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EMS Systems in Lower-Middle Income Countries: A Literature Review

Published online by Cambridge University Press:  12 December 2016

School of Nursing and Midwifery, Monash University, Victoria, Australia School of Nursing, Brawijaya University, Malang, Indonesia
Virginia Plummer
School of Nursing and Midwifery, Monash University, Victoria, Australia Peninsula Health, Victoria, Australia
Malcolm Boyle
Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
Correspondence: Suryanto, M.Nurs PhD Candidate School of Nursing and Midwifery Monash University, Australia Lecturer School of Nursing Brawijaya University, Indonesia E-mail:;



Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped.


There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries.


A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care.


There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing the prehospital care system.


The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organized EMS system with most ambulances used purely for transport and not as an emergency care vehicle. Financial issues are the most common problems faced by LMICs with support from developed countries a necessity.

Suryanto , Plummer V , Boyle M . EMS Systems in Lower-Middle Income Countries: A Literature Review. Prehosp Disaster Med. 2017;32(1):6470.

Comprehensive Reviews
© World Association for Disaster and Emergency Medicine 2016 

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