The pre-hospital emergency care is a system that provides emergency care to critically ill and injured patients in the field (1). Pre-hospital emergency care aims to deliver care on time to sufferers of sudden, life-threatening injuries and avoid unnecessary death or long-term morbidity. It is an important component of the health system that helps to improve outcomes of injuries and illnesses. A well-functioning prehospital emergency care system offers opportunities for effective emergency preparedness and response capability within a broader disaster risk reduction strategy (2, 3, 4).
The pre-hospital care can be delivered by emergency medical technicians (EMT), paramedics, emergency physicians, emergency nurses, and other health professionals. Providing emergency care outside the hospital and immediate transfer of patients to emergency units are important measures that promote the survival rate of the patients (5). Emergency medical service systems exist in one-third of African countries which is very low (6). Pre-hospital emergency services (PEMS) are established to serve diverse, multicultural, and multilingual populations of varying socioeconomic strata (7). PEMS in Ethiopia has been started in 1935 by the Ethiopian Red Cross society. It is the first service provider institution in society that started the service with free ambulance service on a 24-hour schedule (8).
PEMS system is well built and advanced widely in developed countries whereas a still slow development in low and medium-income countries (9). This is why the global burden of trauma and medical illness continues to be the main cause of morbidity and mortality in developing countries. This is due to poor PEMS, no uniform emergency medical service communications, and dispatching for the entire country (10).
A study in Uganda indicated that PEMS provision was overwhelmed by poor coordination and communication. There was also the absence of the utmost basic equipment and medicines desired to monitor and treat emergency conditions in ambulances and at emergency units (11). In Ethiopia, there are limited EMTs, untrained ambulance crews, poor ambulance systems and there is no medical oversight by experienced emergency physicians and nurses as a consultant as well as there are no coordinated systems from the institutions during transportation (12).
There is a huge problem of non-communicable illnesses and injuries in Addis Ababa due to the growth of the city and the way of life modifications of the tenants. A lot of factors intensified this condition including the absence of an interconnected PEMS, the deficiency of doomed substantially developed emergency center, the insufficient human and material resources to provide care for injured or acutely ill patients, the lack of medical training on rationales of triage and emergency management, and the shortage of sustainable funding for emergency service (13). In Addis Ababa, there is a less developed pre-hospital emergency medical service system and a scantiness of studies on the existing level of pre-hospital emergency medical service system, and the subsidizing factors were not addressed (14).
Every year, closely 5 million people internationally pass away from accidental injuries (15). Unintentional injuries, cardiac halt, stroke, and obstetric emergencies are usually the causes of early mortality and disability in low and middle-income countries. In these countries, most premature deaths are the consequence of poor pre-hospital care services (3). Pre-hospital injuries are the top reason for death between 1 and 44 years of age (16). Even in the UK, the most developed country, pre-hospital care for major injured patients is given by emergency medical technicians and paramedics but their expertise and the enactment of these clinicians confines the range of life-keeping interferences which can be given to the patient before they arrived the hospital (17).
A study conducted in Afghanistan indicated that the pre-hospital facility is not directed through any type of scheme protocols. Respondents sensed that the present number of ambulances is inadequate to cater to the demands of the population. Besides, there is no strategy to ensure that ambulance service givers have adequate supplies in ambulances to manage patients. Moreover, there is no methodical process of communication for healthcare facilities to help them with the handover of information and the pre-hospital care process in Kabul lacks a protocol for triage of the severely injured patients which hits the outcome of care negatively (18).
A study employed in Thailand showed that lack of medical devices and collaboration with other organizations were core concerns in the pre-hospital situations (5). A study in Uganda found that an unstructured emergency medical services system stumbled by a lack of national policy, guidelines, and standards; funding; medical products, and coordination (20). Another study in South Africa showed that the deficiency of paramedics and EMTs that were the main factor that affects the PEMS (21). In Ethiopia, the study showed that there are resource constraints, and cost-efficient emergency medical services affect the pre-hospital service (2).
There were limited studies of documentation quality in the pre-hospital emergency care services that were delivered during "the golden hour". Crucial information on the mechanism of trauma and preliminary patient physiology can only be assembled at the trauma scene, where numerous emergency services with differing objectives interact. A study in USA result showed that the multivariate analysis discovered that patients missing one or more evaluates of patient physiology at the scene had a heightened risk of death (22, 23).
The level of complete medical documentation as well as the presence of protocols and guidelines in Ethiopia was lower. Even though low, there was variability in medical record documentation practice in Ethiopia regarding time, place, and institutions (23).