The Practice and Determinants of Ambulance Service Utilization in Pre-Hospital Settings, Jimma City, Ethiopia

Abstract

Abstract Introduction: Pre-hospital treatments and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries that severely suffer from mortality burden arising from emergency conditions. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the emergency departments within the context of pre-hospital care system in public hospitals of Jimma City. Method An institutional-based cross-sectional study design was conducted in two public hospitals in Jimma city, from June to July 2022. A systematic sampling technique was used to select 468 sample size. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05. Results Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The main determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2–0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3–4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1–0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5–26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7–6.6 in case of bystanders); distance to hospital (AOR,0.37, 95%CI, 0.2–0.7 among the patients within ≤ 15km radius); and prior experience in ambulance use (AOR, 4.1,95%CI, 2.4-7). Conclusion Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.