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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
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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 

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