Dataset Information

Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana.

ABSTRACT: BACKGROUND:Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion. METHODS:Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 and 60 minutes of each of the 128 ambulance stations in Ghana. With network analysis methods, a two-step floating catchment area model was created to identify district-level variability in access. Districts without NAS stations within their catchment areas were identified as candidates for an additional NAS station. Additionally, five candidate stations for capacity expansion (e.g., addition of an ambulance) were then identified through iterative simulations that were designed to identify the stations that had the greatest influence on the access scores of the ten lowest access districts. RESULTS:Following NAS inception, the proportion of Ghana's landmass serviceable within 60 minutes of a station increased from 8.7 to 59.4% from 2004 to 2014, respectively. Over the same time period, the proportion of the population with access to the NAS within 60-minutes increased from 48% to 79%. The two-step floating catchment area model identified considerable variation in district-level access scores, which ranged from 0.05 to 2.43 ambulances per 100,000 persons (median 0.45; interquartile range 0.23-0.63). Seven candidate districts for NAS station addition and five candidate NAS stations for capacity expansion were identified. The addition of one ambulance to each of the five candidate stations improved access scores in the ten lowest access districts by a total 0.22 ambulances per 100,000 persons. CONCLUSIONS:The NAS in Ghana has expanded its population-level spatial access to the majority of the population; however, access inequality exists in both rural and urban areas that can be improved by increasing station capacity or adding additional stations. Geospatial methods to identify access inequities and inform service expansion might serve as a model for other LMICs attempting to understand and improve formal prehospital care services.

SUBMITTER: Tansley G

PROVIDER: S-EPMC5153373 | biostudies-literature | 2016 Nov-Dec

REPOSITORIES: biostudies-literature

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Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana.

Tansley Gavin G Stewart Barclay B Zakariah Ahmed A Boateng Edmund E Achena Christiana C Lewis Daniel D Mock Charles C

Prehospital emergency care 20160413 6

<h4>Background</h4>Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion.<h4>Methods</h4>Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 an ...[more]

PMID: 27074588

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Project description:Introduction This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services. Zakariah A , Stewart BT , Boateng E , Achena C , Tansley G , Mock C . The birth and growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83-93.

Project description:ImportanceConditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known.ObjectivesTo assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana.Design, setting, and participantsPopulation-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014.Main outcomes and measuresAll procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis.ResultsOf 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure-capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440-1418 vs 360; interquartile range, 0-896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2% (uncertainty interval [UI], 82.2%-83.4%) and 71.4% (UI, 64.4%-75.0%), respectively. Five hospitals were identified for targeted capability improvement.Conclusions and relevanceAlmost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.

Project description:ObjectivesTo explore what factors shape a service user's decision to call an emergency ambulance for a 'primary care sensitive' condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.DesignAn ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS 'emergency' telephone call recording.ResultsWe analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine 'triggers', which we categorise as either 'internal' or 'external', depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.ConclusionsPrevious work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems-although inefficient-is often conceptualised as 'rational' by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an 'emergency' situation.

Project description:In the Netherlands prehospital trauma care is provided by emergency medical services (EMS) nurses. This care is extended by Physician staffed Helicopter Emergency Medical Services (P-HEMS) for the more severely injured patient. Prehospital communication is a factor of influence on the identification of these patients and the dispatch of P-HEMS. Though prehospital communication it is often perceived to be incomplete and unstructured. To elucidated factors of influence on prehospital triage and the identification of the severely injured patient a Delphi study was performed.A three round modified Delphi study was designed to explore concepts amongst experts in prehospital trauma care. P-HEMS physicians/nurses, trauma surgeons, EMS nurses and dispatch center operators where asked to state their opinion regarding identification of the poly trauma patient, trauma patient characteristics, prehospital communication and prehospital handover.Seventy-one panellist completed all three rounds. For the first round seven cases and 13 theses were presented. From the answers/argumentation the second round was build, in which 68 theses had to be ranked within four principle themes: factors that influence prehospital communication, critical information for proper handover, factors influencing collaboration and how training/education can influence this. Out of these answers the third survey was build, focussing on determining the exact content of a prehospital trauma handover. The majority of the panellists agreed to a set of parameters resulting in a new model of inter-professional hand over regarding prehospital trauma patients.Exact identification of the poly trauma patient in need of care by P-HEMS is difficult though prehospital communication and the prehospital handover may be improved.The respondents report that prehospital communication needs to be unambiguous to improve trauma care. Consensus was reached on a set of ten parameters that should minimally be handed over with regard to a prehospital trauma patient. This to facilitate prehospital communication between the Dispatch centre, EMS, P-HEMS and the receiving hospital.

Project description:BackgroundBillions of people have faced the problem of accessing appropriate sanitation services. This study aimed to explore the spatial distribution of households' access to sanitation services and identify associated factors in Ethiopia.MethodsThe 2019 Ethiopian Mini Demographic and Health Survey data was used with a total of 6261 weighted samples. A cross-sectional study design with a two-stage cluster sampling technique was used. Global Moran's I statistic measure, Getis-Ord Gi*, and the ordinary Kriging Gaussian interpolation were used for spatial autocorrelation, hot spot analysis, and interpolation of unsampled areas, respectively. A purely spatial Bernoulli-based model was employed to determine the geographical locations of the most likely clusters. A multilevel logistic regression model was used, and predictors with a P value of less than 0.05 with a 95% CI were considered significant factors.ResultsOverall, 19.7% of households had access to improved sanitation services in Ethiopia. Poor sanitation service access was significantly clustered, with hotspots of poor access identified in the South Nations Nationality and People's Region (SNNPR), Oromia, Amhara, and Benishangul Gumuz regions. A total of 275 significant clusters were identified. Households in the circled area were more vulnerable to poor sanitation service access. Rural households, on-premises water access, media exposure, and rich wealth status were statistically significant factors for access to sanitation services.ConclusionsAccess to sanitation services among households in Ethiopia is insufficient. The majority of the households had no access to sanitation services. Stakeholders are recommended to raise household members' awareness of sanitation services, give priority to the hotspot areas, and encourage poor households to have access to toilet facilities. Household members recommended using the available sanitation service and keeping the sanitation service clean. Households are recommended to construct clean shared sanitation facilities.

Dataset Information

Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana.

Publications

Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana.

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