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