Background Injury burden is disproportionately high in low- and middle-income countries (LMICs) but the healthcare systems are least prepared to meet the challenge. Significant gaps exist in emergency care, with most preventable deaths occurring in the pre-hospital phase due to lack of emergency medical services (EMS). There are no tools to define gaps and prioritise interventions in pre-hospital care. Realising this gap, our study was conducted to: i) develop a rapid assessment tool to define the structures, resources and processes comprising EMS; ii) pilot test the tool in Kampala, Uganda; and iii) identify gaps and provide recommendations for the improvement of EMS in Uganda.
Methods The study comprised of three phases: in Phase I rapid assessment tool was developed using the health systems framework with six building blocks; in Phase II a 3600 evaluation was performed by conducting relevant document review, objective assessment of ambulance services representing various levels of pre-hospital care and qualitative assessment through key informant interviews (KIIs) and focus group discussions (FGDs). Phase III, data analysis is underway.
Results The data was collected using the structured tool. Three study personnel reviewed 15 documents for the study. Three data collectors simultaneously performed 20 purposefully sampled KIIs and objective assessment. In addition, 4 FGDs will be completed by November 2015. The pilot study of the rapid assessment tool demonstrated the reliability, accuracy and completeness of the tool; further analysis after FDGs will allow us to describe the current state of EMS in Kampala. Based on the findings, context-specific interventions will be recommended.
Conclusions There is an immediate need to understand the contextual barriers of providing systematic emergency care in LMICs. The study has successfully developed an EMS assessment tool, which will also help establish strategies for improvement of pre-hospital care in similar settings.
- trauma care
- pre-hospital care