Prehospital and Disaster Medicine

Case Report

Prehospital System Development in Jaffna, Sri Lanka

John R. Zimmermana1 p1, Kecia M. Bertermanna2 p2, Paul J. Bollingera2 c1 p2 and Donnie R. Woodyard Jr.a3 p3

a1 United States Sri Lanka Fulbright Commission, Colombo, Sri Lanka.

a2 Medical Teams International, Tigard, Oregon USA.

a3 Medical Teams International, Colombo, Sri Lanka.


Introduction The building of prehospital emergency medical care systems in developing and lower middle-income countries (as defined by the World Bank) is a critical step in those countries’ efforts to reduce unnecessary morbidity and mortality. This case report presents the development of a prehospital care system in Jaffna District, Sri Lanka and provides the results of the system's first year of operations, the likely reasons for the results, and the prospects for sustained operations of the system. The goal of this report is to add to the literature surrounding Emergency Medical Services (EMS) in developing countries by providing insight into the implementation of a prehospital emergency care system in developing and lower middle-income settings.

Methods The level of utilization and the financial performance of the system during its first year of operation were analyzed using data from the Jaffna Regional Director of Health Services (RDHS) Call Center database and information from the implementing organization, Medical Teams International.

Results The system responded to >2000 emergency calls in its first 11 months of operation. The most utilized ambulance of the system experienced only a US $13.50 loss during the first 12 months of operation. Factors such as up-front support, a systematic approach, and appropriateness contributed to the successful implementation of the Jaffna prehospital EMS system.

Conclusion The implementation of a prehospital EMS system and its functioning were successful in terms of utility and, in many regards, financial stability. The system's success in development may serve as a potential model for implementing prehospital emergency medical care in other developing and lower middle-income country settings, keeping in mind factors outside of the system that were integral to its developmental success.

JR Zimmerman, KM Bertermann, PJ Bollinger, DR Woodyard. Prehospital system development in Jaffna, Sri Lanka. Prehosp Disaster Med. 2013;28(5):1-8.

(Received July 21 2010)

(Revised April 27 2011)

(Accepted November 01 2011)

(Online publication July 10 2013)


  • ambulance;
  • Emergency Medical Services;
  • Sri Lanka


  • EMS:Emergency Medical Services;
  • EMT:emergency medical technician;
  • IDP:internally displaced persons;
  • MOH:Ministry of Health;
  • MTI:Medical Teams International;
  • NGO:nongovernmental organization;
  • NHTSA:National Highway Traffic and Safety Administration;
  • RDHS:Regional Department of Health Services


c1 Correspondence: Paul J. Bollinger, MPH Emergency Medical Care Senior Advisor Medical Teams International 14150 SW Milton Court Tigard, OR 97224 USA E-mail

p1 Mr. Zimmerman is currently an independent consultant.

p2 Ms. Bertermann is currently affiliated with Girl Hub in Rwanda.

p3 Mr. Woodyard is currently affiliated with Falck Sri Lanka.


  Conflicts of interest:: None.