title: Emergency medical services and cultural determinants of an emergency in Karachi, Pakistan.
abstract: OBJECTIVE
  The study was conducted to understand the prehospital system in Karachi, the mode of transport that adult inpatients use to reach the emergency departments (EDs), and the barriers to the use of ambulances.
  
  
  METHODS
  The study consisted of two parts. The first part involved interviewing the administrators of major ambulance services in Karachi. The second part consisted of a structured interview of randomly selected adult inpatients admitted to one government and one private hospital.
  
  
  RESULTS
  Seven ambulance service administrators were interviewed. The interviews revealed that ambulances in Karachi are mainly involved in transporting patients from hospital to hospital or to home. A large number of calls are for transporting dead bodies. A total of 92 patients were interviewed (58 male, 34 female). Admission complaints included abdominal pain (22), blunt trauma (11), penetrating trauma (3), chest pain (6), shortness of breath (4), hematemesis (3), acute focal weakness (4), high fever (4), and other (32). The most common mode of transport to the ED was taxi (53, 58%), followed by private car (21, 23%). Specific reasons for not using ambulances included a perception that the patient was not sick enough (34, 45%), slow response of the ambulance services (17, 23%), not knowing how to find one (8, 11%), and the high cost (6, 8%).
  
  
  CONCLUSIONS
  In case of a medical emergency, most people in Karachi do not use ambulances. The reasons for this low usage include not only poor accessibility, but also cultural barriers and lack of education in recognition of danger signs.
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticu, USA. junaid.razzak@yale.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Razzak
authors.forename: D C
authors.initials: DC
authors.lastname: Cone
authors.forename: R
authors.initials: R
authors.lastname: Rehmani
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D003469:Culture; D004630:Emergencies / Q000145:classification; D004631:Emergency Medical Service Communication Systems; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012959:Socioeconomic Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*