Prehospital Care Practice for Critically Ill Patients Presented to the ED: prospective observational study

Abstract Background The prevalence of critical illness is increasing globally, placing substantial demand on emergency healthcare systems. In low-resource settings like Ethiopia, prehospital care practices remain underdeveloped, contributing to preventable morbidity and mortality. The level of contemporary avoidable hypoxia and the adequacy of pre-arrival communication, both of which are anticipated to be addressed in the prehospital setting, were not evaluated in Ethiopia. Objective This study aimed to assess prehospital care practices among critically ill patients upon arrival at the emergency department, focusing on mode of arrival, oxygen saturation status, and prehospital communication. Methods An observational study was conducted from August 20 to October 20, 2023, at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital. A total of 202 critically ill patients were enrolled using a convenience sampling technique. Data were collected through structured questionnaires and analyzed using descriptive statistics and chi-square tests via SPSS version 27. Results Ambulance transport was used by 94 patients (46.5%) out of 202 patients, while others arrived via taxi (47%), on foot (4%), or by police/others (2.5%). 174 (86.1%) were hypoxic (oxygen saturation ≤ 93%) upon arrival. Only 63 patients (31.2%) received any form of oxygen therapy during prehospital transport. Oxygen was administered via nasal prongs in 52 (25.7%), face mask in 6 (3%), face mask with reservoir in 2 (1%), and endotracheal intubation in 3 (1.5%) cases. A chi-square test of independence indicated that there was no statistically significant (p ≥ 0.05) association between mode of transportation and oxygen saturation status χ² (1, N = 202) = 2.52, p = 0.112. Prehospital communication was done in only 34 cases (16.8%), indicating that most patients arrived without prior notification. Conclusion The majority of critically ill patients presented with unmanaged hypoxia and lacked prehospital notification, reflecting significant deficiencies in airway management and EMS coordination. These findings underscore the urgent need for a centralized, well-equipped EMS system in Ethiopia, including national protocols for oxygen delivery and prearrival communication.