“Dying due to poverty and lack of easy transport”: A qualitative study on access and availability of pre-hospital emergency medical services in Kampala, Uganda

Abstract Background Emergency care services in low-and middle-income countries (LMICs) have traditionally received less attention in the dominant culture favouring vertical health programs. The unmet needs of pre-hospital and hospital-based emergency services are high but the barriers to accessing safe and quality emergency medical services (EMS) remain largely unaddressed. Few studies in Sub-Saharan Africa have qualitatively investigated barriers to EMS use, and quality of pre-hospital services from the providers and community perspective. We conducted a qualitative study to describe the patient-centred approach to emergency care in Kampala, Uganda, with specific attention to access to EMS.Methods The data collection was comprised of Key Informant Interviews (KII) and Focus Group Discussions (FGDs) with the community members. KII participants were selected using maximum purposive sampling based on expert knowledge of emergency care systems, and service delivery. FGDs were conducted to understand perceptions and experiences towards access to pre-hospital care, and to explore barriers to utilization of EMS. The respondents of ten KII and seven FGDs included pre-hospital EMS (PEMS) administrators, policy makers, police, health workers and community members. We conducted a directed content analysis to identify key themes and triangulate findings across different informant groups.Results Key themes emerged across interviews and discussions concerning: (1) lack of funds, (2) lack of standards, (3) need for upfront payments for emergency transport and care, 4) corruption, 5) poor quality pre-hospital emergency service, 6) poor quality hospital emergency care, and 7) delay in seeking treatment.Conclusions Patient-centred emergency care should be an integral part of comprehensive health care services. As Uganda and other LMICs continue to strive for universal health coverage, it is critical to prioritize and integrate emergency care within health systems owing to its cross-cutting nature. Community perceptions around access and quality of PEMS should be addressed in national policies covering affordable and safe EMS.

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Emergency medical services responders’ perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2016-014057 ◽

2017 ◽

Vol 7 (2) ◽

pp. e014057 ◽

Cited By ~ 11

Author(s):

Jeanne-Marie Guise ◽

Matthew Hansen ◽

Kerth O'Brien ◽

Caitlin Dickinson ◽

Garth Meckler ◽

...

Keyword(s):

Patient Safety ◽

Qualitative Study ◽

Emergency Medical Services ◽

Emergency Care ◽

Medical Services ◽

Hospital Emergency ◽

Emergency Medical

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Evaluation of the Quality of Medical Care to the Population at the Level of Day Stations and Emergency Stations

Bulletin of Science and Practice ◽

10.33619/2414-2948/74/16 ◽

2022 ◽

Vol 8 (1) ◽

pp. 114-121

Author(s):

B. Niyazov ◽

S. Niyazovа

Keyword(s):

Medical Care ◽

Emergency Medical Services ◽

Chronic Diseases ◽

Emergency Care ◽

Rural Population ◽

Medical Services ◽

Emergency Medical ◽

Medical Institutions ◽

Quality Of Medical Care

Insufficient availability of emergency medical services to the rural population is noted. The dynamics of the growth of calls to emergency medical services testifies to the fact that emergency medical institutions have taken over part of inpatient services for the provision of emergency care to patients with chronic diseases and acute colds.

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Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: A qualitative study

African Journal of Emergency Medicine ◽

10.1016/j.afjem.2012.12.003 ◽

2013 ◽

Vol 3 (4) ◽

pp. 172-177 ◽

Cited By ~ 7

Author(s):

Nichole Bosson ◽

Michael A. Redlener ◽

George L. Foltin ◽

Maria C. Raven ◽

Mark P Foran ◽

...

Keyword(s):

Qualitative Study ◽

Emergency Medical Services ◽

Medical Services ◽

Hospital Emergency ◽

Emergency Medical

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A Review of Data Quality Assessment in Emergency Medical Services

The Open Medical Informatics Journal ◽

10.2174/1874431101812010019 ◽

2018 ◽

Vol 12 (1) ◽

pp. 19-32 ◽

Cited By ~ 1

Author(s):

Mehrnaz Mashoufi ◽

Haleh Ayatollahi ◽

Davoud Khorasani-Zavareh

Keyword(s):

Data Quality ◽

Quality Assessment ◽

Emergency Medical Services ◽

Emergency Care ◽

Quality Data ◽

Medical Services ◽

Care Services ◽

Emergency Medical ◽

Data Quality Assessment ◽

Emergency Care Services

Introduction:Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services.Methods:The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study.Results:The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved.Conclusion:In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users’ perspectives can provide a broader picture of the reasons for poor quality data.

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Management of COVID-19-related challenges faced by EMS personnel: a qualitative study

BMC Emergency Medicine ◽

10.1186/s12873-021-00489-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fateme Mohammadi ◽

Banafsheh Tehranineshat ◽

Mostafa Bijani ◽

Ali Asghar Khaleghi

Keyword(s):

Emergency Medical Services ◽

Emergency Care ◽

Healthcare Services ◽

Medical Services ◽

Hospital Emergency ◽

Current Crisis ◽

Professional Performance ◽

Professional Challenges ◽

Emergency Medical ◽

Emergency Medical Services Personnel

Abstract Background As the first link in the chain of providing healthcare services in the frontline of the battle against COVID-19, emergency medical services (EMS) personnel are faced with various challenges, which affect their professional performance. The present study aimed to identify some strategies to manage the COVID-19-related challenges faced by the pre-hospital emergency care personnel in the south of Iran. Methods In this qualitative descriptive study, 27 pre-hospital emergency care personnel who were selected through the purposeful sampling method. Data were collected through 27 semi-structured, in-depth, individual interviews. The collected data were then analyzed based on the Granheim and Lundman’s method. Results Analysis of the data resulted in the identification of 3 main themes and eight sub-themes. These three main themes were as follows: comprehensive and systematic planning, provision of medical equipment, and reduction of professional challenges. Conclusion The findings of the present study showed that, during the COVID-19 crisis, emergency medical services personnel should be provided with a comprehensive and systematic protocol to provide pre-hospital care and their performance should be assessed in terms of a set of scientific standards. Due to lack of equipment and work overload in the current crisis, emergency medical services personnel are faced with many psychological challenges, which adversely affect their quality of pre-hospital emergency care. Furthermore, emergency care senior managers should develop comprehensive protocols, provide more equipment, and eliminate professional challenges to pave the ground for improving the quality and safety of the healthcare services in pre-hospital emergency care during the current COVID-19 crisis.

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The emergency medical system

10.1093/med/9780199687039.003.0007 ◽

2015 ◽

Cited By ~ 1

Author(s):

Marc Sabbe ◽

K Bronselaer ◽

O Hoogmartens

Keyword(s):

Medical Care ◽

Emergency Medical Services ◽

Medical Services ◽

Emergency Medical Care ◽

Hospital Emergency ◽

High Quality Research ◽

Emergency Medical ◽

System P ◽

Quality Of Medical Care

The mission of the emergency medical services is to promote and support a system that provides timely, professional, and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time or location and at any phase of the emergency incident. These phases include lay people’s prevention and preparedness, occurrence of the problem, its detection, alarming of trained responders, help provided by bystanders and trained pre-hospital providers, transport to the appropriate hospital, and, if necessary, admission or transfer to a more appropriate hospital. In order to meet the goal outlined, emergency medical services must work closely with local and state officials—fire and rescue departments, other ambulance providers, hospitals, and other agencies—to foster a smooth functioning network. The term emergency medical services evolved to reflect a change from a simple system of ambulances, providing only transportation, to a system in which actual medical care is given at the scene and during transport. Medical supervision and/or participation of emergency medicine physicians in the emergency medical services systems contribute to the quality of medical care. This emergency medical services network must be capable of responding instantly and reliably around the clock, with well-trained, well-equipped personnel linked, as needed, through a strong communication system. Research plays an important role in conserving resources and improving the delivery of health care. This chapter gives an overview of the different aspects of emergency medical services and calls for high-quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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Barriers and facilitators to cardiopulmonary resuscitation within pre-hospital emergency medical services: a qualitative study

BMC Emergency Medicine ◽

10.1186/s12873-021-00514-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nahid Dehghan-Nayeri ◽

Hassan Nouri-Sari ◽

Fatemeh Bahramnezhad ◽

Fatemeh Hajibabaee ◽

Mojtaba Senmar

Keyword(s):

Qualitative Study ◽

Cardiopulmonary Resuscitation ◽

Emergency Medical Services ◽

Human Resource ◽

Organizational Factors ◽

Medical Services ◽

Hospital Emergency ◽

Human Resource Policy ◽

Emergency Medical ◽

Resource Policy

Abstract Background Out-of-hospital cardiopulmonary arrest is a common and fatal problem. Rescuing patients with this problem by pre-hospital emergency medical services is associated with various barriers and facilitators. Identifying these barriers as well as the facilitators in a qualitative and an information-rich way will help to improve the quality of performing the maneuver and to increase the patients’ survival. Therefore, the current study was qualitatively conducted with the aim of identifying the factors affecting the cardiopulmonary resuscitation within the pre-hospital emergency medical services. Methods This qualitative study was conducted using a content analysis approach in Iran in 2021. The participants were 16 Iranian emergency medical technicians who were selected through a purposive sampling method. For data collection, in-depth and semi-structured interviews were conducted. For data analysis, the Elo and Kyngäs method was applied. Results The mean participants’ age was 33.06 ± 7.85 years, and their mean work experience was 10.62 ± 6.63 years. The collected information was categorized into one main category called “complex context of the cardiopulmonary resuscitation” and 5 general categories with 17 subcategories. These categories and subcategories include patient condition (patient’s underlying diseases, age, high weight, number of children, and place of living), dominant atmosphere in companions at home (companions’ feeling of agitation, companions doing harm, and companions helping), policy (educational policy, human resource policy, up-to-date equipment and technology, and do-not-resuscitate policy), performance of the out-of-organizational system (disorganization in the patient handover process, and cooperation of the support organizations), and conditions related to the treatment team (conscience, cultural dominance, and shift burden). Conclusions The results showed that the conditions related to the patient and his/her companions, as well as the organizational factors such as the policies and the out-of-organizational factors act as the barriers and the facilitators to the cardiopulmonary resuscitation within pre-hospital emergency medical services. Therefore, the barriers can be modified and the facilitators can be enhanced by taking various measures such as educating, human resource policy-making, upgrading the equipment, and considering appropriate management policies.

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Emergency care education in South Africa: past, present and future

Australasian Journal of Paramedicine ◽

10.33151/ajp.16.647 ◽

2019 ◽

Vol 16 ◽

Cited By ~ 2

Author(s):

Simpiwe Sobuwa ◽

Lloyd Denzil Christopher

Keyword(s):

South Africa ◽

Emergency Medical Services ◽

Emergency Care ◽

Education And Training ◽

Medical Services ◽

Hospital Emergency ◽

Care Education ◽

Emergency Medical ◽

The Many ◽

And Training

There have been major changes in pre-hospital emergency care training and education in South African over the past 30 years. This has culminated in the publication of a regulation that brings an end to an era of short courses in emergency care and paves the way for the implementation of the National Emergency Care Education and Training (NECET) policy. The policy envisions a 1-year higher certificate, a 2-year diploma and the 4-year professional degree in emergency medical care. This paper aims to describe the history of emergency care education and training in South Africa that culminated in the NECET policy. The lessons in the professional development of pre-hospital emergency care education and training may have application for emergency medical services in other countries.The migration of existing emergency medical services personnel to the new higher education qualification structure is a major challenge. The transition to the new framework will take time due to the many challenges that must be overcome before the vision of the policy is realised. Ongoing engagement with all stakeholders is necessary for the benefits envisioned in the NECET policy to be realised.

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