title: Prehospital system development in Jaffna, Sri Lanka.
abstract: BACKGROUND
  The building of prehospital emergency medical care systems in developing and lower middle-income countries (as defined by the World Bank) is a critical step in those countries' efforts to reduce unnecessary morbidity and mortality. This case report presents the development of a prehospital care system in Jaffna District, Sri Lanka and provides the results of the system's first year of operations, the likely reasons for the results, and the prospects for sustained operations of the system. The goal of this report is to add to the literature surrounding Emergency Medical Services (EMS) in developing countries by providing insight into the implementation of a prehospital emergency care system in developing and lower middle-income settings.
  
  
  METHODS
  The level of utilization and the financial performance of the system during its first year of operation were analyzed using data from the Jaffna Regional Director of Health Services (RDHS) Call Center database and information from the implementing organization, Medical Teams International.
  
  
  RESULTS
  The system responded to >2000 emergency calls in its first 11 months of operation. The most utilized ambulance of the system experienced only a US $13.50 loss during the first 12 months of operation. Factors such as up-front support, a systematic approach, and appropriateness contributed to the successful implementation of the Jaffna prehospital EMS system.
  
  
  CONCLUSIONS
  The implementation of a prehospital EMS system and its functioning were successful in terms of utility and, in many regards, financial stability. The system's success in development may serve as a potential model for implementing prehospital emergency medical care in other developing and lower middle-income country settings, keeping in mind factors outside of the system that were integral to its developmental success.
authors.affiliation: 1 United States Sri Lanka Fulbright Commission, Colombo, Sri Lanka.
authors.forename: John R
authors.initials: JR
authors.lastname: Zimmerman
authors.forename: Kecia M
authors.initials: KM
authors.lastname: Bertermann
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Bollinger
authors.forename: Donnie R
authors.initials: DR
authors.lastname: Woodyard
mesh_terms: D016208:Databases, Factual; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D006302:Health Services Research; D016730:Program Development; D013188:Sri Lanka