title: Ambulance referral for emergency obstetric care in remote settings.
abstract: OBJECTIVE
  To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications.
  
  
  METHODS
  A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital.
  
  
  RESULTS
  A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient.
  
  
  CONCLUSIONS
  An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources.
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Ademe
authors.initials: A
authors.lastname: Tsegaye
authors.affiliation: Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: dadosomigliana@yahoo.it.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Tadesse
authors.initials: T
authors.lastname: Alemayehu
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Federico
authors.initials: F
authors.lastname: Calia
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maroli
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Paola
authors.initials: P
authors.lastname: Barban
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy; Wolisso County hospital, Wolisso District, Oromia region, Ethiopia.
authors.forename: Sandro
authors.initials: S
authors.lastname: Accorsi
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D063130:Maternal Death / Q000706:statistics & numerical data*; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Ambulance; EmOC; Remote setting