Zakariah Ahmed N, Boateng Edmund, Achena Christiana, Ansong-Bridjan Foster, Mock Charles
National Ambulance Service, Ministry of Health, Accra, Ghana.
Department of Surgery, University of Washington, Seattle, WA, USA.
Afr J Emerg Med. 2024 Sep;14(3):172-178. doi: 10.1016/j.afjem.2024.06.008. Epub 2024 Jul 5.
Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas.
Data routinely collected by NAS from 2004 to 2023 were analyzed, including structure and capacity (number of stations, ambulances, employees) and utilization and process of care (number of patients served, demographics, medical conditions, response site). Per population indicators of capacity and utilization were compared across Ghana's 16 regions.
From 64 emergency medical technicians (EMTs) and nine ambulances in 2004, NAS has grown to 3,473 EMTs and 356 ambulances. From covering three cities in 2004, NAS now has at least one station in each of Ghana's 261 districts. From transporting 205 patients in 2004, NAS transported 38,393 patients in 2022. There have been interruptions due to financial restrictions, with numbers of patients transported per year in 2017-2019 decreasing by over 50% from the prior peak ( = 20,236 in 2014). In 2022, there were 1.13 ambulances per 100,000 people and 0.33 transports/100,000/day. Most (81.3%) transports are inter-facility transfers. Among Ghana's 16 regions, there is moderate variation in utilization from 0.16 to 0.50 transports/100,000/day. However, the three lowest-income, remoter regions currently have utilizations of 0.16, 0.30, and 0.37 transports/100,000/day, mostly near the National average of 0.33.
Despite periodic limitations due to finances, the NAS has expanded to cover all of Ghana's 261 districts and has largely achieved geographic equity. Sustainability has been aided by having a training school directly under NAS's control, assuring a steady supply of EMTs. Challenges include assuring financial stability and increasing utilization for emergencies at the scene, in addition to the current high utilization for inter-facility transfer.
许多非洲国家的紧急医疗服务（EMS）发展极为有限。我们试图记录加纳国家救护服务局（NAS）在其20年全国范围扩张过程中取得的成就和面临的挑战，并了解其为以前未得到服务的偏远地区提供服务的情况。
对NAS在2004年至2023年期间定期收集的数据进行分析，包括结构和能力（站点数量、救护车数量、员工数量）以及服务利用和护理过程（服务的患者数量、人口统计学、医疗状况、响应地点）。比较了加纳16个地区按人口计算的能力和利用指标。
NAS从2004年的64名急救医疗技术员（EMT）和9辆救护车发展到2023年的3473名EMT和356辆救护车。从2004年覆盖3个城市，到如今NAS在加纳的261个区每个区至少设有一个站点。NAS在2004年运送205名患者，到2022年运送了38393名患者。由于财政限制出现过中断情况，2017 - 2019年每年运送的患者数量比之前的峰值（2014年为20236例）减少了50%以上。2022年，每10万人中有1.13辆救护车，每天每10万人中有0.33次转运。大多数（81.3%）转运是机构间转运。在加纳的16个地区中，利用率在每天每10万人0.16次至0.50次转运之间存在适度差异。然而，三个收入最低的偏远地区目前的利用率分别为每天每10万人0.16次、0.30次和0.37次转运，大多接近全国平均水平0.33次。
尽管因财政问题存在周期性限制，但NAS已扩展到覆盖加纳所有261个区，并在很大程度上实现了地理公平。由NAS直接控制的一所培训学校有助于实现可持续性，确保了EMT的稳定供应。挑战包括确保财政稳定以及增加现场紧急情况的利用率，此外目前机构间转运的利用率较高。
