{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:48:13Z","timestamp":1780393693037,"version":"3.54.1"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.<\/jats:p>","DOI":"10.1017\/s1049023x20001442","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T08:57:22Z","timestamp":1606813042000},"page":"115-120","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":16,"title":["Designing, Implementing, and Managing a National Emergency Medical Service in Sierra Leone"],"prefix":"10.1017","volume":"36","author":[{"given":"Luca","family":"Ragazzoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-4756","authenticated-orcid":false,"given":"Marta","family":"Caviglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Rosi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Buson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Merlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Della Corte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew Jusu","family":"Vandy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amara","family":"Jambai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Putoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"S1049023X20001442_ref26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000410"},{"key":"S1049023X20001442_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-4886-3"},{"key":"S1049023X20001442_ref19","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.1239"},{"key":"S1049023X20001442_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31824bde1e"},{"key":"S1049023X20001442_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12032"},{"key":"S1049023X20001442_ref2","unstructured":"2. United Nations Development Programme. Human Development Indicators. http:\/\/hdr.undp.org\/en\/countries\/profiles\/SLE#. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref16","doi-asserted-by":"publisher","DOI":"10.4314\/gjds.v12i1-2.5"},{"key":"S1049023X20001442_ref8","unstructured":"8. World Bank. http:\/\/data.worldbank.org\/country\/sierra-leone. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref10","unstructured":"10. World Health Organization. WHO emergency care system framework infographic. http:\/\/www.who.int\/emergencycare\/emergencycare_infographic\/en\/. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref18","doi-asserted-by":"publisher","DOI":"10.1186\/1476-072X-13-25"},{"key":"S1049023X20001442_ref24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223328"},{"key":"S1049023X20001442_ref15","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-15-00170"},{"key":"S1049023X20001442_ref9","unstructured":"9. Government of Sierra Leone. National Ebola Recovery Strategy for Sierra Leone 2015-2017. https:\/\/ebolaresponse.un.org\/sites\/default\/files\/sierra_leone_recovery_strategy_en.pdf. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref22","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.14.148338"},{"key":"S1049023X20001442_ref17","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2016.1164775"},{"key":"S1049023X20001442_ref20","first-page":"626","article-title":"Emergency medical systems in low- and middle-income countries: recommendations for action","volume":"83","author":"Kobusingye","year":"2005","journal-title":"Bull World Health Organ."},{"key":"S1049023X20001442_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60796-6"},{"key":"S1049023X20001442_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X1600114X"},{"key":"S1049023X20001442_ref14","doi-asserted-by":"publisher","DOI":"10.4314\/gmj.v49i3.1"},{"key":"S1049023X20001442_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.afjem.2017.06.002"},{"key":"S1049023X20001442_ref3","unstructured":"3. Government of Sierra Leone, Ministry of Health and Sanitation. Annual Health Sector Performance Report 2016. https:\/\/www.afro.who.int\/publications\/sierra-leone-health-sector-performance-report-2016. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref6","unstructured":"6. Government of Sierra Leone, Ministry of Health and Sanitation. Service Availability and Readiness Assessment (SARA) Plus report 2017. https:\/\/www.opendatasl.gov.sl\/dataset\/sierra-leone-sara-plus-report-2017. Accessed June 23, 2020."},{"key":"S1049023X20001442_ref23","volume-title":"Curriculum Development for Medical Education: A Six-Step Approach.","author":"Kern","year":"2009"},{"key":"S1049023X20001442_ref1","unstructured":"1. World Health Organization. Sierra Leone Country Information. https:\/\/www.afro.who.int\/countries\/sierra-leone. 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