A Comprehensive Review of the Emergency Medical Services System in Kenya Open Access

Abstract

Background: Kenya, a low-income country, is disproportionately affected by a high burden of morbidity and mortality from emergencies, trauma and road traffic injuries. It has been deemed one of ten countries that accounts for 50% of the world's traffic accidents. Studies have shown that even rudimentary Emergency Medical Services (EMS) can alleviate significant death and disability from emergencies. Currently, Kenya's EMS is fragmented and lacks standards and coordination. Furthermore, there has been no research specifically on EMS or pre-hospital care in Kenya, and no baseline assessment to comprehensively describe its current status.

Methods: A qualitative research study was conducted with in depth key informant interviews. Snowball sampling was used to identify interviewees, and data collection ended when saturation was reached. A total of 17 interviews were conducted in Nairobi, Kenya that lasted an average of two and a half hours each. Transcribed interviews were coded and analyzed using a qualitative and mixed methods data software called Dedoose. Key themes were identified and summarized.

Results: Seven main themes regarding the development of EMS emerged from the analysis: 1) Burden of Emergencies and Trauma in Kenya, 2) Accident Prevention, 3) EMS Policy and Funding, 4) EMS Communications Systems Capacity, 5) Ambulance and Transport Services Capacity, 6) Training and Curriculum for EMS Providers, and 7) Research, Data Collection and Sharing in the Pre-Hospital Environment. Each topic was divided into background information, insights provided by the interviewees, and recommendations specific to the topic. Results were put into context of the Kenyan setting and WHO expert guidelines.

Conclusion: This study brought together people from all aspects of the Kenyan health sector, with a common goal of developing EMS in a coordinated and sustainable manner. The use of qualitative research added a rich depth of quality, as it truly represents the voices of those who have dedicated years of work into emergency response and the pre- hospital care system. As Kenya utilizes the results and recommendations from this study, and continues to progress with coordination and effort, their EMS has the potential to become one of the most robust systems in all of Africa.

Table of Contents

List of Abbreviations and Definition of Terms ........................................................... 1

Chapter 1: Introduction ........................................................................................ 2

Introduction and Rationale .................................................................................... 2

Background ........................................................................................................ 2

Expert Guidelines for EMS Development .................................................................. 3

History of EMS in Kenya.........................................................................................4

Identified Categories of EMS Development.................................................................5

Ramifications, Social, and Economic Costs of the Problem .......................................... 6

Significance for Public Health................................................................................. 6

Problem Statement .............................................................................................. 7

Purpose Statement .............................................................................................. 9

Project Objective: ............................................................................................... 10

Specific Project Aims: ......................................................................................... 10

Significance Statement ........................................................................................ 10

Chapter 2: Literature Review ................................................................................ 12

Introduction to Literature Review ........................................................................... 12

EMS in Kenya ..................................................................................................... 12

EMS in Specific Low and Middle Income Countries (LMIC) ........................................... 14

EMS Development in Developing Countries .............................................................. 17

Summary .......................................................................................................... 24

Chapter 3: Methods.............................................................................................. 26

Introduction ....................................................................................................... 26

Population and Sample......................................................................................... 26

Study Site.......................................................................................................... 27

Rationale for Population Selection........................................................................... 28

Ethical Considerations........................................................................................... 28

Instruments ....................................................................................................... 29

Data Collection ................................................................................................... 30

Data Analysis ..................................................................................................... 31

Chapter 4: Results and Recommendations................................................................ 32

Introduction ....................................................................................................... 32

Demographics..................................................................................................... 32

Burden of Emergencies and Trauma........................................................................ 33

Background ....................................................................................................... 33

Results from Key Informant Interviews.................................................................... 34

Recommendations ............................................................................................... 35

Accident Prevention ............................................................................................. 36

Background ........................................................................................................ 36

Results from Key Informant Interviews.................................................................... 36

Recommendations ............................................................................................... 38

EMS Policy and Funding ........................................................................................ 38

Background ........................................................................................................ 38

Results from Key Informant Interviews.................................................................... 40

Recommendations ............................................................................................... 43

EMS Communications Systems Capacity .................................................................. 44

Background ........................................................................................................ 44

Results from Key Informant Interviews..................................................................... 44

Recommendations ................................................................................................ 52

Ambulance and Transport Services Capacity ............................................................. 53

Background ........................................................................................................ 53

Results from Key Informant Interviews..................................................................... 54

Recommendations ................................................................................................ 61

Training and Curriculum for EMS Providers ............................................................... 62

Background ......................................................................................................... 62

Results from Key Informant Interviews..................................................................... 64

Recommendations ................................................................................................ 69

Research, Data Collection and Sharing for EMS .......................................................... 69

Background ......................................................................................................... 69

Results from Key Informant Interviews..................................................................... 70

Recommendations ................................................................................................ 72

Chapter 5: Discussion and Conclusion....................................................................... 73

Introduction ........................................................................................................ 73

Discussion of Findings ........................................................................................... 73

Significance......................................................................................................... 76

Limitations........................................................................................................... 77

Recommendations for Further Research .................................................................... 79

Conclusion............................................................................................................ 79

References .......................................................................................................... 80

Appendix.............................................................................................................. 84

Research Tool ....................................................................................................... 84

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Health Care Management
Keyword	EMS Kenya Emergency Development Emergency Medical Services Kenya EMS Development of EMS in low and middle income countries EMS in Developing Countries Kenya
Committee Chair / Thesis Advisor	Martel, Lise D., Emory University
Committee Members	Brachman, Philip S, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Non-US governmental agency (e.g., Minister of Health in Haiti) CDC

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