Coyle Rachel M, Harrison Hooi-Ling
Department of Primary Care and Public Health, King's College, London, England, SE1 3QD, UK.
King's Sierra Leone Partnership, King's Centre for Global Health, Weston Education Centre, London, England, SE5 9RJ, UK.
BMC Emerg Med. 2015 Feb 3;15(1):2. doi: 10.1186/s12873-015-0027-4.
There is an increasing global recognition of the role of emergency medical services in improving population health. Emergency medical services remain underdeveloped in many low income countries, particularly in sub-Saharan Africa. There have been no previous evaluations of specialist emergency and critical care services in Sierra Leone.
Emergency care capacity was evaluated at a sample of seven public and private hospitals in Freetown, the capital of Sierra Leone. A structured set of minimum standards necessary to deliver emergency and critical care in the low-income setting was used to evaluate capacity. The key dimensions of capacity evaluated were infrastructure, human resources, drug and equipment availability, training, systems, guidelines and diagnostics. A score for each dimension of capacity was calculated based on the availability of a list of specified indicators within each dimension. In addition, an Emergency Care Capacity Score was calculated to demonstrate a composite measure of capacity based on the various indicator scores. This method has been used by the World Health Organisation in evaluating the availability and readiness of healthcare systems in low- and middle-income countries.
Substantial deficiencies in capacity were demonstrated across the range of indicators and predominantly affecting publically funded facilities. Capacity was weakest in the domain of infrastructure, with an average score of 43%, while the strongest areas of capacity overall were in drug availability, 82%, and human resources, 79%. A marked disparity was noted between public and private healthcare facilities with consistently lower capacity in the former. The overall Emergency Care Capacity Score was 66%.
There are substantial deficiencies in emergency care systems in public hospitals in Freetown which are likely to compromise effective care. This represents a serious barrier to access to emergency healthcare. Emergency care systems have an important role in improving population health and as such should a priority for local policy makers.
全球越来越认识到紧急医疗服务在改善人群健康方面的作用。在许多低收入国家，尤其是撒哈拉以南非洲地区，紧急医疗服务仍不发达。此前尚未对塞拉利昂的专科急诊和重症监护服务进行过评估。
在塞拉利昂首都弗里敦的7家公立和私立医院抽样评估急诊护理能力。使用一套在低收入环境下提供急诊和重症护理所需的结构化最低标准来评估能力。评估的能力关键维度包括基础设施、人力资源、药品和设备供应、培训、系统、指南和诊断。根据每个维度内指定指标清单的可得性计算每个能力维度的得分。此外，计算了一个急诊护理能力得分，以根据各种指标得分展示能力的综合衡量。世界卫生组织已使用这种方法评估低收入和中等收入国家医疗系统的可得性和准备情况。
各项指标均显示出能力存在重大缺陷，且主要影响公共资助的设施。基础设施领域的能力最弱，平均得分为43%，而总体上能力最强的领域是药品供应，为82%，以及人力资源，为79%。公立和私立医疗机构之间存在明显差距，前者的能力一直较低。急诊护理能力总得分是66%。
弗里敦公立医院的急诊护理系统存在重大缺陷，这可能会影响有效护理。这是获得紧急医疗服务的严重障碍。急诊护理系统在改善人群健康方面具有重要作用，因此应成为地方政策制定者的优先事项。
