Pre-hospital emergency care system: Utilization of ambulance services in Nairobi county

Abstract

Emergency Medical Service (EMS) is the system that organizes all aspects of medical care provided to patients in the pre-hospital environment and emergency department within hospitals. It comprises agencies and organizations (both private and public), communication and transportation networks, hospitals, highly trained professionals and a public aware on how to respond in emergencies. Kenya needs robust EMS due to the high prevalence of acute medical events such as COVID-19, natural and man-made disasters. The objective of this study was to assess utilization of ambulance services in Nairobi County. The study design was descriptive cross-sectional, using quantitative and qualitative research methods. Data was collected using interviewer-administered semi-structured questionnaires and key in-depth interviews from 14 ambulance services, 19 Emergency Care Centers (ECC), and community. Thirty-nine key informants were sampled using purposive sampling technique and 101 community members sampled using simple random sampling technique from 10 sub-counties. Data tools were pretested at Mukuru Kwa Njenga, a populous slum in Nairobi County. Approval to carry out the study was granted by the Ministry of Health, Kenya. Qualitative data was analyzed using NVIVO12 and quantitative data analyzed using descriptive statistics by use of SPSS vs 25 software. Findings are represented as frequencies and percentages. There were 14 ambulance service providers in the Nairobi Metropolitan Services area with a total of 42 ambulances. Forty-one ambulances were facility-based ambulances. All ambulance services had emergency numbers, and only 3 had short-toll free ambulance access numbers. There were 9 different ambulance dispatch centers in the county. Five ambulance services did not have a dispatch Centre. Public members were the first to assist in in 79% emergencies. There was low public awareness on available pre-hospital emergency care services and tollfree lines for emergency services. Ambulances utilization was also low.