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Description
Background: Prehospital care is vital for reducing mortality from traumatic injuries, especially in low- and middle-income countries. This study determined prehospital care utilization and associated factors among trauma patients in referral hospitals in West Amhara, Ethiopia.
Methods: A concurrent triangulation mixed-methods design was employed from March–August 2024 in Debre Markos, Tibebe Ghion, and Felege Hiwot hospitals. Quantitative data were collected from 518 trauma patients via questionnaire, with proportional allocation based on patient flow, and analyzed using logistic regression to identify factors associated with prehospital care use. Qualitative data were collected through semi-structured interviews with healthcare professionals and trauma patients, reported in line with the Consolidated criteria for reporting qualitative research (COREQ) checklist. Reflexive Thematic Analysis guided by the WHO Emergency Care System Framework was used, integrating quantitative and qualitative findings while maintaining reflexivity to understand prehospital care utilization.
Results: The prehospital care utilization rate was 49.8%. The majority of patients (84.2%) arrived at hospitals via taxi or on foot, reflecting reliance on non-Emergency Medical Service (EMS) transport. Rural residence (AOR = 4.80), lower education (AOR = 0.54), violence/quarrel-related injuries (AOR = 2.60), Motor Vehicle Accidents (AOR = 2.00), gunshot injuries (AOR = 8.61), and penetrating injuries (AOR = 0.34) were significantly associated with prehospital care use.
Qualitative findings revealed challenges across four themes: (1) limited awareness and lack of emergency communication systems during Initial Contact and Dispatch (Scene), (2) scarce ambulances, long response times, and reliance on non-EMS transport in Prehospital Treatment and Transportation (Transport), (3) resource and personnel shortages that indirectly affect prehospital response within Facility-Based Emergency Care linkages (Facility), and (4) the need for Advocacy and Public Education
Conclusion: Prehospital care utilization is sub-optimal, influenced by sociodemographic and injury-related factors. Qualitative insights reveal systemic and community challenges that warrant further investigation through larger, more representative studies.
