title: The State of Emergency Medical Services (EMS) Systems in Africa.
abstract: Introduction Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.
  
  
  METHODS
  A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems' jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.
  
  
  RESULTS
  The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).
  
  
  CONCLUSIONS
  Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service. Mould-Millman NK , Dixon JM , Sefa N , Yancey A , Hollong BG , Hagahmed M , Ginde AA , Wallis LA . The state of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273-283.
authors.affiliation: 1University of Colorado,School of Medicine,Department of Emergency Medicine,Aurora,ColoradoUSA.
authors.forename: Nee-Kofi
authors.initials: NK
authors.lastname: Mould-Millman
authors.affiliation: 1University of Colorado,School of Medicine,Department of Emergency Medicine,Aurora,ColoradoUSA.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Dixon
authors.affiliation: 3Oakland University,William Beaumont School of Medicine,Royal Oak,MichiganUSA.
authors.forename: Nana
authors.initials: N
authors.lastname: Sefa
authors.affiliation: 4Emory University,School of Medicine,Department of Emergency Medicine,Atlanta,GeorgiaUSA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Yancey
authors.affiliation: 5University of Cape Town,Division of Emergency Medicine,Cape Town,South Africa.
authors.forename: Bonaventure G
authors.initials: BG
authors.lastname: Hollong
authors.affiliation: 6University of PittsburghMedical Center,Pittsburgh,PennsylvaniaUSA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hagahmed
authors.affiliation: 1University of Colorado,School of Medicine,Department of Emergency Medicine,Aurora,ColoradoUSA.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.affiliation: 5University of Cape Town,Division of Emergency Medicine,Cape Town,South Africa.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
mesh_terms: D000349:Africa; D002959:Civil Defense; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D011795:Surveys and Questionnaires
keywords:  AFEM African Federation for Emergency Medicine;  ALS Advanced Life Support;  BLS Basic Life Support;  EMS Emergency Medical Services;  EMT emergency medical technician;  IFT inter-facility transport;  PI Principal Investigator;  WHO World Health Organization; Africa; EMS; Emergency Medical Services; ambulance; global health