The Current State of Ambulances and Emergency Medical Services in the Hilly Region of Nepal.

Background Pre-hospital care in Nepal has seen marked improvement in recent years. Emergency medical services means out of hospital acute medical care and/or transportation provided to a patient with an illness or an injury. It continues to lack centralization of resources and standardization across personnel and patient transport vehicles operating in the country. Objective To describe the current state of ambulances including on-board equipment, emergency medical services and driver training among ambulances servicing a hilly region of Nepal. Method A descriptive study was conducted among 117 ambulance drivers transporting patients to the Emergency Department at Dhulikhel Hospital in Kavre, Nepal. A convenience sampling was done to collect data using the self-structured questionnaire during a one-month period from 1st to 30th November 2021. The questionnaire contained 21 items to gather information about the status of ambulance services. Data was analyzed using descriptive statistics. Result The majority of ambulances lack basic and advanced life support equipment. None of the ambulance drivers surveyed had completed formal ambulance driver training and only 35% had received some form of medical training. Most ambulances (70.1%) did not have a licensed paramedic onboard during transport. Majority of the ambulances (91%) were functioning as patient transport vehicle only and these were classified as C-grade ambulances. Conclusion Ambulances remain poorly staffed and under-resourced and ambulance drivers largely lack formal training and credentialing. Targeted interventions and investment are required to bring emergency medical services into compliance with national standards.