Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA 98104, USA.
Prehosp Emerg Care. 2012 Jul-Sep;16(3):381-9. doi: 10.3109/10903127.2012.664245. Epub 2012 Apr 10.
Injury and other medical emergencies are becoming increasingly common in low- and middle-income countries (LMICs). Many to most of the deaths from these conditions occur outside of hospitals, necessitating the development of prehospital care. Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most LMICs.
In order to better plan for development of prehospital care globally, this study sought to better understand the current status of prehospital care in a wide range of LMICs.
A survey was conducted of emergency medical services (EMS) leaders and other key informants in 13 LMICs in Africa, Asia, and Latin America. Questions addressed methods of transport to hospital, training and certification of EMS providers, organization and funding of EMS systems, public access to prehospital care, and barriers to EMS development.
Prehospital care capabilities varied significantly, but in general were less developed in low-income countries and in rural areas, where utilization of formal EMS was often very low. Commercial drivers, volunteers, and other bystanders provided a large proportion of prehospital transport and occasionally also provided first aid in many locations. Although taxes and mandatory motor vehicle insurance provided supplemental funds to EMS in 85% of the countries, the most frequently cited barriers to further development of prehospital care was inadequate funding (36% of barriers cited). The next most commonly cited barriers were lack of leadership within the system (18%) and lack of legislation setting standards (18%).
Expansion of prehospital care to currently underserved or unserved areas, especially in low-income countries and in rural areas, could make use of the already-existing networks of first responders, such as commercial drivers and laypersons. Efforts to increase their effectiveness, such as more widespread first-aid training, and better encompassing their efforts within formal EMS, are warranted. In terms of existing formal EMS, there is a need for increased and more regular funding, integration and coordination among existing services, and improved organization and leadership, as could be accomplished by making EMS administration and leadership a more desirable career path.
在中低收入国家（LMICs），伤害和其他医疗急症越来越常见。这些情况下的大多数死亡发生在医院之外，因此需要发展院前护理。大多数 LMICs 的院前能力都不足以满足对紧急护理日益增长的需求。
为了更好地规划全球院前护理的发展，本研究旨在更好地了解广泛的 LMICs 中院前护理的现状。
对非洲、亚洲和拉丁美洲 13 个 LMIC 的紧急医疗服务（EMS）领导者和其他主要信息提供者进行了调查。问题涉及到运往医院的方法、EMS 提供者的培训和认证、EMS 系统的组织和资金、公众获得院前护理的途径以及 EMS 发展的障碍。
院前护理能力差异很大，但总体而言，低收入国家和农村地区的能力较差，在这些地区，正规 EMS 的使用率通常非常低。在许多地方，商业司机、志愿者和其他旁观者提供了大部分院前运输服务，偶尔还提供急救。尽管 85%的国家的税收和强制性机动车保险为 EMS 提供了补充资金，但进一步发展院前护理的最常见障碍是资金不足（36%的障碍）。其次最常被引用的障碍是系统内部缺乏领导力（18%）和缺乏设定标准的立法（18%）。
将院前护理扩展到目前服务不足或未服务的地区，特别是在低收入国家和农村地区，可以利用现有的急救人员网络，如商业司机和非专业人员。值得努力提高他们的效率，例如更广泛的急救培训，并更好地将他们的努力纳入正规 EMS。就现有的正规 EMS 而言，需要增加和更定期的资金，整合和协调现有服务，并改善组织和领导，通过使 EMS 管理和领导成为更理想的职业道路来实现这一目标。
