute at Columbia University, New York, New York USA
Michael Millin
Affiliation:
Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland USA
*
Correspondence: Sarah Stewart de Ramirez, MD, MPH, MSc Department of Emergency Medicine The Johns Hopkins University School of Medicine 1830 E. Monument Street Suite 6-100 Baltimore, Maryland 21287 USA E-mail sderamirez@jhmi.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries.

Problem

The objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda.

Methods

An EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed.

Results

In total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $89.95 per life saved with an estimated $0.93/capita to establish the system and $0.09/capita/year to maintain the system.

Conclusion

Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.

Stewart De RamirezS, DollJ, CarleS, AnestT, AriiM, HsiehYH, OkongoM, MoreskyR, SachsSE, MillinM. Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda. Prehosp Disaster Med. 2014;29(3):1-6.

Keywords

ambulancedeveloping countriesEmergency Medical Services (EMS)global healthinjuryprehospital carerural healthtraumaUganda
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 3 , June 2014 , pp. 311 - 316
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Razzak, JA, Kellermann, AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002(80):900-905.Google ScholarPubMed
2. World Health Organization. Violence, injuries and disability: Biennial 2006-2007 report. 2008.Google Scholar
3. World Health Organization. Child injuries in context. In: Peden M, Oyegbite K, Ozanne-Smith J, et al, eds. World report on child injury prevention. Geneva, Switzerland: World Health Organization; 2008:1-22.Google Scholar
4. Kobusingye, OC, Hyder, AA, Bishai, D, Joshipura, M, Hicks, ER, Mock, C. Emergency medical services. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease control priorities in developing countries, 2nd ed. New York: Oxford University Press; 2006:1261-1280.Google Scholar
5. Mock, C, Jurkovich, G, nii-Amon-Kotei, D, Arreola-Risa, C, Maier, R. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-812.CrossRefGoogle ScholarPubMed
6. World Health Organization. Malaria fact sheet. http://www.who.int/mediacentre/factsheets/fs094/en/. Accessed January 8, 2011.Google Scholar
7. World Health Organization. World malaria report 2011. Geneva, Switzerland: World Health Organization; 2011.Google Scholar
8. World Health Organization. Uganda health profile. http://www.who.int/gho/countries/uga.pdf. Accessed April, 2013.Google Scholar
9. UNDP. Uganda country profile: Human development indicators. http://hdrstats.undp.org/en/countries/profiles/UGA.html. Accessed January 8, 2011.Google Scholar
10. Sanchez, P, Palm, C, Sachs, J, et al. The African millennium villages. Proc Natl Acad Sci. 2007;104(43):16775-16780.Google Scholar
11. Patton, MQ. Qualitative evaluation and research methods. Newbury Park, CA: SAGE Publications; 1990.Google Scholar
12. Goodman, LA. Snowball sampling. Annals of Mathematical Statistics. 1961;32(1):148-170.CrossRefGoogle Scholar
13. Bass, RR. History. In: Bass RR, Brice JH, Delbridge TR, Gunderson MR, eds. Medical oversight of EMS. Vol 2. Dubuque, IA: Kendall Hunt Professional; 2009:3-21.Google Scholar
14. Accidental Death and Disability: The neglected disease of modern society. Washington DC: National Academy of Sciences; 1966:38.Google Scholar
15. Ghaffar, A, Hyder, AA, Masud, TI. The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan. Public Health. 2004;118(3):211-217.Google Scholar
16. Mock, CN, Adzotor, KE, Conklin, E, Denno, DM, Jurkovich, GJ. Trauma outcomes in the rural developing world: comparison with an urban level I trauma center. J Trauma. 1993;35(4):518-523.Google Scholar
17. Mock, C, Ofosu, A, Gish, O. Utilization of district health services by injured persons in a rural area of Ghana. Int J Health Plann Manage. 2001;16(1):19-32.CrossRefGoogle Scholar
18. Zwi, AB, Forjuoh, S, Murugusampillay, S, Odero, W, Watts, C. Injuries in developing countries: policy response needed now. Trans R Soc Trop Med Hyg. 1996;90(6):593-595.Google Scholar
19. Smith, GS, Barss, P. Unintentional injuries in developing countries: the epidemiology of a neglected problem. Epidemiol Rev. 1991;13:228-266.CrossRefGoogle ScholarPubMed
20. Kirsch, TD, Beaudreau, RW, Holder, YA, Smith, GS. Pediatric injuries presenting to an emergency department in a developing country. Pediatr Emerg Care. 1996;12(6):411-415.CrossRefGoogle Scholar
21. Emergency Medical Services Systems Act of 1973. 1973.Google Scholar
22. Committee on the Future of Emergency Care in the United States Health System. Emergency medical services at the crossroads. Washington DC: The National Academies Press; 2007.Google Scholar
23. Myers, B. Medical oversight for emergency medical services: Defining success. N C Med J. 2007;68(4):268-271.Google Scholar
24. VanRooyen, MJ, Thomas, TL, Clem, KJ. International emergency medical services: Assessment of developing prehospital systems abroad. J Emerg Med. 1999;17(4):691-696.CrossRefGoogle Scholar
25. Bailey, BW. Federal policy leading the way in emergency medical services. N C Med J. 2007;68(4):242-243.Google ScholarPubMed