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The Birth and Growth of the National Ambulance Service in Ghana

Published online by Cambridge University Press:  12 December 2016

Ahmed Zakariah ,
Barclay T. Stewart ,
Edmund Boateng ,
Christiana Achena ,
Gavin Tansley  and
Charles Mock
Ahmed Zakariah
Affiliation:
National Ambulance Service, Ministry of Health, Accra, Ghana
Barclay T. Stewart*
Affiliation:
Department of Surgery, University of Washington, Seattle, Washington USA School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
Edmund Boateng
Affiliation:
National Ambulance Service, Ministry of Health, Accra, Ghana
Christiana Achena
Affiliation:
National Ambulance Service, Ministry of Health, Accra, Ghana
Gavin Tansley
Affiliation:
Department of Surgery, Dalhouise University, Nova Scotia, Canada Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
Charles Mock
Affiliation:
Department of Surgery, University of Washington, Seattle, Washington USA Harborview Injury Prevention & Research Center, Seattle, Washington USA Department of Global Health, University of Washington, Seattle, Washington USA
*
Correspondence: Barclay T. Stewart, MD, MscPH University of Washington Department of Surgery 1959 NE Pacific St., Suite BB-487 PO Box 356410 Seattle, Washington 98195-6410 USA E-mail: stewarb@uw.edu
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Abstract

Introduction

This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.

Methods

Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.

Results

In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.

Conclusion

The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services.

ZakariahA , StewartBT , BoatengE , AchenaC , TansleyG , MockC . The Birth and Growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83–93.

Keywords

developing countriesEmergency Medical ServicesGhana
Type
Special Reports
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 1 , February 2017 , pp. 83 - 93
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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Footnotes

(Note: Drs. Zakariah and Stewart are co-First Authors.)

References

1. Lozano, R, Naghavi, M, Foreman, K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128.Google Scholar
2. Stewart, B, Khanduri, P, McCord, C, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101(1):e9-22.Google Scholar
3. Mock, CN, Donkor, P, Gawande, A, Jamison, DT, Kruk, ME, Debas, HT. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;385(9983):2209-2219.CrossRefGoogle ScholarPubMed
4. Arreola-Risa, C, Mock, CN, Lojero-Wheatly, L, et al. Low-cost improvements in prehospital trauma care in a Latin American city. J Trauma. 2000;48(1):119-124.Google Scholar
5. Forjuoh, S, Mock, C, Freidman, D. Transport of the injured to hospitals in Ghana: the need to strengthen the practice of trauma care. Prehosp Immediate Care. 1999;3:66-70.Google Scholar
6. Mock, CN, Tiska, M, Adu-Ampofo, M, Boakye, G. Improvements in prehospital trauma care in an African country with no formal EMS. J Trauma. 2002;53(1):90-97.Google Scholar
7. Tiska, MA, Adu-Ampofo, M, Boakye, G, Tuuli, L, Mock, CN. A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J. 2004;21(2):237-239.Google Scholar
8. Mock, C, Jurkovich, G, nii-Amon-Kotei, D. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-814.Google Scholar
9. Quansah, R, Mock, C, Abantanga, F. Status of trauma care in Ghana. Ghana Med J. 2004;38:149-152.Google Scholar
10. Crandon, IW, Harding, HE, Williams, EW, Cawich, SO. Inter-hospital transfer of trauma patients in a developing country: prospective descriptive study. Int J Sur. 2008;6(5):387-391.Google Scholar
11. Mock, C, Juillard, C, Joshipura, M, Goosen, J. Strengthening Care for the Injured: Success Stories and Lessons Learned from Around the World. Geneva, Switzerland: World Health Organization; 2010.Google Scholar
12. United States Central Intelligence Agency. CIA World Factbook. 2014. http://www.ciaworldfactbook.us/africa/ghana.html. Accessed April 12, 2015.Google Scholar
13. World Bank Group. Ghana. 2015. http://data.worldbank.org/country/ghana. Accessed January 14, 2015.Google Scholar
14. Institute of Health Metrics and Evaluation. Data Visualizations: Global Burden of Disease Cause Patterns. http://vizhub.healthdata.org/gbd-cause-patterns/. Accessed May 27, 2015.Google Scholar
15. World Bank Group. United Kingdom and Great Britain. 2014. http://www.worldbank.org/en/country. Accessed May 6, 2015.Google Scholar
16. Stewart, BT, Quansah, R, Gyedu, A, et al. Serial assessment of trauma care capacity in Ghana in 2004 and 2014. JAMA Surg. 2016;151(2):164-171.Google Scholar
17. Rominski, S, Bell, SA, Yeboah, D, Sarna, K, Hartney, H, Oteng, R. Skills and educational needs of accident and emergency nurses in Ghana: an initial needs analysis. African J Emerg Med. 2011;1(3):119-125.Google Scholar
18. Ankomah, J, Stewart, BT, Oppong-Nketia, V, et al. Strategic assessment of the availability of pediatric trauma care equipment, technology, and supplies in Ghana. J Pediatr Surg. 2015;50(11):1922-1927.CrossRefGoogle ScholarPubMed
19. Stewart, BT, Quansah, R, Gyedu, A, Ankomah, J, Donkor, P, Mock, C. Strategic assessment of trauma care capacity in Ghana. World J Surg. 2015;39(10):2428-2440.Google Scholar
20. Japiong, KB, Asiamah, G, Owusu-Dabo, E, et al. Availability of resources for emergency care at second-level hospital in Ghana: a mixed methods assessment. African J Emerg Med. 2016;6(1):30-37.CrossRefGoogle Scholar
21. Mock, C, Abantanga, F, Goosen, J, Joshipura, M, Juillard, C. Strengthening care of injured children globally. Bull World Health Organ. 2009;87(5):382-389.Google Scholar
22. National Ambulance Service. Accra: Ghana Ministry of Health; 2009.Google Scholar
23. National Transportation Safety Administration. Emergency Medical Systems: Agenda for the Future. Washington, DC USA: US National Transportation Safety Administration; 1996.Google Scholar
24. Ryynanen, OP, Iirola, T, Reitala, J, Palve, H, Malmivaara, A. Is Advanced Life Support better than Basic Life Support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med. 2010;18:62.CrossRefGoogle ScholarPubMed
25. Razzak, JA, Kellermann, AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002;80(11):900-905.Google ScholarPubMed
26. Ali, J, Adam, RU, Gana, TJ, Bedaysie, H, Williams, JI. Effect of the Prehospital Trauma Life Support (PHTLS) program on prehospital trauma care. J Trauma. 1997;42(5):786-790.Google Scholar
27. Waseem, H, Naseer, R, Razzak, JA. Establishing a successful prehospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan. Emerg Med J. 2011;28(6):513-515.Google Scholar
28. Kobusingye, OC, Hyder, AA, Bishai, D, Joshipura, M, Hicks, ER, Mock, C. EMS: Disease Control Priorities in Developing Countries. Washington, DC USA: World Bank Group; 2006.Google Scholar
29. Prinja, S, Bahuguna, P, Lakshmi, PV, et al. Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India. PLoS One. 2014;9(10):e109911.CrossRefGoogle ScholarPubMed
30. Cowell, J. Review of Operations of Ground Emergency Medical Services in Alberta. Alberta, Canada: Health Care Quality Council of Alberta; 2013.Google Scholar
31. Terzi, O, Sisman, A, Canbaz, S, Dundar, C, Peksen, Y. A geographic information system-based analysis of ambulance station coverage area in Samsun, Turkey. Singapore Med J. 2013;54(11):653-658.Google Scholar
32. Man, Lo S, Min, Yu Y, Larry Lee, LY, et al. Overview of the Shenzhen Emergency Medical Service call pattern. World J Emerg Med. 2012;3(4):251-256.Google Scholar
33. New South Wales Government. Ambulance services of New South Wales, Australia. 2014. http://www.nsw.gov.au. Accessed June 22, 2015.Google Scholar
34. Martel, J, Oteng, R, Mould-Millman, NK, et al. The development of sustainable emergency care in Ghana: physician, nursing, and prehospital care training initiatives. J Emerg Med. 2014;47(4):462-468.CrossRefGoogle ScholarPubMed
35. Gyedu, A, Baah, EG, Boakye, G, Ohene-Yeboah, M, Otupiri, E, Stewart, BT. Quality of referrals for elective surgery at a tertiary care hospital in a developing country: an opportunity for improving timely access to and cost-effectiveness of surgical care. Int J Surg. 2015;15:74-78.Google Scholar