Patient's Mode of Transportation Presented in the Emergency Department of a Tertiary Care Centre, Kavre, Nepal.

Background In many developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected. It is the major obstacle for provision of timely care. Patients are regularly brought to emergency department by the relatives in taxis, bus or other readily available mode of transportation that lacks emergency medical services. Development the Nepal Ambulance Service established its first proper ambulance service in Nepal in 2011 and Dhulikhel Emergency Medical Services in 2013 at Dhulikhel Hospital, Kathmandu University Hospital. Proper prehospital emergence medical service can improve survival rates. Objective To determine the mode of transportation used by patients to arrive at the emergency department and effectiveness of medical services specific to Dhulikhel Hospital, Kavre, Nepal. Method In this study, 160 patients who arrived to emergency department during one-month period were included. The emergency physicians and paramedics collected data on a predesigned questionnaire regarding demographic details, mode of transport used by the patients to arrive emergency department, reason for not using ambulance, knowledge on emergency medical services at Dhulikhel Hospital and their acceptability for those services. Result Mean age of the patients was 46±18 years and (52%) were men. Out of them, only 31% arrived to the emergency department by ambulance while the rest other patients used other forms of transport such as private vehicles (21%), bus (16%), taxi (13%), motorbike (11%) and van (7%). Among 50 patients who used ambulance, 24% of the patients who used Dhulikhel Hospital ambulance received medical care and trained medical staff services; all patients were satisfied with the services. 155 out of 160 patients mentioned the need of a trained medical personal in ambulance. The mean duration for waiting time for ambulance was 33.78 minutes. The main reasons to not using ambulance were they did not know the ambulance number, ability to find other vehicles easily and having own private vehicle. Conclusion A prominent proportion of patients did not arrive by ambulance to the emergency department and the main reason was that they didn't know the number of ambulance service. Developing three-digit phone number for ambulance service at the local level will make people easier to remember and contact. Similarly, education and training must be developed to improve emergency medical services. These strategies along with team management of patients could significantly improve patient care in Nepal.