Ambulance Response Times in Developing Emergency Health Care Systems

Ambulance Response Times in Developing Emergency Health Care Systems Outline

Thesis: Dispatcher training can improve ambulance response times in EMS systems in low income countries. I. Statement of the problem A. Introduction

II. Survey of the literature

A. How do we improve emergency care in an area with limited resources? B. Training is one way to do this. C. Dispatcher Training can be effective.

1. What training programs are available for dispatchers? D. How do we evaluate the effectiveness of our training?

1. Look at ambulance response times

III. Research design and data collection A. Study design and protocol:

ii. Collect data for ambulance response times before and after implementation

B. Subjects

C. Interventions

ii. Tone system - description

D. Measurements and other observations E. Explanation of results and relation to examples from the literature. V. Conclusion

Dispatcher training can improve ambulance response times in emergency medical service (EMS) systems in low income countries. Emergency health care systems are of increasing concern in international healthcare developments and the global fight against the burdens of disease. Studies show that emergency health care improvements in developing countries should focus on ambulance response. Low-cost changes including emergency medical dispatch training in developing urban emergency health care systems can improve ambulance response times. Concerns about focusing on ambulance response time as a single indicator are addressed by showing a case sensitive approach for developing emergency health care systems that in return can identify ambulance response as main indicator for a particular system. This approach has been chosen for the subject of study, the Osh Ambulance Service, a municipal EMS in Kyrgyzstan. This particular service, the implemented research, the study design and, the data analysis are presented. The data show that there has been a change from an average response time of 23, 18 minutes to 20, 15 minutes. This data is statistically significant and indicates that the implemented changes, despite severe challenges, likely have an effect, but it is unclear if this change will have a large clinical impact. Further research on emergency medical dispatch and emergency medical response in low- and middle- income countries is encouraged. With increased opportunities and further globalization emergency health care professionals could play a greater role in research and development of emergency medical service systems in resource-limited countries.

Schmidt 1

Ambulance Response Times in Developing Emergency Health Care Systems

1. Statement of the problem

This research was based on the experience of the authors in emergency medical service (EMS) development and training in low-income countries. As one would expect, the problems with ambulance response are many and varied. They range from poor road conditions, lack of equipment and vehicles, overspecialization of the ambulance units, lack of training for dispatchers, frequent power outages which limit the radio usage and a limited supply of gasoline for the ambulances themselves. When thinking about what vast resources are necessary to address the complex web of problems, the question surfaced; if dispatcher training can improve ambulance response times in low income countries?

Health care systems in low- and middle income countries need improvement and support in order to ease the global burden of disease and enable human development. A lot of financial resources are poring into third world countries in order to accomplish this. Emergency health care is becoming an important focus in international health care development. Emergency medical services are seen as a critical component of health care in developing countries (Kobusingye, 2005). It has been recognized as an important horizontal approach to improve living conditions, burdens of disease and long-lasting economic effects due to improved disease adjusted life years (DALYs) in industrialized nations and developing countries alike (Davis, 2004; Kellermann, 2002). Rather than focusing on a vertical (disease oriented) approach a horizontal approach like on emergency medical services provides benefits to the population suffering from various medical conditions.

Schmidt 2

If we define EMS systems based on experiences from industrialized nations system development and improvements will fail in the Third World because resources in low- and middle- income countries (LIMC) are limited and sustainable approaches are needed in order to develop an emergency health care system with a lasting effect for the population (Kobusingye, 2005).

Changes need to be made that are able to be maintained by the health care system long after international aid has vanished. Otherwise there are a lot of resources and time that is wasted. Indeed many people in third world countries still do not have access to proper emergency care and equipment. This results from a lack of infrastructure and financial resources (Jamison 2006; Kobusingye 2005).

2. Survey of the literature

How can we improve emergency care in a region with limited resources and maintain a sustainable approach? Before changes are implemented and further investments are made into the area of emergency medical services in developing countries it is important to find support for this approach. Hauswald and Yeoh (1997) have studied this issue and came to the conclusion that the benefits of an EMS system for a developing country are small if it is based on western models. The authors support the search for alternative approaches to a North American EMS model in low- and middle-income countries. Also Kobusingye (2005) concludes that EMS system development must be carefully designed to the countries needs.