EMS at 3600 Meters: Exploring Barriers to Emergency Care and Transport in Rural Andean Perú.

Abstract

Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention. Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes. Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as "structural problems," such as lack of infrastructure, lack of structured care delivery, and unclear protocols.Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement. While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.