Insights into collapse in ambulances (CIA): a retrospective analysis of interfacility transfers from Emergency Medical Services (EMS) of Sindh, Pakistan

BACKGROUND: Emergency Medical Services (EMS) is the cornerstone of healthcare service delivery, especially in lower and middle-income countries (LMICs). Given the scarcity of literature, the study determines the rate of patient collapse in ambulances (CIA), in association with history, complaints, and other contributing factors. CIA is a novel terminology coined by the study team, referring to out-of-hospital deaths in ambulances. METHODS: The study employed a retrospective approach from EMS records in Sindh to determine the patient collapse rate from July 2023 to February 2024. The dataset included interfacility transfers in which patients were transported between health facilities. Data collected via reports of ambulance response and transfer reports were extensively studied to determine the rate of CIA, response time, types of cases, types of transfers, and need for transfers, along with patient condition, diagnosis, and procedures conducted en route to transfer. RESULTS: The findings reported a rate of CIA as 0.019% (n = 37) out of 195,638 cases, with the average response time for all the cases being less than 10 min, highlighting the consistent service delivery. In line with the presenting complaints, the majority of CIAs resulted from abnormal breathing (32.4%) and cardiac/respiratory arrest (32.4%). All the CIA cases were either serious or life-threatening, transferred to the need for a higher level of care. All the requests were made from the public sector secondary hospital to a similar setup or tertiary care, thereby highlighting shortcomings in the existing model of healthcare service delivery in Sindh. CONCLUSION: To prevent the collapse of serious and life-threatening patients in ambulances regardless of uncontrolled risks, it is important to obtain comparative data as well as measure the performance of EMS and ambulance crews for healthcare improvement. In addition, addressing the healthcare inequities through a systems approach is vital to improve patient outcomes at both the prehospital and hospital levels through the provision of essential care before patient transfer.