Prehospital and Emergency Care

Disease or illness can strike at any time. If the condition is acute, or if the injury is life-threatening or limbthreatening, immediate care is needed. These timedependent conditions that affect both adults and children may be due to medical, surgical, or obstetric conditions. They may result from acute injuries or illnesses or from exacerbations of chronic disease. In lowand middle-income countries (LMICs), patients with such conditions may face delays of hours or even days before reaching the nearest medical facility or provider. Transportation may be provided by ambulance, but more often it is provided by laypersons using the handiest mode of transport available (Arellano, Mello, and Clark 2010; Khorasani-Zavareh and others 2009; Nguyen and others 2008; Ramanujam and Aschkenasy 2007). Health care before arrival at heath facilities may be provided by trained paramedics or by laypersons; quite often, however, no health care is provided (Bavonratanavech 2003; Khorasani-Zavareh and others 2009; Nguyen and others 2008; Solagberu and others 2009). In contrast to systems in high-income countries (HICs), the prehospital and emergency medical systems of LMICs are often rudimentary. Justifiably, health systems in LMICs have focused on increasing access to health care by building facility-based health care systems. Such thinking is abetted by a perception that the provision of prehospital and emergency care is not cost-effective in LMICs (Kobusingye and others 2005), leading to policies that allocate the bulk of scarce health care resources elsewhere. This chapter identifies the scale of the challenge by presenting data on the burden of disease that prehospital and emergency care systems in LMICs could potentially address. It then describes the common health care delivery structures in these countries and assesses the literature on costs and effectiveness of such mechanisms. It closes with a discussion of future directions in research and policy.