PW 1287 Emergency medical services in kampala, uganda: results from piloting a rapid assessment tool

Background The burden of injuries is substantial and growing in Uganda. Although Emergency Medical Services (EMS) has been proven to prevent morbidity and mortality for time-sensitive illnesses and injuries, Uganda lacks a formal EMS system. We assessed existing EMS system in Kampala using a rapid assessment tool. Methods The development of the rapid assessment tool was guided by the WHO’s Health Systems Framework and its six building blocks. We used qualitative methods: document review (16 documents including government and organization level policy documents), observation of ambulance services (7 stations and 11 vehicles), key informant interviews (KIIs) (6 government and 16 EMS organization administrators and 12 EMS personnel). We analyzed interview and observation notes and categorized relevant information by the appropriate building blocks. We used document review for triangulation where appropriate. Results Service delivery: we identified 11 different EMS providers in Kampala with no coordination among them; majority was government run/funded (6); three were charities and 2 private agencies. Health workforce: staffing of ambulance vehicles varied greatly from only driver and patient attendant to driver and nurse or volunteer and driver, nurse and doctor. Information systems: only half of the providers had some type of database and data were collected in logbooks, run sheets or registers. Medical products: Most providers had triage system (2/9); most vehicles had medication cabinet (9/11), oxygen cylinders (8/11), medical supplies (9/11), life saving medications (IV fluids, pain medications and epinephrine) (8/11) and only 2 had advanced equipment. Financing: a fixed salary was the most widely used compensation structure. Governance: There was no formal EMS system and no lead agency for EMS. Conclusion and policy implications The EMS system is fragmented with gaps in all components of the system in Kampala. Focusing on EMS system improvement could improve the outcome of injuries and other time-sensitive conditions.