You are viewing the site in preview mode

Skip to main content

Advertisement

Table 2 Summary of Reviewed articles BMC. Overview of all articles included in the systematic review

From: Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review

First Author and year published Country Study design Population/ Disease studied Type of EMS system Level of training of EMS providers How the community access the EMS system EMS transport vehicles OHEC Barrier Category Specific issues/barriers raised in the article
Cham et al. 2005 [11] Gambia Cross sectional study Interview based qualitative study General obstetrics Hospital based dispatch Not addressed Walk to central location Ambulance Personal cars Culture/community Infrastructure Transport • Lack of knowledge of danger signs • Unfavorable experience with health system • Roads are in poor condition • Facility inappropriate to treat patient • Transportation not available • Ambulance lacked fuel
Kobusingye et al. 2005 [9] Multiple countries Expert review paper Expert review with recommendations General N/A N/A N/A N/A Communication/Coordination Equipment Infrastructure Personnel • Patient access issues • Communication • Equipment • Coordination and management of EMS system • Skilled personnel • Triage prioritization
Thomson 2005 [2] Zimbabwe Cross sectional study Descriptive study of the development of emergency medical services General EMS with paramedics dispatched Layperson First Aid EMT Nurse Call designated number Ambulance Ox-drawn ambulance Communication/Coordination Transport Equipment Personnel • Dispatcher is not available or has variable level of training • Ambulances travel very long distance to respond to emergencies • Ambulances are not well equipped to respond to emergencies • Providers lacked formal prehospital training
Ali et al. 2006 [35] Pakistan Cross sectional study Retrospective data analysis + Interviews of key personnel and survey of community members General Physician respond First Aid Physician Call designated number Ambulance Infrastructure Equipment Personnel • Challenge with road navigation • Lack of equipment • Providers lacked formal prehospital training
Kawuwa et al. 2007 [12] Nigeria Cross sectional study Semi-structured interviews of community representatives Obstetric complications None Layperson None Ambulance Other non-ambulance vehicles (bikes, buses, motorbike, etc.) Culture/Community Infrastructure Transport • Lack of knowledge of danger signs • Preference of traditional/spiritual therapies • Women rely on husband to seek care • Community perception of care facility influence whether to seek care • Poor road conditions especially during rainy season • Unreliable transportation
Hofman et al. 2008 [13] Malawi Evaluation/Report Observational study after new intervention was implemented Obstetrics Hospital based dispatch Community health workers Walk to central location Motocycle ambulance, Ambulance Private vehicles, Bicycles, Motorcycle Infrastructure Communicaton/Coordination Transport • Poor road conditions especially during rainy season • Lack of means to directly communicate with local hospital • Reliance on alternative means of transportation • Long transport time
Siddiqui et al. 2008 [14] Pakistan Cross sectional study Survey conducted of patients with stroke at one hospital Adult stroke Not mentioned Not mentioned Not mentioned Ambulance Culture/Community Infrastructure Transport Personnel • Lack of knowledge of danger signs • Facility inappropriate to teat patient • Lack of effective ambulance services • Doctors to training to be able refer patients appropriately
Jayaraman et al. 2009 [29] Uganda Cross sectional study Survey conducted of prehospital providers: police officers, minibus taxi drivers, and local council officials. General trauma No system Layperson First aid None Personal car Taxi cars Personnel Equipment • First responders lack training • Lack of first aid equipment
Macharia et al. 2009 [36] Kenya Cross sectional study Survey of patients and health personnel at 53 hospitals General trauma Not mentioned Layperson Not mentioned Ambulance Personal car Personnel • Lack of trained emergency responders
Khan et al. 2010 [33] Pakistan Cross sectional study Retrospective analysis of data from one hospital’s trauma database General trauma None Layperson None Personal means Infrastructure Personnel • Facility inappropriate to treat patient • Lack of trained personnel in the prehospital setting
Mahmood et al. 2010 [32] Pakistan Cross sectional study Descriptive study based on observation of patients interaction with EMS General EMS with paramedics dispatched EMT Call designated number Ambulance Infrastructure Personnel Equipment • Traffic congestion • Emergency responders lack training • Lack of equipment (spine board, burn and airway kit)
Roy et al. 2010 [15] India Cross sectional study Semi-structured interview of admitted patients or informants General trauma None Layperson None Ambulance Taxi cars Police Vans Infrastructure Communication/Coordination Transport Equipment Personnel • Facility inappropriate to treat patient • Lack of coordination of emergency responders • Transport done primarily using non-ambulance vehicle • Long transport distance • Ambulance lack resuscitation equipment • Emergency responders use inappropriate treatment in the prehospital setting
Essendi,et al. 2011 [21] Kenya Qualitative Interview based qualitative study General obstetrics Not mentioned Not mentioned Not mentioned Not mentioned Culture/Community Infrastructure Transport • Lack of knowledge on danger signs • Preference to see TBA over going to health center • Woman rely on husband or other family member to seek care • Poor road condition • Insecurity at night • Facility inappropriate to treat patient • Lack of availability of ambulance • To use ambulance patient must first provide fuel
Jammeh et al. 2011 [3] Gambia Cross sectional study Interview based qualitative study Obstetrics emergencies Not mentioned Layperson None Donkey Bike Culture/Community Infrastructure Transport • Lack of knowledge on danger signs • Women lack autonomy • Poor road conditions especially in rainy season • Transportation mode inconvenient for laboring woman • Long transport time • Lack of availability of ambulance
Wen et al. 2011 [28] Rwanda Cross sectional study Descriptive study based on observations and Interviews General Not mentioned Not mentioned None Ambulance Personal car Taxi cars Taxi motobikes Hired individual cars Infrastructure Communication/Coordination Transport Personnel • Facility inappropriate to treat patient • No prehospital triage • No prehospital care and coordination of services • Few ambulances available • Ambulance used infrequently • Lack of trained providers
Adewole et al. 2012 [22] Nigeria Longitudinal study Retrospective analysis of data on ambulance services General EMS with paramedics dispatched First aid Nurse Call designated number Ambulance Culture/Community Infrastructure Transport • Uncooperative motorist refusing to yield to the ambulance • Harassment by social miscreants • Poor road conditions • High traffic density restricted transport • Long transport distance
Cannoodt et al. 2012 [19] Multiple countries  Systematic review A review of published evidence published in PubMed General Not mentioned Not mentioned Not mentioned Not mentioned Culture/Community Infrastructure Communication/Coordination Transport Equipment Personnel • Woman relies a males relative for permission • Preference of traditional approach • Lack of knowledge on danger signs • Poor road conditions • Inability to triage patients • Long transport distance • Lack of transportation • Ambulance not available • Lack of equipment • Shortage or lack of training of emergency responders
Nicks et al. 2012 [25] Tanzania Evaluation/Report A descriptive overview of the EMS General Hospital based dispatch Layperson First aid Not mentioned Ambulance Infrastructure Communication/Coordination Equipment Personnel • Poor road conditions • Limited communication between responding team and hospital • Ambulance poorly equipped • No formal training for prehospital providers
Nielsen et al. 2012 [26] Multiple countries Cross sectional study Survey conducted of EMS leaders in 13 LMIC in Africa General Many different systems Layperson First Aid EMT Nurse Physician Assistant Physician Call designated number Ambulance Personal car Rickshaw Communication/Coordination Personnel Transport • Emergency responders communicated with receiving facility part of the time • Lack of uniform dispatch number • Lack of formal training for emergency responders • Transportation using alternative means
Bhopal et al. 2013 [16] Sierra Leone Evaluation/report Semi-structured interview based qualitative study and thematic analysis + Retrospective analysis data from health office records Obstetric emergencies Hospital based dispatch Layperson Walk to central location Motorbike ambulance Culture/Community Infrastructure Communication/Coordination • Lack of knowledge on danger sign • Roads in poor condition • No triaging system
Germa et al. 2013 [37] Ethiopia Expert review A historical overview of the development of emergency medicine in Addis Ababa, General Private EMS system First aid Call designated number Ambulance Patient means (non-ambulance vehicles) Communication/Coordination Equipment Personnel • Lacks a coordinated EMS • Patients are not triaged • Emergency responders don’t communicate with receiving hospital • No coordinated response between emergency responders • Lack of a uniform dispatch number • Ambulance are poorly equipped • Lack of standardized training • Lack of training for emergency responders, physicians and nurses
Joshi et al. 2013 [27] India Evaluation/ report Expert review with recommendations General EMS with paramedics dispatched Not mentioned Call designated number Ambulance Communication/Coordination Personnel • Lack of centralized call center to coordinate emergency response • Emergency responder training not standardized
Radjou et al. 2013 [17] India Prospective study Descriptive study of Prehospital care of trauma fatalities Adult trauma Not mentioned Not mentioned Not mentioned Ambulance Infrastructure Communication/Coordination Transport Personnel • Facility inappropriate to teat patient • Lack of coordination between emergency responders and hospital • Long transport times • Emergency responders lack knowledge of appropriate prehospital care • Emergency responders lack awareness of trauma centers
Tayler-Smith et al. 2013 [4] Burundi Cross sectional study Retrospective analysis of data on ambulance records, patient registers and logistics records General obstetrics EMS with paramedics dispatched Hospital based dispatch Nurse Call designated number Ambulance Communication/Coordination Transport • Need better coordination between dispatcher and ambulance crew • Long transfer times
Wilson et al. 2013 [8] Multiple countries  Systematic review Systematic review in 10 databases General obstetrics Not mentioned Not mentioned Not mentioned Taxi cars Taxi motobikes Hired individual cars Culture/Community Infrastructure Transport • Women lack autonomy • Using emergency may summon evil or bad luck • Poor road conditions especially in rainy season • Long wait times and long transport times
Butrick et al. 2014 [34] Zambia Cross sectional study Retrospective analysis of data from a randomized cluster trial Obstetric emergency EMS with paramedics dispatched Nurse Call designated number Ambulance Personnel • Providers lack training to recognize danger signs
Echoka 2014 [23] Kenya Cross sectional study Interview based qualitative study and thematic analysis of data from women that experienced obstetric complications Obstetric emergency Hospital based dispatch Nurse Physician Walk to central location Ambulance Hired car Culture/Community Infrastructure Transport Coordination/Communication • Lack of knowledge on danger signs • Facility inappropriate to treat patient • Road in poor condition • Lack of availability of ambulance
Sidney et al. 2014 [30] India Cross sectional study Survey taken of women at qualifying health facilities Obstetrics EMS with paramedics dispatched Not mentioned Call designated number Ambulance Personal car Hired car Culture/Community Infrastructure Transport • Lack of attendant to accompany patient to the hospital • Poor road condition • Transportation delays • Use of alternative means of transportation • Lack of availability of ambulance • Long transport times
Elbashir et al. 2015 [24] Sudan Cross sectional study Qualitative descriptive study based on data from Ministry of Health, internet, interviews and empirical observations General EMS with paramedics dispatched First aid Call designated number Ambulance Personal car Taxi cars Communication/Coordination Transport Personnel • Emergency response number not well publicized • Lack of structures to help coordinate response to correct location • Long response times • Roads in poor condition • Lack of availability of ambulance • No training for EMS providers or dispatchers
Wesson et al. 2015 [18] Kenya Cross sectional study Interview based qualitative study with data from of key informants and focus groups Adult trauma Hospital based dispatch Layperson First aid Call designated number Ambulance Personal car Taxi cars Culture/Community Communication/Coordination Personnel Transport • Preference of traditional or religious alternatives • No central dispatcher • Poor coordination of the emergency response • Community not aware of emergency number • Emergency number thought by some as not functional • Ambulance unreliable • Lack of trained first responders
Kumar et al. 2009 [52] India Cross sectional study Qualitative descriptive study based on observations and structured questionnaire of one participant General Hospital based dispatch Not mentioned Not mentioned Ambulance No EMS system exists • Skilled personnel