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Using geographic information systems (GIS) to assess response intervals for diffuse community bystander-driven (Tier-1) emergency medical services integrated with emergency medical dispatch in Tanzania: an 8-year analysis.

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Τίτλος: Using geographic information systems (GIS) to assess response intervals for diffuse community bystander-driven (Tier-1) emergency medical services integrated with emergency medical dispatch in Tanzania: an 8-year analysis.
Συγγραφείς: Delaney PG; Cleveland Clinic, Cleveland, OH USA. Electronic address: delanep@ccf.org., Eisner ZJ; University of Michigan Medical School, Ann Arbor, MI USA., Pine H; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA., Friesen J; Trek Medics International, Mwanza, Tanzania., Raghavendran K; University of Michigan Medical School, Ann Arbor, MI USA., Patterson B; Cleveland Clinic, Cleveland, OH USA., Vallier H; Cleveland Clinic, Cleveland, OH USA., Piuzzi NS; Cleveland Clinic, Cleveland, OH USA., Hingi M; Tanzania Rural Health Movement, Mwanza, Tanzania.
Πηγή: Injury [Injury] 2026 May; Vol. 57 (5), pp. 112910. Date of Electronic Publication: 2025 Nov 26.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0226040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0267 (Electronic) Linking ISSN: 00201383 NLM ISO Abbreviation: Injury Subsets: MEDLINE
Imprint Name(s): Publication: <2002->: Amsterdam : Elsevier
Original Publication: Bristol, Wright.
Ιατρικοί όροι (MeSH): Emergency Medical Services*/organization & administration , Emergency Medical Dispatch*/organization & administration , Geographic Information Systems* , Emergency Medical Service Communication Systems*, Tanzania/epidemiology ; Humans ; Triage ; Ambulances ; Male ; Female
Περίληψη: Introduction: The global trauma burden disproportionately affects low- and middle-income countries(LMICs), which lack robust emergency medical services(EMS). The Global Prehospital Consortium determined Tier-1 EMS response intervals are a priority for investigation. On-scene response intervals for professional ambulance-driven Tier-2 EMS vary by density of centralized ambulance dispatch sites per population, requiring costly infrastructure to improve response times. Community bystander-driven (Tier-1) systems are less costly with diffuse and non-centrally dispatched responders. Therefore, we hypothesized Tier-1 EMS response intervals to emergencies are not distance-related, due to the inherent diffusion of Tier-1 responders.
Methods: In 2016, Tanzania Rural Health Movement launched a Tier-1 lay first responder(LFR) program in Tanzania integrated with Beacon, a mobile emergency medical dispatch(EMD) platform. LFRs were provided with a two-day training course. Chief complaints, diurnal emergency variation, and response/triage/encounter intervals were prospectively recorded for analysis. GIS software (ArcGIS Pro 2.8) evaluated encounter latitude/longitude and distance from Mwanza city center, compared with response interval, using a logarithmic distribution for correlational analysis.
Results: 1273 entries were prospectively catalogued (2017-2024). 60 encounters lacked ≥67 % data compliance, 136 lacked GPS coordinates, and 89 geographic/time outliers were excluded, leaving 988 encounters for analysis (77.6 %). Of chief complaints, 81.0 % were road traffic injury-related. Median dispatch to on-scene arrival interval = 1 minute 4 seconds (IQR:36s-5m9s) and median on-scene arrival to triage decision interval = 1 minute 2 seconds (IQR:37s-2m32s) (n = 988). There was no correlation between log (response time interval) and log (distance from Mwanza center) (r = 0.028, p = 0.380) (n = 1012).
Conclusions: In this community-based EMS model, response times were rapid and not associated with geographic distance, highlighting the effectiveness of decentralized Tier-1 systems when combined with mobile dispatch technology. These findings support the scalability of low-cost, bystander-driven EMS networks in LMICs without reliance on traditional costly dispatch infrastructure, offering a promising strategy to address the global trauma burden.
(Copyright © 2025 Elsevier Ltd. All rights reserved.)
Competing Interests: Declaration of competing interest Jason Friesen - Founder of Trek Medics International, which developed Beacon Dispatch software Nicolas Santiago Piuzzi - The Journal of Bone and Joint Surgery, Executive Editor: Type: Editorial or governing board - Journal of Knee Surgery, Associate Editor: Type: Editorial or governing board - Osteal Therapeutics: Type: Stock Option Zimmer Biomet Holdings, Inc.: Type: Other Professional Activities - Ethicon Endo-Surgery: Type: Other Professional Activities - Stryker Corporation: Type: Other Professional Activities - Pacira Pharmaceuticals Incorporated: Type: Other Professional Activities. Other authors have no conflicts of interest to declare.
Contributed Indexing: Keywords: Emergency medical services; First responders; Tanzania; Trauma
Entry Date(s): Date Created: 20251130 Date Completed: 20260430 Latest Revision: 20260430
Update Code: 20260501
DOI: 10.1016/j.injury.2025.112910
PMID: 41320615
Βάση Δεδομένων: MEDLINE
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  Data: Using geographic information systems (GIS) to assess response intervals for diffuse community bystander-driven (Tier-1) emergency medical services integrated with emergency medical dispatch in Tanzania: an 8-year analysis.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Delaney+PG%22&quot;&gt;Delaney PG&lt;/searchLink&gt;; Cleveland Clinic, Cleveland, OH USA. Electronic address: delanep@ccf.org.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Eisner+ZJ%22&quot;&gt;Eisner ZJ&lt;/searchLink&gt;; University of Michigan Medical School, Ann Arbor, MI USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Pine+H%22&quot;&gt;Pine H&lt;/searchLink&gt;; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Friesen+J%22&quot;&gt;Friesen J&lt;/searchLink&gt;; Trek Medics International, Mwanza, Tanzania.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Raghavendran+K%22&quot;&gt;Raghavendran K&lt;/searchLink&gt;; University of Michigan Medical School, Ann Arbor, MI USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Patterson+B%22&quot;&gt;Patterson B&lt;/searchLink&gt;; Cleveland Clinic, Cleveland, OH USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Vallier+H%22&quot;&gt;Vallier H&lt;/searchLink&gt;; Cleveland Clinic, Cleveland, OH USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Piuzzi+NS%22&quot;&gt;Piuzzi NS&lt;/searchLink&gt;; Cleveland Clinic, Cleveland, OH USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hingi+M%22&quot;&gt;Hingi M&lt;/searchLink&gt;; Tanzania Rural Health Movement, Mwanza, Tanzania.
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  Data: Introduction: The global trauma burden disproportionately affects low- and middle-income countries(LMICs), which lack robust emergency medical services(EMS). The Global Prehospital Consortium determined Tier-1 EMS response intervals are a priority for investigation. On-scene response intervals for professional ambulance-driven Tier-2 EMS vary by density of centralized ambulance dispatch sites per population, requiring costly infrastructure to improve response times. Community bystander-driven (Tier-1) systems are less costly with diffuse and non-centrally dispatched responders. Therefore, we hypothesized Tier-1 EMS response intervals to emergencies are not distance-related, due to the inherent diffusion of Tier-1 responders.&lt;br /&gt;Methods: In 2016, Tanzania Rural Health Movement launched a Tier-1 lay first responder(LFR) program in Tanzania integrated with Beacon, a mobile emergency medical dispatch(EMD) platform. LFRs were provided with a two-day training course. Chief complaints, diurnal emergency variation, and response/triage/encounter intervals were prospectively recorded for analysis. GIS software (ArcGIS Pro 2.8) evaluated encounter latitude/longitude and distance from Mwanza city center, compared with response interval, using a logarithmic distribution for correlational analysis.&lt;br /&gt;Results: 1273 entries were prospectively catalogued (2017-2024). 60 encounters lacked ≥67 % data compliance, 136 lacked GPS coordinates, and 89 geographic/time outliers were excluded, leaving 988 encounters for analysis (77.6 %). Of chief complaints, 81.0 % were road traffic injury-related. Median dispatch to on-scene arrival interval = 1 minute 4 seconds (IQR:36s-5m9s) and median on-scene arrival to triage decision interval = 1 minute 2 seconds (IQR:37s-2m32s) (n = 988). There was no correlation between log (response time interval) and log (distance from Mwanza center) (r = 0.028, p = 0.380) (n = 1012).&lt;br /&gt;Conclusions: In this community-based EMS model, response times were rapid and not associated with geographic distance, highlighting the effectiveness of decentralized Tier-1 systems when combined with mobile dispatch technology. These findings support the scalability of low-cost, bystander-driven EMS networks in LMICs without reliance on traditional costly dispatch infrastructure, offering a promising strategy to address the global trauma burden.&lt;br /&gt; (Copyright &#169; 2025 Elsevier Ltd. All rights reserved.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Declaration of competing interest Jason Friesen - Founder of Trek Medics International, which developed Beacon Dispatch software Nicolas Santiago Piuzzi - The Journal of Bone and Joint Surgery, Executive Editor: Type: Editorial or governing board - Journal of Knee Surgery, Associate Editor: Type: Editorial or governing board - Osteal Therapeutics: Type: Stock Option Zimmer Biomet Holdings, Inc.: Type: Other Professional Activities - Ethicon Endo-Surgery: Type: Other Professional Activities - Stryker Corporation: Type: Other Professional Activities - Pacira Pharmaceuticals Incorporated: Type: Other Professional Activities. Other authors have no conflicts of interest to declare.
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