Pre-Hospital and Emergency Care

Life-threatening or limb-threatening conditions requiring immediate care face significant delays in reaching medical care in low- and middle-income countries (LMICs). Communicable and maternal conditions, chronic conditions, and injuries (both intentional and unintentional) cause 24.3 million deaths in LMICs and translate into a staggering 1,023 million DALYs (disability-adjusted life years). Prehospital care encompasses first responder care provided by the community—from the scene of injury, home, school, or other location—until the patient arrives at a formal health care facility – and paramedical care such as paid ambulance personnel or fire or police personnel. In most of East Asia and the Pacific, South Asia, and Sub-Saharan Africa, commercial ambulances may not be available, and transport options mean private motorized or nonmotorized vehicles. Training of community paramedics and first responders remains a challenge as illustrated by experiences in Iraq and Cambodia. The wide availability of cellular phones has revolutionized both the availability and the cost of communications for prehospital emergency care system.