Disaster Medicine - 2017 (The Clinical Medicine Series Book 36)

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Comparing transcripts with audio files and summaries helps in monitoring quality of data.

Open and axial coding helps to conceptualize and label data from KIIS or FGDs that would be subsequently grouped into categories and sub-themes [ 37 ]. Simultaneous data collection and summarization of information helps in identifying the point where saturation is achieved. Based on this approach, the tool was initially validated in Uganda, where a limited PEMS assessment of the Kampala city was conducted, and the results were used to refine the questionnaire and identify solutions to the common logistical barriers during implementation [ 38 ].

Gaps and weaknesses in the infrastructure, resources, or health workforce have been studied previously in LMIC settings, but from an input perspective [ 16 ]. While the WHO health system framework is valuable because of its simplicity, segmented analysis of resources as building blocks without accounting for interaction among inputs may impact understanding of the process and outcomes [ 39 ].

Our proposed approach could overcome this limitation by incorporating quantitative and qualitative measures, triangulating data, and including secondary data spanning over a period of time. In conducting a comprehensive assessment, logistical delays must be kept in mind and could be overcome by pre-implementation planning.

36th International Symposium on Intensive Care and Emergency Medicine

Early engagement with the stakeholders would expedite the approval processes needed for obtaining secondary data and organization of KIIs and FGDs. It is important to note that the tool is designed for a comprehensive system-wide PEMS assessment, not for service delivery monitoring purposes. The tool covers the entire framework of PEMS; therefore, it is possible to deploy the tool for specific parts which are the focus of planning or evaluation of an intervention instead of conducting a comprehensive assessment.

For instance, FGDs highlight the access, financial barriers, responsiveness, and quality of PEMS; document review to observe trends of service delivery and outcome indicators, etc.

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We have demonstrated that such an assessment could be done by local team including public health practitioners, without extensive guidance from international experts. Most of the document reviews and KIIs are conducted through semi-structured questionnaire, and observational study through checklists. FGDs are the only component that requires training and qualitative data analysis skills.

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Given the fact that neither this method is uncommon in LMICs nor underutilized in answering programmatic and operational questions, it is expected that local teams would be able to conduct the assessment successfully. This paper describes a comprehensive EMS assessment tool with a solid health system foundation.


This tool could enable researchers, policy makers, and administrators alike to apply rigorous methods of PEMS assessment and use the information to set up and monitor benchmarks of health outcomes impacted by an organized EMS system. This tool provides a comprehensive health systems framework and at the same time carries the flexibility to focus on different parts of the PEMS where LMICs could focus, set their own benchmarks, and monitor their progress.

Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma Acute Care Surg. Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev.

Understanding barriers to emergency care in low-income countries: view from the front line. Prehosp Disaster Med. Prehospital emergency care. Use of emergency medical services in acute myocardial infarction and subsequent quality of care. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. Gilmore WS.

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Emergencies of pregnancy. Emergency medical services: clinical practice and systems oversight. West Sussex: Wiley; Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. EMS: a practical global guidebook. Factors associated with delays to surgical presentation in North-West Cameroon.

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  8. Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue service in Pakistan. Emerg Med J. Preparedness for mass casualties of road traffic crashes in Uganda: assessing the surge capacity of highway general hospitals. Health Policy Dev. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia.

    Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan. Public Health. Assessing emergency medical care in low income countries: a pilot study from Pakistan. BMC Emerg Med. Emergency medical services and cultural determinants of an emergency in Karachi, Pakistan. Prehosp Emerg Care. Emergency care and health systems: consensus-based recommendations and future research priorities.

    Acad Emerg Med. The state of emergency medical services EMS systems in Africa. Prehospital and disaster medicine. World Health Assembly Resolution Ann Emerg Med. Emergency care capacity in Freetown, Sierra Leone: a service evaluation. Quality indicators for evaluating prehospital emergency care: a scoping review. Developing program performance measures for rural emergency medical services.

    Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels. Assessing trauma care at the district and provincial hospital levels: a case study of hospitals in Kenya. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient. Chicago: 6th ed: Americal College of Surgeons; World Health Organization. Guidelines for essential trauma care. Geneva: World Health Organization; Pre-hospital trauma care systems. Strengthening health systems to provide emergency care.

    Disease control priorities: improving health and reducing poverty. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies.

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    The world health report health systems: improving performance, Report no. Logic models—tools to bridge the theory-research-practice divide. JAMA Pediatr. Building the field of health policy and systems research: an agenda for action.