Ambulance Response Times in Developing Emergency Health Care Systems

by

Jochen Schmidt

EMS 450 Baccalaureate Capstone Project

Andrew Jackson University, Birmingham, Alabama, USA

03.09.2006

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Ambulance Response Times in Developing Emergency Health Care Systems

Outline

Thesis: Dispatcher training can improve ambulance response times in EMS systems in

low income countries.

I.

Statement of the problem

A. Introduction

1. Why was the research started

2. We need to improve health care in 3rd world countries.

3. In order to do this, we need to improve emergency care.

A. Why emergency care?

B. Why focus on this?

C. Ambulance response time plays an important role in improving the

outcome of patients in health emergencies.

4. Ambulance response time has impact on short-term survival.

5. Need for sustainable approaches in low- and middle- income countries in

order to improve emergency health care. One approach could be

ambulance response time.

II.

Survey of the literature

A. How do we improve emergency care in an area with limited resources?

B. Training is one way to do this.

C. Dispatcher Training can be effective.

1. What training programs are available for dispatchers?

D. How do we evaluate the effectiveness of our training?

1. Look at ambulance response times

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a. Is this a good method?

i. Some say yes why?

1. Ambulance response has been area of

interest in recent years.

2. Ambulance response is prone to perceptions,

demands and utilization of emergency

medical services.

3. Changes are necessary in order to improve

response time.

4. Example of changes from Canada.

5. Study that changes in developing countries

should focus on ambulance response.

Support of pilot projects and research.

ii. Some say no why?

1. Arguments against focus on ambulance

response time.

2. Widespread development of indicators is

needed.

3. No universal approach to emergency medical

service performance indicators has been

developed so far.

4. Traditional approach to performance

measurement should be questioned.

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5. The right development of indicators is

questioned.

b. Counter argument

1. Example of Addis Ababa shows that a case sensitive

assessment of performance indicators and focus of

change should be developed in individual case can

this be ambulance response time.

III.

Research design and data collection

A.

Study design and protocol:

i. Experimental research design

ii. Collect data for ambulance response times before and after implementation

of training program

B.

Subjects

i. Osh Ambulance description

ii. Dispatchers in that system description and level of education

iii. Ambulance workers - description

C.

Interventions

i.

Training program description

ii.

Tone system - description

D.

Measurements and other observations

E.

Explanation of results and relation to examples from the literature.

V. Conclusion

A. Result supports thesis and importance of topic.

B. Further research in this area is needed.

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Ambulance Response Times in Developing Emergency Health Care Systems

Abstract

Dispatcher training can improve ambulance response times in emergency medical service

(EMS) systems in low income countries. Emergency health care systems are of increasing

concern in international healthcare developments and the global fight against the burdens of

disease. Studies show that emergency health care improvements in developing countries should

focus on ambulance response. Low-cost changes including emergency medical dispatch training

in developing urban emergency health care systems can improve ambulance response times.

Concerns about focusing on ambulance response time as a single indicator are addressed by

showing a case sensitive approach for developing emergency health care systems that in return

can identify ambulance response as main indicator for a particular system. This approach has

been chosen for the subject of study, the Osh Ambulance Service, a municipal EMS in

Kyrgyzstan. This particular service, the implemented research, the study design and, the data

analysis are presented. The data show that there has been a change from an average response time

of 23, 18 minutes to 20, 15 minutes. This data is statistically significant and indicates that the

implemented changes, despite severe challenges, likely have an effect, but it is unclear if this

change will have a large clinical impact. Further research on emergency medical dispatch and

emergency medical response in low- and middle- income countries is encouraged. With increased

opportunities and further globalization emergency health care professionals could play a greater

role in research and development of emergency medical service systems in resource-limited

countries.

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Schmidt 1

Ambulance Response Times in Developing Emergency Health Care Systems

1. Statement of the problem

This research was based on the experience of the authors in emergency medical service

(EMS) development and training in low-income countries. As one would expect, the problems

with ambulance response are many and varied. They range from poor road conditions, lack of

equipment and vehicles, overspecialization of the ambulance units, lack of training for

dispatchers, frequent power outages which limit the radio usage and a limited supply of gasoline

for the ambulances themselves. When thinking about what vast resources are necessary to

address the complex web of problems, the question surfaced; if dispatcher training can improve

ambulance response times in low income countries?

Health care systems in low- and middle income countries need improvement and support

in order to ease the global burden of disease and enable human development. A lot of financial

resources are poring into third world countries in order to accomplish this.

Emergency health care is becoming an important focus in international health care

development. Emergency medical services are seen as a critical component of health care in

developing countries (Kobusingye, 2005). It has been recognized as an important horizontal

approach to improve living conditions, burdens of disease and long-lasting economic effects due

to improved disease adjusted life years (DALYs) in industrialized nations and developing

countries alike (Davis, 2004; Kellermann, 2002). Rather than focusing on a vertical (disease

oriented) approach a horizontal approach like on emergency medical services provides benefits to

the population suffering from various medical conditions.

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Schmidt 2

If we define EMS systems based on experiences from industrialized nations system

development and improvements will fail in the Third World because resources in low- and

middle- income countries (LIMC) are limited and sustainable approaches are needed in order to

develop an emergency health care system with a lasting effect for the population (Kobusingye,

2005).

Changes need to be made that are able to be maintained by the health care system long

after international aid has vanished. Otherwise there are a lot of resources and time that is wasted.

Indeed many people in third world countries still do not have access to proper emergency care

and equipment. This results from a lack of infrastructure and financial resources (Jamison 2006;

Kobusingye 2005).

2. Survey of the literature

How can we improve emergency care in a region with limited resources and maintain a

sustainable approach? Before changes are implemented and further investments are made into

the area of emergency medical services in developing countries it is important to find support for

this approach. Hauswald and Yeoh (1997) have studied this issue and came to the conclusion that

the benefits of an EMS system for a developing country are small if it is based on western

models. The authors support the search for alternative approaches to a North American EMS

model in low- and middle-income countries. Also Kobusingye (2005) concludes that EMS

system development must be carefully designed to the countries needs.

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