Emergency Medical Services System Development in Yaoundé, Cameroon Public
Chung, Yunmi (2015)
Abstract
Background: Cameroon is a lower-middle income country in sub-Saharan Africa with poor health indicators compared to other similar income level countries. Health indicators such as life expectancy and years of life lost are greatly affected by infectious diseases and road injuries. Emergency Medical Services (EMS) is important in reducing preventable disabilities and deaths by promptly responding to unexpected illnesses or accidents, yet development of a national EMS system has been minimal in Cameroon. Korea International Cooperation Agency (KOICA) and Cameroon's Ministry of Public Health (MoPH) have recently established the Yaoundé Medico-Surgical Emergency Center (YMSEC) to increase EMS capacity. To inform the integration of YMSEC into Cameroon's EMS system of care, this project aimed to assess the current EMS environment, emergency department (ED) resources, patient demand, and utilization.
Methods: EMS environment was assessed through key informant interviews and resource surveys. Resource surveys and patient demographic and satisfaction (PDS) surveys were conducted at four tertiary level hospital EDs in Yaoundé between June and July 2014. Resource surveys were conducted with twelve hospital employees and PDS surveys were conducted with 103 patients (88.8% response rate). PDS survey data was collected in Epi Info and analyzed using SAS and Excel. Excel was also used to analyze the resource survey. Qualitative data was analyzed using MAXQDA.
Results: Emergency medicine (EM) and emergency care exist and EDs are well established in Yaoundé. Level of available essential emergency medical equipment and resources vary between EDs. Emergency protocols exist but many are outdated or only exist in oral form.No formal EMS system is in place and patients rely almost exclusively on taxis or personal vehicles to get to an ED despite the existence of SAMU and ambulances.
Conclusion: There is potential for Yaoundé to develop a great EMS system as it already has many basic components required for building an effective one. However, existing EM specialists, hospital resources, and communication systems are often underutilized and misused. Additional EM specialists must be trained, funds must be allocated, and legal and regulatory actions must be taken to set up an effective EMS system to reduce preventable morbidity and mortality.
Table of Contents
CHAPTER I. INTRODUCTION 1
1.1 BACKGROUND 1
1.2 PROBLEM STATEMENT 5
1.3 PURPOSE OF THE STUDY 7
Objective 8
Specific Aims 8
1.4 SIGNIFICANCE OF THE STUDY 8
CHAPTER II. LITERATURE REVIEW 10
2.1 INTRODUCTION 10
2.2 EMERGENCY MEDICAL SERVICES 10
2.3 EMS MODELS 11
Franco-German vs. Anglo-American models 11
EMS models by level of pre-hospital care 12
2.4 EMS SYSTEM DEVELOPMENT IN OTHER SUB-SAHARAN AFRICAN COUNTRIES 13
EMS Development in Tanzania 15
EMS Development in Ghana 17
EMS development in South Africa 19
EMS Development in Ethiopia 21
EMS Development in Botswana and Sudan 22
2.5 SUMMARY 23
CHAPTER III. METHODS 25
3.1 STUDY DESIGN 25
Resource Survey 25
Patient Demographic and Satisfaction Survey 27
3.2 DATA ANALYSIS 29
3.3 LIMITATIONS 29
CHAPTER IV. RESULTS 31
4.1 PARTNERSHIP BETWEEN KOICA AND CAMEROON'S MINISTRY OF PUBLIC HEALTH 31
4.2 EMS ENVIRONMENT 33
4.3 HOSPITAL AND ED PERSONNEL CHARACTERISTICS 35
4.4 PRE-HOSPITAL LEVEL EMS RESOURCES 36
4.4a Human Resources 36
4.5 HOSPITAL LEVEL EMS RESOURCES 38
4.5a Human Resources 38
4.5b Emergency Department Facilities 39
4.5c Emergency Care Protocol 39
4.5d Emergency Department Equipment and Supplies 40
4.6 PATIENT SOCIO-DEMOGRAPHIC CHARACTERISTICS 41
4.7 HOSPITAL ED VISIT EXPERIENCE 44
CHAPTER V. DISCUSSION / CONCLUSION 49
DISCUSSION 49
RECOMMENDATIONS 53
CONCLUSION 55
APPENDIX 56
LIST OF ABBREVIATIONS AND DEFINITION OF TERMS 56
APPENDIX A.1. RESOURCE SURVEY AND INFORMATION SHEET (ENGLISH) 58
APPENDIX A.2. RESOURCE SURVEY AND INFORMATION SHEET (FRENCH) 80
APPENDIX B.1. PATIENT DEMOGRAPHIC AND SATISFACTION SURVEY AND INFORMATION SHEET (ENGLISH) 103
APPENDIX B.2. PATIENT DEMOGRAPHIC AND SATISFACTION SURVEY AND INFORMATION SHEET (FRENCH) 110
REFERENCES 117
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