Evaluation of the 2014-2016 Droughts on Provision of Prehospital Services in the Kingdom of Swaziland Open Access

Abstract

Background: Swaziland, a country of 1.3 million, experienced severe droughts between 2014-2016. The impact of this drought on provision of emergency medical services (EMS) is unknown. This study aimed to assess the impact of drought on EMS response and utilization in Swaziland.

Methods: We performed a review of emergency calls placed to Swaziland EMS from 1/28/2014 to 7/11/2017. We used a before and after study design with drought (between October 2014 to November 2016) as exposure. The main outcomes were chief complaints and 3 ambulance response time intervals, analyzed using mixed-effects quantile regression (50^th, 70^th, and 90^th percentiles), adjusted for age, sex, and shift, and clustered by administrative region. Chief complaints were aggregated into 10 categories and analyzed as outcomes separately, summarized with Mantel-Haenszel risk ratios, stratified on propensity score quintiles.

Results: We reviewed 136,540 consecutive calls. Median call-to-dispatch, dispatch-to-scene, and scene-to-facility times were 29 minutes, 27 minutes, and 39 minutes, respectively. The 50^th percentile of call-to-dispatch time increased by 13 minutes (95%CI 10-16), 70^th percentile increased by 32 minutes (95%CI 27-37), and 90^th percentile increased by 67 minutes (95%CI 57-78) during the drought. Other response times were unrelated to the drought.

Hypertension-related calls increased during the drought (RR = 1.17; 95%CI: 1.08-1.28). We found a reduction in calls during the drought for GI (RR = 0.97; 95%CI: 0.94-0.99), HIV (RR = 0.84; 95%CI: 0.79-0.89), malnutrition (RR = 0.78; 95%CI: 0.66-0.93), seizure (RR = 0.91; 95%CI: 0.83-0.99), and injury (RR = 0.94; 95%CI: 0.91-0.96) calls. There was no significant association between drought and calls related to respiratory, tuberculosis, diabetes, or obstetric-gynecologic emergencies. There were 2.03 more calls per day (95%CI: 1.92 - 2.14) in the drought period.

Conclusion: Increased number of calls per day and increased delays in call-to-dispatch times with no changes after ambulance dispatch suggest a strain on EMS resources during the drought period. Very small changes in chief complaint categories do not allow for an obvious interpretation.

Table of Contents

1.     Title Page

 

2.     Abstract

 

3.     Thesis

 

4.     Acknowledgements

 

5.     References

 

6.     Tables and Figures

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Health Sciences, General
Keyword	Emergency Medicine Africa Swaziland EMS Emergency Medical Services Drought Prehospital Services
Committee Chair / Thesis Advisor	Pitts, Stephen, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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