title: The Birth and Growth of the National Ambulance Service in Ghana.
abstract: Introduction This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.
  
  
  METHODS
  Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.
  
  
  RESULTS
  In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.
  
  
  CONCLUSIONS
  The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services. Zakariah A , Stewart BT , Boateng E , Achena C , Tansley G , Mock C . The birth and growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83-93.
authors.affiliation: 1National Ambulance Service,Ministry of Health,Accra,Ghana.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zakariah
authors.affiliation: 2Department of Surgery,University of Washington,Seattle,WashingtonUSA.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: 1National Ambulance Service,Ministry of Health,Accra,Ghana.
authors.forename: Edmund
authors.initials: E
authors.lastname: Boateng
authors.affiliation: 1National Ambulance Service,Ministry of Health,Accra,Ghana.
authors.forename: Christiana
authors.initials: C
authors.lastname: Achena
authors.affiliation: 6Department of Surgery,Dalhouise University,Nova Scotia,Canada.
authors.forename: Gavin
authors.initials: G
authors.lastname: Tansley
authors.affiliation: 2Department of Surgery,University of Washington,Seattle,WashingtonUSA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D000552:Ambulances / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration; D005869:Ghana; D006801:Humans; D016730:Program Development; D055818:Public-Private Sector Partnerships
keywords:  EMT emergency medical technician;  LMICs low- and middle-income countries;  NAS National Ambulance Service;  PHTLS Prehospital Trauma Life Support; Emergency Medical Services; Ghana; developing countries