Emergency response in resource-poor settings: a review of a newly-implemented EMS system in rural Uganda.

INTRODUCTION: The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries. Problem The objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda. METHODS: An EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed. RESULTS: In total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $89.95 per life saved with an estimated $0.93/capita to establish the system and $0.09/capita/year to maintain the system. CONCLUSION: Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.

Learning from Japan: strengthening US emergency care and disaster response.

As Hurricane Katrina demonstrated in 2005, US health response systems for disasters-typically designed to handle only short-term mass-casualty events-are inadequately prepared for disasters that result in large-scale population displacements. Similarly, after the 2011 Great East Japan Earthquake, Japan found that many of its disaster shelters failed to meet international standards for long-term provision of basic needs and health care for the vulnerable populations that sought refuge in the shelters. Hospital disaster plans had not been tested and turned out to be inadequate, and emergency communication equipment did not function. We make policy recommendations that aim to improve US responses to mass-displacement disasters based on Japan's 2011 experience. First, response systems must provide for the extended care of large populations of chronically ill and vulnerable people. Second, policies should ensure that shelters meet or exceed international standards for the provision of food, water, sanitation, and privacy. Third, hospital disaster plans should include redundant communication systems and sufficient emergency provisions for both staff and patients. Finally, there must be routine drills for responses to mass-displacement disasters so that areas needing improvement can be uncovered before an emergency occurs.