Situation analysis of the provision of prehospital emergency medical services in the Nairobi County, Kenya.

Abstract

Emergency Medical Services or EMS is the patient care provided on-scene and en-route to hospital. It serves as the first point of contact for majority of people to healthcare services during emergencies and life threatening injuries; these services serve the purpose of reducing preventable morbidity and chances of mortality. Developing countries such as most of the African states lack these services, except for the few such as Kenya; where these relatively new services are provided by locally trained EMS personnel mainly working in privately run ambulance agencies. There is insufficient documented information on prehospital EMS in Kenya. The objective of this study was to explore factors influencing provision of emergency medical services in the urban setting of Nairobi County. A cross-sectional mixed methods study design was selected. The participants were; emergency medical .technicians (EMTs) and EMS ambulance agency managers, all were purposively selected. After verbal consent the data was generated by use of questionnaires, focus group discussions and in-depth-interviews. Forty four self administered questionnaires were completed by the EMTs. One focus group discussion per gender was conducted with the EMTs. Nine in-depth interviews were conducted with EMS ambulance agency mangers. The quantitative data was analysed using descriptive statistics. The qualitative data was transcribed, coded, and analyzed using constant comparison. Four factors were identified as influencing provision of pre-hospital emergency medical services in the urban setting; subjective EMS standards, availability and distribution of EMS resources, EMS awareness and existing road infrastructure. The common factor or core category that linked to the other four was; ‘the role of the government in prehospital EMS implementation.’ 95.5% (42) of the EMTs emphasized that to provide proper healthcare there was a need to enforce standards on the qualifications of an EMT, only 25% (11) EMTs had valid practising licenses and only 50% (22) had attended an additional medical course. According to 72.2% (32) of the EMTs, adequate numbers of appropriate equipment was a constituent of quality service. 61.4% (27) of the EMTs agreed that for provision of quality service there was need for adequate numbers of personnel per shift. 75% (33) EMTs stated that EMS awareness among the public led to proper utilisation of their services and cooperation thus increasing the chances of the casualty having a better outcome. It was argued by 90.9% (40) EMTs that a good working environment provided for by an agency administration that was conversant with all the aspects of prehospital EMS would enhance their potential. Findings of this study led to the following conclusion; the establishment and development of EMS in Nairobi is determined by the extent of involvement and engagement of the national government. The recommendation is that the relevant organs within the county government should play an active and the main role in the establishment and development of EMS, this will enhance service provision.