Table 4.
Evolution and Future Directions of the NAS in Ghana since 2004
| EMS Component | Past and Present | Future |
|---|---|---|
| Integration of Health Services | Ad hoc transfer of patients to nearest facility; limited communication with facility regarding incoming patients. | Selective transfer to capable health facilities based on patient acuity; standardize communication to receiving facilities regarding incoming patients; integrate the care of seriously ill and injured persons with the new emergency medicine training programs. |
| EMS Research | Capacity assessment and advocacy research; establishment and staffing of a research department. | Defining access to care gaps; identifying ways to improve NAS service uptake; supporting the research department efforts to improve NAS care and EMS care in LMICs more broadly. |
| Legislation and Regulation | NAS Bill drafted and proposed to Parliament. | Ratification of NAS Bill, which will increase NAS scope from service delivery to regulation of all ambulances services nationwide. |
| System Finance | Inconsistent/insufficient funding, namely the result of delay in NAS Bill ratification. | Dedicated funding after ratification of NAS Bill. |
| Human Resources | Reliance on cross-trained staff with National Fire Service; steady expansion of EMT pool after opening EMT school. | Keep pace with demand; strategic increase in numbers of EMT-As to provide more advanced care during transport. |
| Medical Direction | Regional medical coordination; insufficient funds and expertise to finance local medical direction. | Provide medical direction at the sub-regional level; performance evaluation; develop a pool of emergency medicine physicians in prehospital care management. |
| Education Systems | Combined education with National Fire Service; opening of EMT school. | Provide continuing education for EMTs and medical directors. |
| Public Education | Television and radio shows regarding NAS services and potential benefits of prehospital care. | Community-based first aid and prehospital care promotion campaigns. |
| Prevention | Television and radio shows regarding ways to prevent injury. | Join efforts with other national and non-governmental organizations that participate in injury and disease prevention initiatives. |
| Public Access | Multiple emergency access telephone numbers for: NAS, National Fire Service, and Police Service; creation of public relations department. | Single emergency access telephone number for all safety and security services. |
| Communication Systems | Telephone-based sub-national communication system for dispatch; toll-free access telephone numbers now recognized by all mobile communication service providers. | Single shared call center for all national safety and security services; standardize communication regarding incoming patients between ambulances and hospitals. |
| Clinical Care | Single level of EMT was expanded to basic and advanced levels. | Increase availability of resources in the ambulance to maximize capabilities of EMTs; performance monitoring and evaluation. |
| Information Systems | Data were compiled with Excel and analyzed manually each month; access-based system now used with built-in macros for automatic analysis; station-level pretabulated data are sent to NAS Headquarters for evaluation. | Develop infrastructure for cloud-based, real-time data collection and reporting; GIS data collection and management to identify “hot spots” and population-based geospatial access gaps. |
| Evaluation | Time and efficiency indicators have been monitored since NAS inception; station locations, staffing requirements, and performance audits have been proposed using these data. | Add indicators for staff performance and patient outcome; telephone-based random assessment of quality of services provided from patients’ perspectives. |
Abbreviations: EMS, Emergency Medical Service; EMT, emergency medical technician; EMT-A, EMT Advanced; GIS, geographic information system; NAS, National Ambulance Service.