title: Assessment of the status of prehospital care in 13 low- and middle-income countries.
abstract: BACKGROUND
  Injury and other medical emergencies are becoming increasingly common in low- and middle-income countries (LMICs). Many to most of the deaths from these conditions occur outside of hospitals, necessitating the development of prehospital care. Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most LMICs.
  
  
  OBJECTIVE
  In order to better plan for development of prehospital care globally, this study sought to better understand the current status of prehospital care in a wide range of LMICs.
  
  
  METHODS
  A survey was conducted of emergency medical services (EMS) leaders and other key informants in 13 LMICs in Africa, Asia, and Latin America. Questions addressed methods of transport to hospital, training and certification of EMS providers, organization and funding of EMS systems, public access to prehospital care, and barriers to EMS development.
  
  
  RESULTS
  Prehospital care capabilities varied significantly, but in general were less developed in low-income countries and in rural areas, where utilization of formal EMS was often very low. Commercial drivers, volunteers, and other bystanders provided a large proportion of prehospital transport and occasionally also provided first aid in many locations. Although taxes and mandatory motor vehicle insurance provided supplemental funds to EMS in 85% of the countries, the most frequently cited barriers to further development of prehospital care was inadequate funding (36% of barriers cited). The next most commonly cited barriers were lack of leadership within the system (18%) and lack of legislation setting standards (18%).
  
  
  CONCLUSIONS
  Expansion of prehospital care to currently underserved or unserved areas, especially in low-income countries and in rural areas, could make use of the already-existing networks of first responders, such as commercial drivers and laypersons. Efforts to increase their effectiveness, such as more widespread first-aid training, and better encompassing their efforts within formal EMS, are warranted. In terms of existing formal EMS, there is a need for increased and more regular funding, integration and coordination among existing services, and improved organization and leadership, as could be accomplished by making EMS administration and leadership a more desirable career path.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA 98104, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Nielsen
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Manjul
authors.initials: M
authors.lastname: Joshipura
authors.forename: Andres M
authors.initials: AM
authors.lastname: Rubiano
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zakariah
authors.forename: Frederick
authors.initials: F
authors.lastname: Rivara
mesh_terms: D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D019538:Health Care Surveys / Q000295:instrumentation; D006801:Humans