Challenges, opportunities, and priorities for tier-1 emergency medical services (EMS) development in low- and middle-income countries: A modified Delphi-based consensus study among the global prehospital consortium

被引：0
作者：
Delaney P.G. [1 ]
De Vos S. [2 ]
Eisner Z.J. [3 ]
Friesen J. [4 ]
Hingi M. [5 ]
Mirza U.J. [6 ]
Kharel R. [7 ]
Moussally J. [8 ]
Smith N. [9 ]
Slingers M. [2 ]
Sun J. [10 ]
Thullah A.H. [11 ]
机构：
[1] 9500 Euclid Ave, Cleveland, OH 44195 USA
来源：
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2025年 / 56卷 / 01期
关键词：
Emergency medicine; Prehospital; Trauma systems; SYSTEMS; RECOMMENDATIONS; COST;
D O I：
10.1016/j.injury.2024.111522
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Introduction: Though the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disabilityadjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally. Methods: A steering committee coordinated a 9-round, modified Delphi-based expert discussion to identify current challenges, opportunities, and priorities in Tier-1 EMS development globally. 11 panelists represented seven Global Prehospital Consortium(GPC) member organizations with a mean 9.57 years of organizational Tier1 EMS development/implementation experience(median = 9 years). The consortium represents the largest collaboration between organizations directing Tier-1 EMS programs globally across 12 countries on 3 continents (Americas, sub-Saharan Africa, and South Asia) with 22,000 first responders. Results: The GPC identified seven priority areas for Tier-1 EMS development: infrastructure/operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/ equipment. A high level of consensus exists regarding priorities for investigation, including Tier-1 responder density/distribution, Tier-1 patient data variable standardization for trauma registries/quality improvement, dispatch technologies/protocols, modular curricula, broader cost-effectiveness and impact evaluation indices capturing secondary impacts of EMS, standardizing legal protections for first responders, and transportation/ equipment standards. Discussion: Consensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts.
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页数：7
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