Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-23T06:50:58.141Z Has data issue: false hasContentIssue false
  • English
  • Français

The State of Emergency Medical Services (EMS) Systems in Africa

Published online by Cambridge University Press:  23 February 2017

Nee-Kofi Mould-Millman ,
Julia M. Dixon ,
Nana Sefa ,
Arthur Yancey ,
Bonaventure G. Hollong ,
Mohamed Hagahmed ,
Adit A. Ginde  and
Lee A. Wallis
Nee-Kofi Mould-Millman*
Affiliation:
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA
Julia M. Dixon
Affiliation:
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA Denver Health, Department of Emergency Medicine, Denver, ColoradoUSA
Nana Sefa
Affiliation:
Oakland University, William Beaumont School of Medicine, Royal Oak, MichiganUSA
Arthur Yancey
Affiliation:
Emory University, School of Medicine, Department of Emergency Medicine, Atlanta, GeorgiaUSA
Bonaventure G. Hollong
Affiliation:
University of Cape Town, Division of Emergency Medicine, Cape Town, South Africa
Mohamed Hagahmed
Affiliation:
University of PittsburghMedical Center, Pittsburgh, PennsylvaniaUSA
Adit A. Ginde
Affiliation:
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA
Lee A. Wallis
Affiliation:
University of Cape Town, Division of Emergency Medicine, Cape Town, South Africa
*
Correspondence: Nee-Kofi Mould-Millman, MD FACEP Department of Emergency Medicine 12401 East 17th AveLeprino 752, Mailstop B215 Aurora, Colorado 80045 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.

Methods

A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems’ jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.

Results

The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).

Conclusion

Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service.

Mould-MillmanNK, DixonJM, SefaN, YanceyA, HollongBG, HagahmedM, GindeAA, WallisLA. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283.

Keywords

AfricaambulanceEmergency Medical ServicesEMSglobal health
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 3 , June 2017 , pp. 273 - 283
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest/funding: Funding and support for this study was provided by the African Federation for Emergency Medicine (Bellville, South Africa). The African Federation for Emergency Medicine did not limit the study design, data collection, data analysis, or data interpretation. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References

1. World Health Organization. World Health Statistics 2010. World Health Organization; 2010:177. http://www.who.int/whosis/whostat/2010/en/. Accessed September 13, 2015.Google Scholar
2. Lopez, AD, Mathers, CD, Ezzati, M, Jamison, DT, Murray, CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747-1757.Google Scholar
3. Mock, CN, Jurkovich, GJ, Amon-Kotei, D, Arreola-Risa, C, Maier, R V. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-812.Google Scholar
4. World Health Organization. Sixtieth World Health Assembly. Resolution WHA 60.22: Emergency-Care Systems. Geneva, Switzerland: World Health Organization; 2007.Google Scholar
5. Mould-Millman, NK, Naidoo, R, de Vries, S, Stein, C, Wallis, LA. AFEM out-of-hospital emergency care workgroup consensus paper: advancing out-of-hospital emergency care in Africa-advocacy and development. Afr J Emerg Med. 2014;4(2):90-95.CrossRefGoogle Scholar
6. Razzak, JA, Kellermann, AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organization. 2002;80(11):900-905.Google Scholar
7. Kobusingye, OC, Hyder, AA, Bishai, D, Joshipura, M, Hicks, ER, Mock, C. Emergency Medical Services. In Jamison DT, Breman JG, Measham AR, et al, (eds). Disease Control Priorities in Developing Countries. 2nd edition. Washington, DC USA: World Bank; 2006;68:1261-1279.Google Scholar
8. Mock, C, Joshipura, M, Goosen, J. Global strengthening of care for the injured. Bull World Health Organ. 2004;82(4):241.Google ScholarPubMed
9. Sasser, SM, Varghese, M, Joshipura, M, Kellermann, A. Preventing death and disability through the timely provision of prehospital trauma care. Bull World Health Organ. 2006;84(7):507.Google Scholar
10. Nielsen, K, Mock, C, Joshipura, M, Rubiano, AM, Zakariah, A, Rivara, F. Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehosp Emerg Care. 2012;16(3):381-389.CrossRefGoogle ScholarPubMed
11. Mould-Millman, NK, Sasser, SM, Wallis, LA. Prehospital research in sub-Saharan Africa: establishing research tenets. Acad Emerg Med. 2013;20(12):1304-1309.Google Scholar
12. Osei-Ampofo, M, Oduro, G, Oteng, R. The evolution and current state of emergency care in Ghana. Afr J Emerg Med. 2013;2(3):52-58.CrossRefGoogle Scholar
13. Wachira, B, Martin, I. The state of emergency care in the Republic of Kenya. Afr J Emerg Med. 2011;1(4):16-165.Google Scholar
14. Sikka, N, Margolis, G. Understanding diversity among prehospital care delivery systems around the world. Emerg Med Clin North Am. 2005;23(1):99-114.Google Scholar
15. Mould-Millman, NK, Sun, J. The African trauma chain of survival: proposing a model of integrated care. Ann Glob Heal. 2014;80(1):219-220.CrossRefGoogle Scholar
16. Mould-Millman, CN, Oteng, R, Osei-Ampofo, M, Zakariah, AN, Kowalenko, TK. Emergency Medical Services assessment of the Ashanti Region of Ghana. Ghana Medical Journal. 2015;49(3):125-135.Google Scholar
17. Mould-Millman, NK, Dixon, J, Sefa, N, Patel, H, Yaffee, AQ, Imediegwu, A, et al. Out-of-Hospital Emergency Care in Africa – A 15-Year Literature Review. Poster Presentation. African Conference in Emergency Medicine (AfCEM) 2014 – Addis Ababa, Ethiopia.Google Scholar
18. Reinman, SL. The World Factbook Cia.gov. Washington, DC: Central Intelligence Agency. https://www.cia.gov/library/publications/resources/the-world-factbook/. Accessed July 1, 2015.Google Scholar
19. City Population [Internet] Germany: Thomas Brinkhoff: City Population. http://www.citypopulation.′de/Angola-Cities.html. Accessed July 3, 2015.Google Scholar
20. Ceita, C, Mauchado, AP, Ribeiro, G, Lourenco, M. Resultados Preliminares Recenseamento Geral Da Populacao e Habitacao -2014. Angola Instituto Nacional de Estatística Subcomissão de Difusão de Resultados 2014. http://www.ine.gov.ao. Accessed September 15, 2015.Google Scholar
21. Majelantle, A. 2011 Population & Housing Census Preliminary Results Brief. Botswana Census Office 2011 September. http://ecastats.uneca.org. Accessed September 15, 2015.Google Scholar
22. Rapport de Presentation des Resultats Definitifs. Cameroon; Bureau Central des Recensements et des Etudes de Population 2010 April. http://www.statistics-cameroon.org/ downloads/La_population_du_Cameroun_2010.pdf. Accessed September 15, 2015.Google Scholar
23. Arab Republic of Egypt. Egypt: Central Agency for Public Mobilization and Statistics. http://www.msrintranet.capmas.gov.eg/database.aspx?parentid=2940&free=1. Accessed July 3, 2015.Google Scholar
24. Population and Housing Census Report-Country – 2007. Ethiopia; Central Statistical Agency 2010 July. http://www.csa.gov.et. Accessed September 15, 2015.Google Scholar
25. 2010 Population and Housing Census. Ghana; Ghana Statistical Service 2012 October. http://www.statsghana.gov.gh/docfiles/publications/2010_PHC_demographic_social_economic_housing_characteristics.pdf. Accessed September 15, 2015.Google Scholar
26. The 2009 Kenya Population and Housing Census Volume 1A-Population Distribution by Administrative Units. Kenya; Kenya National Bureau of Statistics 2010 August. http://www.knbs.or.ke/index.php?option=com_phocadownload&view=category&id=109:population-and-housing-census-2009&Itemid=599. Accessed September 15, 2015.Google Scholar
27. Recensement General De La Population Et De L’Habitat. Madagascar; Commission National Du Recensement General De La Population et de L’Habitat; Institut National de la Statistique. 1997 January. http://instat.mg/essai/wp-content/uploads/2015/01/rgph_1.pdf. Accessed September 15, 2015.Google Scholar
28. Namibia 2011 Population and Housing Census Main Report. Namibia; Namibia Statistics Agency 2012. http://nsa.org.na/page/publications. Accessed September 15, 2015.Google Scholar
29. 2006 Population and Housing Census of the Federal Republic of Nigeria. Nigeria; National Population Commission 2009 February. http://www.population.gov.ng/images/Priority%20Tables%20Volume%20I-update.pdf. Accessed September 15, 2015.Google Scholar
30. Census 2011: Census in Brief. South Africa; Statistics South Africa 2012. http://www.statssa.gov.za/?page_id=3955. Accessed September 15, 2015.Google Scholar
31. 5th Sudan Population and Housing Census-2008-Priority Results. Sudan; Population Census Council, Central Bureau of Statistics 2009 April. catalog.ihsn.org/index.php/catalog/4216/download/55706. Accessed September 15, 2015.Google Scholar
32. Zimbabwe Population Census 2012. Zimbabwe; Population Census Office, Zimbabwe National Statistics Agency 2013 October. http://www.zimstat.co.zw/dmdocuments/Census/CensusResults2012/National_Report.pdf. Accessed September 15, 2015.Google Scholar
33. United Nations DGACM. United Nations. http://www.un.org/depts/DGACM/RegionalGroups.shtml. Accessed September 20, 2015.Google Scholar
34. United Nations: Department of Field Support Cartographic Section; UN.org. c 2011. http://www.un.org/Depts/Cartographic/map/profile/africa.pdf. Accessed October 1, 2015.Google Scholar
35. Mould-Millman, NK, Rominski, S, Oteng, R. Ambulance or taxi? High acuity prehospital transports in the Ashanti region of Ghana. Afr J Emerg Med. 2014;4(1):8-13.Google Scholar
36. Bosson, N, Redlener, M, Foltin, G. Services among residents in Libreville, Gabon: a qualitative study: obstacles à l’utilisation des services d’urgence médicale préhospitaliers parmi les habitants. Afr J Emerg Med. 2013;3(4):172-177.Google Scholar
37. Mould-Millman, NK, Rominski, SD, Bogus, J, et al. Barriers to accessing Emergency Medical Services in Accra, Ghana. Global Health: Science and Practice. 2015;3(4):577-590.Google Scholar
38. Calvello, EJ, Skog, AP, Tenner, AG, Wallis, LA. Applying the lessons of maternal mortality reduction to global emergency health. Bull World Health Organ. 2015;93(6):417-423.Google Scholar
39. Calvello, E, Reynolds, T, Hirshon, J. Emergency care in sub-Saharan Africa: results of a consensus conference. Afr J Emerg Med. 2013;3(1):42-48.Google Scholar
40. Mowafi, H, Dworkis, D, Bisanzo, M, et al. Making recording and analysis of chief complaint a priority for global emergency care research in low-income countries. Acad Emerg Med. 2013;20(12):1241-1245.Google Scholar
41. Papali, A, McCurdy, MT, Calvello, EJB. A “three delays” model for severe sepsis in resource-limited countries. J Crit Care. 2015;30(4):861.e9-861.e14.Google Scholar
42. Tayler-Smith, K, Zachariah, R, Manzi, M, et al. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality. Trop Med Int Health. 2013;18(8):993-1001.Google Scholar
43. Yancey, AH, Mould-Millman, NK. The Implementation Status of Obstetric EMS Systems in Selected South African Health Districts with Recommendations for Future Development. Published for United States Agency for International Development (USAID), United States Presidents Emergency Plan for AIDS Relief (PEPFAR), and South Africa Foundation for Professional Development (SA-FPD). February 9, 2015.Google Scholar
44. Stiell, IG, Wells, GA, Spaite, DW, et al. The Ontario Prehospital Advanced Life Support (OPALS) study: rationale and methodology for cardiac arrest patients. Ann Emerg Med. 19988;32(2):180-190.Google Scholar
45. Henry, JA, Reingold, AL. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2012;73(1):261-268.Google Scholar