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

  • Sarah Stewart de Ramirez (a1), Jacob Doll (a2), Sarah Carle (a1), Trisha Anest (a1), Maya Arii (a3), Yu-Hsiang Hsieh (a1), Martins Okongo (a4), Rachel Moresky (a5), Sonia Ehrlich Sachs (a6) and Michael Millin (a1)...

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.


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


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.


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.


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 Ramirez S , Doll J , Carle S , Anest T , Arii M , Hsieh YH , Okongo M , Moresky R , Sachs SE , Millin M . 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 .

Corresponding author
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
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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