Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan

Abstract

Objectives Strengthened EMS systems are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan – GVK EMRI, Aman Foundation and Rescue 1122 – in order to draw out similarities and differences in their models. Study Design Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan). Methods Qualitative methods – interviews, document review and non-participant observation – were utilized, and using a process of constant comparison, data were analyzed across cases according to the WHO health system ‘building blocks’. Results Emergent themes under each health system ‘building block’ of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified. Conclusions This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings.

Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

“…Interfacility transfer is a specific example of prehospital triage within a system's Infrastructure. Longer transport times have been associated with worse outcomes and occur as a result of poor Infrastructure and lack of robust health systems [13][14][15][16]. In recognition of how difficult it has been for both low-and middle-income countries to formally integrate the prehospital system with hospital level healthcare service delivery and outcomes, calls for action toward important progress in health system strengthening have been made [17][18][19].…”

“Dying due to poverty and lack of easy transport”: A qualitative study on access and availability of pre-hospital emergency medical services in Kampala, Uganda

“…[11] Health systems research for emergency medical systems and pre-hospital care has been frequently centred around governance, policy making and human resource development, however community and provider experiences of service delivery are relatively understudied. [1,2,[20][21][22] Therefore, a top-down approach to policy making and planning of services is more common than a patient-centred approach.…”

“…Emergency care systems in low-and middle-income countries (LMICs) have historically received less than desired attention. [1,2] Low-income countries and poor people in individual countries are particularly at the risk of an inequitable distribution of the burden and adverse outcomes of injuries and other emergencies. [3] Currently 90% of all deaths from road traffic injuries (RTIs) occur in LMICs, with majority of early deaths as a result of pre-hospital delays, unavailability of transport, or inadequate care.…”

Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India

“…Most LMICs, especially in rural settings, lack a centralized and coordinated prehospital system and rather depend on untrained laypersons, commercial drivers, or volunteers to transport patients to healthcare facilities [ 2 ]. Some countries have trained a cadre of emergency medical technicians (EMTs), while others have focused on educating community health workers (CHWs) [ 3 - 5 ]. In some countries such as India, cellular phones are used to provide real-time physician medical direction to the prehospital care providers and thus improve the quality of prehospital emergency care [ 3 - 5 ].…”

“…Some countries have trained a cadre of emergency medical technicians (EMTs), while others have focused on educating community health workers (CHWs) [ 3 - 5 ]. In some countries such as India, cellular phones are used to provide real-time physician medical direction to the prehospital care providers and thus improve the quality of prehospital emergency care [ 3 - 5 ]. In the United States (US) and other nations with robust prehospital care systems, some suggest that online medical direction for prehospital services may be unnecessary and time-consuming while others purport improved clinical outcomes [ 6 - 7 ].…”