Unique access measures categorised by type and delays in care
| Availability N=40 | Accessibility N=19 | Accommodation N=42 | Affordability N=17 | Acceptability N=19 | |
| Seeking N=22 | N=2 | N=3 | N=5 | N=1 | N=11 |
| Presence of community (lay) responders (62) | Patient access to a telephone (6, 11, 63) | Ability to get through on phone lines on first attempt (6) | Inability to miss work/secondary to cost (10) | Acceptability of EU care: by sex (21); by education level (23); age (23, 47); economic/financial status (53); social status (13); insurance (13); appearance (13); ethnicity (60); religion (60, 72), proximity to health facility (53) | |
| Presence of dispatchers (68) | Presence of a national universal toll-free emergency no (6, 9, 10, 13, 14, 28, 43, 62, 71) | Concerns over personal safety in seeking care (25) | Awareness of emergency care systems and services (5, 11, 52, 61) | ||
| Median time from onset of patient symptoms to contact with provider (13, 57) | Patients and families responsible for arranging their transportation to the higher-level facility (14) | Community accepts and uses EMS care (62) | |||
| Presence of adequate child care (10) | Fear of emergency dental treatment (47) | ||||
| Required paperwork filled out before emergency care (13) | Knowledge of emergency no (22, 27, 52, 57, 72) | ||||
| Knowledge of where the closest EU facility is located (52) | |||||
| Personally knew a healthcare provider (13, 60) | |||||
| Preference of traditional methods of care (eg, bonesetters) over EU care (5, 8) | |||||
| Social and family disapproval (53) | |||||
| Understanding of how to navigate emergency care systems: general (6, 14, 23, 59) | |||||
| Understanding of what qualifies as an emergency condition/perception that condition is severe enough to seek care (8, 17, 23, 52, 53, 72) | |||||
| Reaching N=46 | N=9 | N=13 | N=12 | N=8 | N=4 |
| Basic building (ie, structural) resources specific and purpose built to emergency care (26) | Dispatcher training provided (6) | EMS delays: general (25); due to referrals (59) | Ambulance fee (27, 64) | Ambulances acceptable based on: language (63), if police involved/transport (63), slow response time (52) | |
| EU radio/communication devices available for EMS handoff (30) | Geography limits access: rural locations (1); mountainous terrain (10) | Existence of a coordinated emergency response system (9, 28, 43, 71, 72) | Ambulance fee by ambulance-type (52) | Patient preference of ambulance care over other forms of transport (52) | |
| Fuel available for ambulances (14) | Calculated accessibility by 2SFCA method (24) | Equitable (plan for) distribution of ambulance stations (63) | Ambulance referral fee (27) | Prehospital care acceptable to: those taking government ambulance (56), those taking taxis (56), road traffic accident victims (56), those being transferred for medicolegal reasons (56) | |
| Fuel for general (non-ambulance) transport (14) | Per cent of patients who sought care or made it to a facility within 60 min of onset of symptoms (59) | Facilities are notified in advance of patients arriving (15) | Cost of transport (11, 14, 17, 19, 22, 47, 72) | Previous ambulance use and willingness to use ambulances in the future (63) | |
| Presence of any healthcare facility (14) | Response time from initial call to scene (3, 7, 14, 22, 35, 63, 70) | General maintenance issues with vehicles (11) | Payment required before treatment (34) | ||
| Presence and no of ambulances for interfacility transport (20) | Roadways limits access: traffic (1); poor or narrow roads (11, 14, 20, 52) | No of separate modes of transportation (per patient) to reach care at facility (20) | Preauthorisation fee (64) | ||
| Presence and no of ambulances with basic life support capabilities (46) | System to access EC from trained first responders and the scene and urgent transport to a health facility (49) | Patients taken to the police station before taking them to the hospital (13, 14) | Fees are equitable (64) | ||
| Presence and no of ambulances without medical capabilities/transport only (52) | Transport time from a location to a facility with specific EU capabilities (ie, PCI-capable hospital, trauma centre, obstetric emergencies, tertiary hospital; 36, 45, 48, 55) | Per cent of missed or prolonged pick-ups due to prehospital provider misunderstanding of location (6) | Private vehicle transport fees (27) | ||
| Presence and no of helicopters for transport (68) | Transport time from home to hospital (2, 36, 46, 48, 51, 54) | Presence of drivers willing to respond to patient request (11) | |||
| Transport time from scene to hospital (13, 29, 33, 35, 74) | Private ambulance services control rooms linked to cellular networks (68) | ||||
| Travel distance (5, 13, 14, 21, 20, 22, 27, 32, 51, 57, 59, 66, 71, 72) | Regulations governing EMS (43) | ||||
| Travel time from home to national ambulance service station (67) | System for care during transfer to a facility or between facilities that has the capability to handle the case (20, 49) | ||||
| Weather/climate limits access: rainy season (11) | |||||
| Receiving N=69 | N=29 | N=3 | N=24 | N=8 | N=4 |
| Absolute no of EU providers (stratified by type: physicians, nurses and EMS providers; 6, 10, 13, 14, 17, 18, 30) | No of (trauma) fatalities within and outside the first hour (70) | Presence of disaster plan including, additional staffing for disasters (49, 68) | Absolute cost of EC treatment (5, 13, 17, 21, 23, 34, 47, 53, 71, 72) | Acceptable providers conduct and attitudes towards patients (13, 14, 57) | |
| Advanced cardiac life support or resuscitation equipment available in ambulances or no of ACLS ambulances (28, 30, 46, 56) | Fatality rate per patient kilometre from facility (70) | Availability of 24-hour ambulance care (no night hours, 52) | Copayment for care (65) | EC in line with patient’s human rights (58) | |
| Availability of basic EU medications available (13, 15, 47, 50) | Able to access and receive care in last 12 months (61) | Availability of 24-hour emergency care (13, 26, 57) | Cost of facility treatment (19) | Providers/per cent of providers deemed corrupt (13) | |
| Availability of basic EU resources/equipment (9, 13, 14, 18, 20, 26, 30, 50, 71, 72) | Availability of 24-hour staff availability (20) | Cost of medical investigations and radiography (19) | Sought care for wounds/trauma (5) | ||
| Availability of EU infection control materials including) soap (26, 77) | Care provided during transport (14) | Cost of medicines (17, 23) | |||
| Availability of EU procedures: Needle thoracostomy (15); chest tube (15); pelvic binding (15), defibrillation (15), cardioversion (15), pericardiocentesis (15); external cardiac pacing (15); blood transfusions (15, 32) | Care provided at lower-level facility before transfer (14) | Cost of treatment by a bonesetter (8) | |||
| Availability of EU specific supplies and equipment: 49, suture and wound care supplies (15); gloves (15); oxygen (15, 45); stethoscopes (20); glucometer (15); pulse oximetry; ECG machine (15); resuscitation equipment (8) | Legal protections for ambulance providers distributing and providing care (28) | Hospital costs beyond scope of patient (eg, proportion of cost to individual finances) (34) | |||
| Availability of imaging (general: 17, X-ray: 15, CT: 30, 68, ultrasound or MRI: 30) | Miscommunication or mistriage of patient acuity (6) | Payment required in cash for imaging (34) | |||
| Availability of laboratory/diagnostic testing material (general blood/urine tests: 17, 30, 32, 57; malaria smears: 32) | No of transfers per patient (6) | ||||
| Availability of potable (sterile) water (20, 73) | No and per cent mistriage (6) | ||||
| Availability of prehospital providers with standardised training (9, 22, 28, 52, 56) | Per cent of hospitals with out-of-hours clinician coverage (18) | ||||
| Availability of sanitation (toilet, 73) | Physician comfort in adequately performing EU-specific procedures (30, 50) | ||||
| Availability of specified care: trauma care (4); orthopaedic (fracture) care (8, 15, 15); obstetrical emergencies (20); HIV care (20); cholera (20); tuberculosis care (20); general surgical services (20); dental care (20); critical care (20); ophthalmological care (20) | Presence of overcrowding (49) | ||||
| Electricity available (20, 26, 45) | Presence of a standardised EMR (13) | ||||
| Emergency equipment list available (20) | Protocols for patient transfers (20) | ||||
| First aid received on scene by lay providers (ie, members of the public, other motorists or the less injured casualties; 34, 49) | Protocols specific to trauma care (15) | ||||
| First aid received on scene by trained providers (34) | Safe passage for health providers to the hospital at night (72) | ||||
| No of doctors staffing EU (appropriate for size; 68) | Staff comfort in treating EU conditions (32, 34) | ||||
| No of EU-specific area beds (20) | Training for community members and police: first aid and triage (72) | ||||
| No of hospital-facility (non-EU specific) rooms or beds (10, 19, 57) | Training for providers: adult triage (18) | ||||
| Presence of EU with resuscitation bed/zone (49, 50) | Training for providers: EU-specific (13, 14, 27, 46, 71) | ||||
| Presence of EU (within facility; 2, 68) | Training for providers: paediatric triage-specific (18) | ||||
| Presence of EU dedicated nursing personnel (18) | Time to lab tests (75); by patient GCS (75) | ||||
| Presence of facility burn unit (2) | Time to provider (eg, wait time; 25, 75) | ||||
| Presence of triage (13, 14, 49, 50) | Utilisation and access to standardised clinical care guidelines: general approach (15, 49); condition-specific (sepsis, DKA, anaemia, 15) | ||||
| Staff qualified to utilise EU equipment (26) | |||||
| Staff qualified to treat EU conditions (27) | |||||
| Staff with EC training: ACLS or BLS training (30, 71, 72); ATLS, PALS (30, 72) | |||||
| Staff with specialised training relevant to EC: 49, adult critical care (18); continuing education (18); EU equipment use (20); neonatal care (50) |
ACLS, Advanced Cardiovascular Life Support; ATLS, Advanced Trauma Life Support; BLS, Basic Life Support; DKA, Diabetic Ketoacidosis; EC, Emergency Care; EMR, Emergency Medical Record; EU, Emergency Unit; GCS, Glascow Coma Scale; PALS, Pediatric Life Support.