title: Prehospital and Emergency Care: Updates from the Disease Control Priorities, Version 3.
abstract: BACKGROUND
  It is increasingly understood that emergency care systems can be cost-effective in low- and middle-income countries (LMICs). The development of such systems, however, is still a work in progress. This article updates previous work in providing the most recent estimates of the burden of disease sensitive to emergency care, the current state of knowledge on the feasibility of emergency care, effect on outcomes, and cost-effectiveness in LMICs, and future directions for research, policy, and implementation.
  
  
  METHODS
  We calculated the potential impact of prehospital and emergency care systems using updated and revised data based on the global burden of disease study. We then assessed the state of current knowledge and potential future directions for research and policy by conducting a review of the literature on current systems in LMICs.
  
  
  RESULTS
  According to these newest updates, 24 million deaths related to emergency medical conditions occur in LMICs annually, accounting for an estimated 932 million years of life lost. Evidence shows that multiple emergency care models can function in different local settings, depending on resources and urbanicity. Emergency care can significantly improve mortality rates from emergent conditions and be highly cost-effective. Further research is needed on implementation of emergency care systems as they become a necessary reality in developing nations worldwide.
  
  
  CONCLUSIONS
  Emergency care implementation in LMICs presents both challenges and opportunities. Investment in evidence-based emergency care, research on implementation, and system coordination in LMICs could lead to a more cost- and outcome-effective emergency care system than exists in advanced economies.
authors.affiliation: UCSF Department of Emergency Medicine, San Francisco General Hospital, 1001 Potrero Avenue, 1E21, San Francisco, CA, 94110, USA, renee.hsia@emergency.ucsf.edu.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zakariah
authors.forename: Eduardo Romero
authors.initials: ER
authors.lastname: Hicks
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000706:statistics & numerical data*; D004630:Emergencies; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration*; D004638:Emergency Treatment; D017048:Health Care Costs; D006291:Health Policy; D006292:Health Priorities; D006801:Humans; D008017:Life Expectancy; D017146:Models, Organizational; D009026:Mortality
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