title: Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana.
abstract: BACKGROUND
  Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana's national ambulance service has relatively low public utilization in comparison with the large burden of acute disease.
  
  
  METHODS
  A survey instrument was developed using Pechansky and Thomas's model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency.
  
  
  RESULTS
  468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18-35 years were more likely than older respondents to prefer an ambulance (odds ratio [OR], 2.27; confidence interval [CI], 1.47 to 3.68), as were those with prior ambulance experience (OR, 1.75; CI, 0.98 to 3.09) (compared with those with no prior experience) and those who believed ambulances were safer than taxis (OR, 2.17; CI, 1.1 to 4.2) (compared with those who did not hold such beliefs).
  
  
  CONCLUSIONS
  Perceptions of public ambulance services in Accra, Ghana, are generally favorable, although use is low. Public health education to improve awareness of the toll-free medical emergency number and about appropriate use of ambulances while simultaneously improving the capacity of ambulance agencies to receive increased caseload could improve use of the EMS system.
authors.affiliation: University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO, USA.
authors.forename: Nee-Kofi
authors.initials: NK
authors.lastname: Mould-Millman
authors.affiliation: University of Michigan Medical School, Global REACH, Ann Arbor, MI, USA.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Rominski
authors.affiliation: Washington University in Saint Louis, School of Medicine, Infectious Diseases Division, Saint Louis, MO, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Bogus
authors.affiliation: University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO, USA.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.affiliation: Ministry of Health Republic of Ghana, National Ambulance Service, Accra, Ghana.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Zakariah
authors.affiliation: Ministry of Health Republic of Ghana, National Ambulance Service, Accra, Ghana.
authors.forename: Christiana A
authors.initials: CA
authors.lastname: Boatemaah
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, GA, USA.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Yancey
authors.affiliation: Ministry of Health Republic of Ghana, National Ambulance Service, Accra, Ghana Ghana Health Service, Institutional Care Division, Accra, Ghana.
authors.forename: Samuel Kaba
authors.initials: SK
authors.lastname: Akoriyea
authors.affiliation: University of Colorado School of Medicine, Department of Medicine, Division of Infectious Diseases, Aurora, CO, USA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances; D001364:Awareness; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D005869:Ghana; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult