title: Emergency response in resource-poor settings: a review of a newly-implemented EMS system in rural Uganda.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Johns Hopkins University,Department of Emergency Medicine,Baltimore,Maryland USA.
authors.forename: Sarah Stewart
authors.initials: SS
authors.lastname: de Ramirez
authors.affiliation: 2University of Chicago,Department of Internal Medicine,Chicago,Illinois USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Doll
authors.affiliation: 1Johns Hopkins University,Department of Emergency Medicine,Baltimore,Maryland USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Carle
authors.affiliation: 1Johns Hopkins University,Department of Emergency Medicine,Baltimore,Maryland USA.
authors.forename: Trisha
authors.initials: T
authors.lastname: Anest
authors.affiliation: 3Harvard Medical School,Department of Emergency Medicine,Boston,Massachusetts USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Arii
authors.affiliation: 1Johns Hopkins University,Department of Emergency Medicine,Baltimore,Maryland USA.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: 4The Millennium Villages Project Field Office,Ruhiira,Uganda.
authors.forename: Martins
authors.initials: M
authors.lastname: Okongo
authors.affiliation: 5Columbia University,Mailman School of Public Health,New York,New York USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Moresky
authors.affiliation: 6The Earth Institute at Columbia University,New York,New York USA.
authors.forename: Sonia Ehrlich
authors.initials: SE
authors.lastname: Sachs
authors.affiliation: 1Johns Hopkins University,Department of Emergency Medicine,Baltimore,Maryland USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Millin
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014454:Uganda