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The State of Emergency Medical Services (EMS) Systems in Africa

Published online by Cambridge University Press:  23 February 2017

Nee-Kofi Mould-Millman*
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA
Julia M. Dixon
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA Denver Health, Department of Emergency Medicine, Denver, ColoradoUSA
Nana Sefa
Oakland University, William Beaumont School of Medicine, Royal Oak, MichiganUSA
Arthur Yancey
Emory University, School of Medicine, Department of Emergency Medicine, Atlanta, GeorgiaUSA
Bonaventure G. Hollong
University of Cape Town, Division of Emergency Medicine, Cape Town, South Africa
Mohamed Hagahmed
University of PittsburghMedical Center, Pittsburgh, PennsylvaniaUSA
Adit A. Ginde
University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, ColoradoUSA
Lee A. Wallis
University of Cape Town, Division of Emergency Medicine, Cape Town, South Africa
Correspondence: Nee-Kofi Mould-Millman, MD FACEP Department of Emergency Medicine 12401 East 17th AveLeprino 752, Mailstop B215 Aurora, Colorado 80045 USA E-mail:



Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.


A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems’ jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.


The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).


Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service.

Mould-MillmanNK, DixonJM, SefaN, YanceyA, HollongBG, HagahmedM, GindeAA, WallisLA. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283.

Original Research
© World Association for Disaster and Emergency Medicine 2017 

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Conflicts of interest/funding: Funding and support for this study was provided by the African Federation for Emergency Medicine (Bellville, South Africa). The African Federation for Emergency Medicine did not limit the study design, data collection, data analysis, or data interpretation. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.


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