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empower laypersons and military medics to provide care, particularly
with hemorrhage control, and have positively influenced the outcomes
of trauma patients.
EMS education and training varies for prehospital providers in
lower-middle income countries. In some countries, EMS staff receive
no formal training and rely only on on-the-job experience. Other countries train providers in very basic emergency care like CPR, oxygen
therapy and first aid. As previously noted, some receive EMS education
and training from high-income countries such as the U.S. and U.K.
Traumatic injury, most often from road traffic accidents, was identified as one of the most common patient categories requiring pre-hospital care in lower-middle income countries. Burn injuries are
Patient transport vehicles in lower-middle income countries vary
from pickup trucks to contemporary ambulances. Equipment also
varies and appears to be influenced by prehospital provider level of
training and system funding.
The lack of financial support for EMS was noted as one of the primary obstacles to creating and sustaining effective prehospital care services. This leads to reduced access to key equipment and medications,
in some cases shifting a prohibitively large financial burden to patients.
Poor road conditions, high traffic volumes and inadequate road infrastructure present both obstacles for EMS delivery as well as contributing factors to the trauma case load in lower-middle income countries.
Lack of public awareness of the need for an EMS system and
knowledge of emergencies negatively impacts the implementation
and development of EMS in lower-middle income countries. Cultural beliefs about traditional medicine as well as religious beliefs also
affect certain population’s perceptions of the value of prehospital care.
Discussion: The status of EMS development in lower-middle income
countries varies but, from these limited reports, it generally remains underdeveloped and underfunded, with a scarcity of trained EMS providers.
Development of EMS systems in LMICs is challenging due to many
factors, including: poor funding, lack of formal educational programs,
lack of national guidelines, cultural values, infrastructure and community
awareness. However, adequate prehospital services have the potential to
improve public health in LMICs suffering from a large percentage of
the world’s burden of traumatic injury, as well as emergencies related
to both communicable and non-communicable disease.
Conclusion: There’s still much to be learned about EMS and pre-hospital care in lower-middle income countries. However, countries
with well-developed prehospital care systems can influence EMS in
these countries through training and education collaborations, support
of local EMS leadership, and advocacy for awareness, funding and regulations. This study highlights the need for devoted international dialogues on delivery of prehospital care. JEMS
William J. Leggio, EdD, NRP, is paramedic program coordinator and assistant professor at
Creighton University in Omaha, Neb. Contact him at firstname.lastname@example.org.
Peter Acker, MD, MPH, is faculty fellow at the Center for Innovation in Global Health and
an assistant professor in the Department of Emergency Medicine at Stanford University School
of Medicine. Contact him at email@example.com.
Jennifer A. Newberry, MD, JD, is clinical assistant professor in the Department of Emergency
Medicine at Stanford University School of Medicine. Contact her at firstname.lastname@example.org.
Benjamin Lindquist, MD, is a clinical instructor in the Department of Emergency Medicine
at Stanford University School of Medicine. Contact him at email@example.com.