To provide a descriptive analysis of the prehospital emergency medical transportation system operating in and around a major Bosnian city, and to discuss the effect of the war on that transportation system.

A prospective, consecutive sample study.

The largest tertiary-care referral hospital currently operating in central Bosnia.

158 consecutive patients who sought care in the trauma and medical receiving rooms at Zenica Hospital.

Patients were surveyed as to time of transportation to the site of first medical care and to Zenica Hospital, and modes of transportation used.

Time to transport to first care within the city of Zenica is 30±21 minutes. Time to transport to Zenica Hospital from within Zenica is 51±39 minutes. Time to transport to first care outside of Zenica is 77±56 minutes. Time to transport to Zenica Hospital from outside the city of Zenica is 178±94 minutes. The prehospital emergency medical service was used in 11.7% of cases reviewed.

The majority of patients with major injury and illness are unable to obtain prehospital transportation and medical care through informal modes of transportation. The existing prehospital emergency medical services system is inadequate for the numbers of patients requiring such services, and transportation time from outside the city of study is especially prolonged.