Table 4

Unique access measures categorised by type and delays in care

Availability N=40Accessibility N=19Accommodation N=42Affordability N=17Acceptability N=19
Seeking N=22N=2N=3N=5N=1N=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=46N=9N=13N=12N=8N=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=69N=29N=3N=24N=8N=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.