Conclusions: Promises and Pitfalls
Emergency medical systems are a critical component of national health systems in low-income countries. Governments and ministries of health in low-income countries need to pay specific attention to the development of EMS in their countries and to ensure that the evolution of any EMS is both evidence based and appropriate to their national needs. More important, the context and implementation of EMS should help health equity and not widen existing health disparities.
This chapter highlights not only the urgent need for more attention to EMS in low-income countries but also points out an opportunity for these countries in defining better EMS for their needs. In promoting the systematic development of an evidence-based EMS, low-income countries could help define more effective and cost-effective emergency systems than currently exist in high-income countries. This opportunity should not be lost as a result of political inattention or lack of funds; the international and national stakeholders must move forward to stem the preventable loss of life from the lack of an EMS.
Emergency care needs to be planned as an integral component of public health systems in low-income countries. Too little is known about the true extent of the need for emergency care, the designs of EMS that would work well for different communities and populations, and the costs and benefits of delivering emergency care in low-income countries. These gaps are a call for more investments in the research, development, and implementation of EMS, especially in these countries. Universal emergency care is consistent with the right to health care because, by definition, emergency care is a matter of life and death. Society should endeavor to ensure that prompt appropriate care is available in critical moments when a delay in care—or the delivery of inappropriate care—could mean loss of lives.
1. There are 4,715,000 trauma deaths in low- and middle-income countries per population of 5,219,401,000; thus, there are 9.033 trauma deaths per 10,000 people.
2. There are 5,699,000 ischemic heart disease deaths per 5,219,401,000 population; thus, there are 10.9 ischemic heart disease deaths per 10,000 people.
3. There are 2,000 to 4,000 births among 10,000 people based on crude birth rates of 26 (South Asia), 39 (Sub-Saharan Africa), 22 (Latin America), and 17 (East Asia). Maternal mortality runs at 1 per 1,000 people.