title: EMS Systems in Lower-Middle Income Countries: A Literature Review.
abstract: Introduction Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped. Problem There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries.
  
  
  METHODS
  A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care.
  
  
  RESULTS
  There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing the prehospital care system.
  
  
  CONCLUSIONS
  The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organized EMS system with most ambulances used purely for transport and not as an emergency care vehicle. Financial issues are the most common problems faced by LMICs with support from developed countries a necessity. Suryanto , Plummer V , Boyle M . EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64-70.
authors.affiliation: 1School of Nursing and Midwifery,Monash University,Victoria,Australia.
authors.lastname: Suryanto
authors.affiliation: 1School of Nursing and Midwifery,Monash University,Victoria,Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Plummer
authors.affiliation: 4Department of Community Emergency Health and Paramedic Practice,Monash University,Victoria,Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Boyle
mesh_terms: D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D008507:Medically Underserved Area
keywords:  CPR cardiopulmonary resuscitation;  ECG electrocardiogram;  ED emergency department;  EMS Emergency Medical Services;  EMT emergency medical technician;  LMICs lower-middle income countries;  NAS National Ambulance Services;  UN United Nations;  VHWs Village Health Workers;  WB World Bank;  WHO World Health Organization; EMS systems; ambulance; lower-middle income countries; out-of-hospital; prehospital