Abstract
BackgroundThere is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). In this study, we sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels.MethodsWe conducted a cross-sectional national survey administering structured questionnaires to EMS providers and policy makers from 38 randomly selected districts across seven of the 14 health regions of Uganda. This resulted in a study sample of 111 health facilities and 52 pre-hospital service providers. We collected data on six pillars of EMS whose frequencies and percentages were calculated and qualitatively compared for different levels of the health care system.ResultsAt the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number.At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care.Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care.Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases.ConclusionOur findings reveal weaknesses at every level of what should be a critical component in the health care system – one that deals with the ability to treat life-threatening conditions in a time sensitive manner. The Ministry of Health needs to speed up efforts to provide policies and guidelines, and to increase investments for the creation of a functional EMS in Uganda.
Highlights
There is limited information on the state of emergency medical services (EMS) in Uganda
Our findings reveal weaknesses at every level of what should be a critical component in the health care system – one that deals with the ability to treat life-threatening conditions in a time sensitive manner
As part of the survey, we administered structured questionnaires to the following: district-level policy makers, administrators or managers of pre-hospital care services, and managers of emergency departments or casualty units who we identified through the District Health Officers (DHOs) and hospital administrators
Summary
There is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). We sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels. EMS is critical to the improvement of outcomes in patients with obstetric and medical emergencies and severe injuries, and other serious time sensitive illnesses. Despite this pivotal role, many countries in Africa (e.g., Lesotho, Malawi, and Tanzania) have been slow to develop EMS systems [2]. Patient survival and recovery are dependent on the presence of appropriately trained medical personnel, and the availability of the necessary equipment, medicines, and supplies in the minutes and hours following the arrival of a critically ill patient at a health care facility [5]
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