We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2–1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33–1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47–3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

Heatwaves are periods of unusual heat, whose frequency and intensity is increasing. Heatwaves also translate into emergency healthcare dysfunctions, but evidence on how to mitigate these effects still needs to be provided. This multicentric study aimed to identify the interactions between heatwaves and prehospital emergency medicine (PHEM). After obtaining informed consent, PHEM personnel working full-time in different districts of the Veneto Region, Northern Italy, were recruited. Their perspective was captured through semi-structured interviews and analyzed using content analysis methodology. Thirteen subjects participated in the study. Their insights were categorized into four themes: perception of heatwaves; clinical impact of heatwaves; social factors and heatwaves; heatwaves and emergency medical service (EMS). According to the interviewees, the strain on EMSs during heatwaves may be partially reduced by interventions targeting vulnerable populations, primary care, social networks, and education and information. Specific public health actions could follow the surge science principles of staff, stuff, structure, and system to help policymakers improve EMS surge capacity planning, preparedness, and responses. The present study also identified PHEM vulnerabilities and targets of interventions to implement heat–health action plans, mitigate the risk of prehospital emergency care dysfunction, and improve EMS sustainability and preparedness against heatwaves and the changing climate.