Pre-hospital care is out-of-hospital emergency care provided by trained healthcare with ability to provide transportation to healthcare facility(1, 2). It includes medical treatments in pre-hospital settings and means of transport necessary to take patients to appropriate health centers. Therefore, pre-hospital care is regarded as vital as in-hospital medication, because its contribution is significant including survival benefits for people who are critically ill and preventing complications in time-sensitive situations(3, 4).
Historically, health care system in many developing countries focused on treating a communicable disease(5). However, the steady rise in the burden of emergency conditions due to high road traffic crash (RTC) and life-threatening non-communicable illnesses have led to the acknowledgment of the importance of pre-hospital care intervention to mitigate the fatalities of the problems(6, 7). According to the World Bank, most of the mortality cases, including about 54% of deaths and 91% years of life lost, which occur in the pre-hospital settings, could have been prevented in the presence of robust emergency care in Low Middle Income Countries (LMIC)(5).
Cognizant of this fact, pre-hospital care systems are rapidly developing in LMIC, especially in remote areas to reduce morbidity and mortality in the region(8). Yet, empirical evidence shows that the level of ambulance utilization to take patients to emergency departments (ED) of nearby health center is very low across low and middle income countries, ranging from 4–37%, which implies that majority of the patients do not get ambulance services(9–16).
In the context of Africa, the ambulance service use in pre-hospital settings is even far worse. A study conducted in Ghana revealed that only 5% of patients use ambulance to arrive EDs although about 75% of people experience medical and traumatic emergencies(17). Scholarly works indicate that, in Africa, pre-hospital care utilization is affected by multitude of factors like socio-economic, beliefs, poor communication, traditional forms of transportation, and misunderstanding of services, among others(8, 17–22).
In the same vein, Ethiopia has recently developed a pre-hospital care system as mechanism to deal with the stress of emergencies arising from high RTC, communicable and non-communicable health deficiencies, disproportionately affecting the productive age groups, resulting in early death and disability(14). The country, is currently pursuing the “two-tiered” pre-hospital emergency care, also known as the “Anglo-American” model, that primarily aims at rapidly bringing patients to hospital to offer basic and advanced emergency medical services by trained personnel(23). In this regard, the Ministry of Health has been working to improve the number of ambulance, manpower, community participation, and raise public awareness of access and use of ambulance services(24). Nevertheless, the pre-hospital care in Ethiopia has, previously, been limited to the capital city, and currently, the services are rapidly becoming an important part of universal health care, and extending to the areas with high burden of emergency diseases, RTC and most populous cities(23, 25).
Jimma City is one of the oldest, rapidly urbanizing and populated urban areas heavily burdened with emergency conditions, where pre-hospital health care is provided at two public hospitals serving the community as the referral health care centers: namely, Jimma University Medical Center (JUMC) and Shenen Gibe Hospital (SGH). As of October 2022, JUMC, in collaboration with Jimma Health Care Office and Ministry of Health, has established a hospital-based Emergency Medical Services (EMS) known as “Aayyoo Ambulance”. Currently, the service has only one dispatch center that operates on four digits ‘6238’ toll-free call number. Since its establishment, the center has been providing 24-hour/7days services to the population of Jimma City and its vicinities.
While quantitative evidence is inadequate with regard to the pre-hospital care in Ethiopia, Jimma City included, it is reported that patients with emergency illnesses often arrive too late to EDs, sometimes after developing complications, despite improvement in the quality and availability of ambulance services. This rationalizes studying the ambulance service utilization and associated factors as an important element of the broader heath care system that determine the pre-hospital emergency outcomes. Therefore, this study is designed with the aim of assessing the status of ambulance service use in the pre-hospital setting among patients visited at adult EDs, and to identify the determinant factors associated with service utilization in the study area.