Title page 1

Contents 4

FOREWORD 5

ACKNOWLEDGEMENTS 7

ABBREVIATIONS 8

EXECUTIVE SUMMARY 10

1. INTRODUCTION 18

1.1. Road traffic injuries: a global crisis 18

1.2. Role of ECS in reducing the burden of road traffic injuries 19

1.3. ECS in low- and middle-income countries 20

1.4. A typology of ECS 22

1.5. Rationale for investing in ECS 23

1.6. Scope and structure of the report 25

2. PRIORITY INTERVENTIONS FOR EMERGENCY CARE SYSTEMS 28

2.1. Identifying high-value interventions for different ECS types 28

2.2. Key interventions and system considerations for nascent ECS 31

2.3. Key interventions and system considerations for maturing ECS 36

2.4. Key interventions and system considerations for mature ECS 42

3. CROSSCUTTING CONSIDERATIONS IN QUALITY, EQUITY, AND FINANCING 46

3.1. Tracking quality and ensuring accountability in ECS 46

3.2. Ensuring equity in ECS design and implementation 50

3.3. Funding ECS in low- and middle-income countries 54

4. GUIDANCE FOR IMPLEMENTING ECS REFORMS 62

4.1. Implementation of considerations for priority reforms 62

4.2. Tools and resources to support ECS reforms 77

5. CONCLUSIONS 84

Appendix A. Key Quality Indicators for Monitoring ECS Performance 87

Appendix B. ECS Data Sources: Advantages and Disadvantages 89

Appendix C. Success Factors for Implementing a National Trauma Registry 94

Glossary 95

References 97

TABLE 1.1. An operational typology of ECS 23

TABLE 2.1. Summary of key recommendations for ECS strengthening 30

TABLE 3.1. Four core values of high-quality ECS 47

FIGURE 2.1. The World Health Organization ECS continuum 29

Boxes 3

BOX 1.1. A LANDMARK WORLD HEALTH ASSEMBLY RESOLUTION ON INTEGRATED EMERGENCY, CRITICAL, AND OPERATIVE CARE 19

BOX 2.1. STRENGTHENING TRAUMA CARE IN SOUTH AFRICA THROUGH TIER-1 SYSTEMS: LESSONS FROM THE CFAR NETWORK 32

BOX 2.2. NIGERIA: TARGETING GAPS IN EMERGENCY CARE LEGISLATION AND REGULATIONS 35

BOX 2.3. STRENGTHENING AMBULANCE SERVICES WITH INFORMATION TECHNOLOGY IN UZBEKISTAN 37

BOX 2.4. NEPAL: DEVELOPMENT AND DELIVERY OF AN EMD TRAINING PROGRAM 40

BOX 2.5. TAMIL NADU: ACCREDITATION AND REGULATORY REFORMS BOOST ECS PERFORMANCE 41

BOX 2.6. CROATIA: OVERCOMING ECS FRAGMENTATION WHILE FOSTERING LOCAL AUTONOMY 44

BOX 3.1. Summarizes the key recommendations presented above for tracking and improving ECS quality 50

BOX 3.2. Summary of recommendations for strengthening equity in ECS 53

BOX 3.3. INDIA: PROMOTING FINANCIAL EQUITY IN ACCESS TO ECS 54

BOX 3.4. OPTIONS FOR ECS FINANCING: EVIDENCE FROM NIGERIA 55

BOX 3.5. Summary of recommendations on sustainable ECS financing 58

BOX 3.6. INDIA: PUBLIC-PRIVATE PARTNERSHIPS FOR INCREASED EFFICIENCY AND ACCESS TO EMERGENCY CARE 59

BOX 4.1. PERU: IMPROVING OUTCOMES THROUGH A UNIFIED RESPONSE SYSTEM 65

BOX 4.2. RWANDA: USING TECHNOLOGY AND DIGITIZATION TO IMPROVE AMBULANCE ALLOCATION AND DESTINATION TRIAGE 70

BOX 4.3. SRI LANKA: 1990 SUWA SERIA AND CONNECTED AMBULANCE 70