Emergency Access and Decision Making in Rural Northwest Nicaragua

Background: Little is known about barriers and decision-making processes rural communities experience when attempting to access emergency medical care in developing countries, such as Nicaragua. Nicaragua has no formal EMS system and rural communities struggle to access emergency services.

Aims: We aim to understand barriers to obtaining emergency care from the perspective of rural Nicaraguan communities. We seek to 1) describe current means of accessing emergency care employed by laypersons in Northwest Nicaragua living outside the vicinity of a hospital, 2) explore knowledge of emergencies and decision making regarding the use of emergency medical care, 3) describe perceived barriers to access.

Methods: In-depth interviews were conducted with 41 laypersons from 6 communities outside the vicinity of a hospital in Northwest Nicaragua. The interviews were approximately 30 minutes, and coded using qualitative software. Themes and categories were identified and grounded theory was used to develop a theoretical framework.

Results: The study identified three main categories of barriers to accessing emergency medical care for laypersons in Northwest Nicaragua living outside the vicinity of a hospital: 1) transportation availability, 2) lack of resources to pay for care-related expenses, 3) perceptions of public quality of care. An individual's decision to access emergency medical care is related to their risk-benefit calculation with regards to these barriers.

Conclusion: The findings will inform efforts in the development of a national EMS service. Decision makers must consider the strengths, challenges and cultural perceptions. Similar assessments should be undertaken in other countries striving to improve pre-hospital care.