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. 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. 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-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. Limited awareness and lack of emergency communication systems during initial contact and dispatch (Scene); scarce ambulances, long response times, and reliance on non-EMS transport in prehospital treatment and transportation (Transport); resource and personnel shortages that indirectly affect prehospital response within facility-based emergency care linkages (Facility); and the need for Advocacy and Public Education. 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.

Background: Despite growing government concerns and interventional efforts in Ethiopia over the last decade to improve utilization of ambulance services, it is still unmet need of the community. Moreover, there is a scarcity of research that has been conducted to assess the utilization of ambulance services in Ethiopia. Thus, this study is aimed at assessing the practice, barriers, perceived solutions, and factors associated with ambulance utilization in Northwest Ethiopia. Methods: A multi-center, institutional-based, cross-sectional study design using a mixed sequential explanatory approach was conducted. Systematic random and purposive sampling techniques were used to select the study participants for the quantitative and qualitativestudies, respectively. Interviewer-administered questionnaires, in-depth interviews, and key-informant interviews were used to collect the data. Data were collected using KoboCollect software and then exported to STATA version 17 for analysis. Numerical descriptive statistics were expressed by using mean and/or median, whereas categorical variables were expressed by percentages. A binary logistic regression model was used, and variables having a p-value < 0.25 in the bivariable analysis were entered into the multivariable analysis model. The model goodness-of-fit test was checked using the Hosmer-Lemshow test. Adjusted odds ratio with 95% confidence intervals (CIs) were used to report the strength of association, and statistical significance was declared at a p-value less than 0.05. The audio records of qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. Finally, the result of qualitative data was summarized with narration. Results: A total of 428 study participants were included in this study. More than half (54.7%) of the study participants were males and about 187 (43.7%) had no formal education. This study found that 16.6 % of the study participants used an ambulance to get to the hospital. Factors positively associated with ambulance utilization were knowing the ambulance call (AOR=2.68; 95% CI: 1.05, 6.82), presenting at the emergency department during the night (AOR=6.60; 95% CI: 3.15, 13.83), having a triage score > 7 (AOR=9.76; 95% CI:4.07, 23.44), and having prior experience of ambulance use (AOR=2.99; 95CI%: 1.28, 6.99). The qualitative findings of this study found that unavailability of road infrastructure, delayed responses from ambulance drivers, and a lack of ambulance vehicles in kebele were the major barriers for ambulance utilization. The participants suggested that increasing the number of ambulances, situating ambulances at health facilities, and resolving of the current conflict were the perceived solutions. Conclusion and recommendations: The utilization of ambulances in the East Gojjam Zone was low. Knowing the ambulance call number, presenting to the ED at night, prior use of an ambulance, and having a higher triage score were determinants of ambulance utilization. Unavailability of road infrastructure, delayed responses from ambulance drivers, and a lack of ambulance vehicles were the major barriers to ambulance utilization. Increasing the number of ambulances, designing ambulance stations at health facilities, and resolving of the current conflict were the perceived solutions. Therefore, increasing the number of ambulances, improving community awareness, and coordination of available resources are essential to improve ambulance utilizations.

Background: Ambulance services are a core component of emergency medical systems, yet utilization remains low in many low- and middle-income countries. Evidence from conflict-affected regions is scarce. This study assessed the prevalence, determinants, barriers, and perceived solutions of ambulance utilization in Northwest Ethiopia. Methods: A multi-center, institutional-based cross-sectional study using a mixed sequential explanatory design was conducted. Systematic random sampling and purposive sampling techniques were used to select participants for the quantitative and qualitative components, respectively. Data were collected using interviewer-administered questionnaires, in-depth interviews, and key-informant interviews. Quantitative data were collected using KoboCollect software and exported to STATA version 17 for analysis. Descriptive statistics were presented using mean and/or median for numerical variables and percentages for categorical variables. A binary logistic regression model was used to identify associated factors. Variables with a p-value < 0.25 in bivariable analysis were entered into the multivariable model. Model fitness was assessed using the Hosmer–Lemeshow goodness-of-fit test. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to report the strength of associations, and statistical significance was declared at p < 0.05. For qualitative data, audio recordings were transcribed, translated, coded, and analyzed using thematic analysis. Results: This study found that 16.6% of the study participants used an ambulance to get to the hospital. Independent factors were knowing the ambulance call (AOR = 2.68; 95% CI: 1.05, 6.82), presenting at the emergency department during the night (AOR = 6.60; 95% CI: 3.15, 13.83), having a triage score ≥ 7 (AOR = 9.76; 95% CI:4.07, 23.44), and having prior experience of ambulance use (AOR = 2.99; 95% CI: 1.28, 6.99). The qualitative findings identified three major barriers; ambulance unavailability, communication barrier, and road inaccessibility. Conclusion and recommendations: The utilization of ambulances in the East Gojjam Zone was low. Knowing the ambulance call number, presenting to the ED at night, prior use of an ambulance, and having a higher triage score were determinants of ambulance utilization. Structural barriers, particularly conflict-related service disruption, substantially limit access n. Efforts should prioritize increasing the number of ambulances, decentralization of ambulance stations, public awareness campaigns, and resolving armed conflicts.