Operationalising the WHO call for integrated emergency care through a national ambulance alliance network: implementation experience and lessons from Addis Ababa, Ethiopia (PRECOS-1)
This paper reports the successful implementation of Ethiopia's HEARTS system and the PRECOS-1 study in Addis Ababa, demonstrating that a multi-provider national ambulance alliance can effectively coordinate fragmented emergency services, generate the first unified performance baseline, and provide a replicable model for integrated prehospital care across Africa.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Imagine a city where emergency help is like a giant, chaotic game of "telephone" played by five different teams. One team is the government fire department, another is a group of private companies, a third is a hospital's own transport, a fourth is a charity, and a fifth is a volunteer network. The problem isn't that they don't have enough trucks; it's that they are all playing on different fields with different rules. Team A has a red phone, Team B has a blue one, and Team C only answers if you knock on their door. If you call for help, you might get a truck that's already busy, or worse, no one hears you at all. This is the reality of emergency care in many African cities: a "fragmented" system where the pieces exist, but they don't talk to each other. Without a way to share information, the city is blind; it doesn't know how long it takes to get help, where the trucks are, or which patients are waiting. This paper dives into a bold experiment to fix this mess, not by buying a thousand new trucks, but by building a single, giant "brain" that connects everyone.
The paper, titled "Operationalising the WHO call for integrated emergency care through a national ambulance alliance network," tells the story of a project in Addis Ababa, Ethiopia, called HEARTS (Hospital Emergency Assistance and Response Tracking System). Think of HEARTS as a massive, digital air-traffic control tower for ambulances. Before this system, the city was like a busy airport where every pilot had their own radio frequency, and the control tower didn't know who was landing where. The researchers built a platform that acts as a universal translator and a shared map. It connects the government fire trucks, hospital ambulances, private services, and NGOs into one "Alliance Network" (EAAN). This network doesn't take away the trucks; it just gives them a shared playbook.
The study, known as PRECOS-1, looked at the first six months of this new system (from December 2025 to June 2026). The results were a mix of "we finally have a map" and "we have a lot of work to do." The system successfully coordinated 1,403 trips using 59 response units from four different types of providers. For the first time, the city could actually measure how fast help arrived. The data showed that the median response time was 14.5 minutes, meaning half the time, help arrived in under 15 minutes. However, the "worst-case" scenario (the 90th percentile) was much slower: 75.0 minutes. This means that for some people, they waited over an hour and a quarter for an ambulance, a fact that was previously invisible because no one was tracking it.
The paper also reveals who needed help the most. The biggest group of patients, making up 44.3% of all trips, were mothers and babies facing obstetric emergencies. This highlights that the new system is already proving vital for saving lives during childbirth. The system also showed that the city-administrative public provider (the fire department) handled the most trips (79.0%), while private providers were just starting to join in, contributing only 0.4% of the trips during this initial phase.
However, the paper is very clear about what this system isn't yet. It is not a magic wand that fixed everything instantly. The authors explicitly rule out the idea that the technology alone solved the problem. In fact, they found that the hardest part wasn't the software; it was getting the different teams to trust each other. Private ambulance companies were scared that sharing data would hurt their business, and some public workers were worried about being judged on their performance. The paper argues that "governance before technology" is the key rule: you have to build trust and agreements before you can turn on the digital switches.
Furthermore, the paper admits that the system is still "learning to walk." While the timing data was good, the medical details were often missing. For example, the system recorded the patient's age in 68.7% of cases, but it only recorded their blood pressure in 1.9% of cases and their breathing rate in 3.9%. This isn't because the computer failed; it's because the people in the ambulances weren't trained or required to write those details down yet. The paper suggests that the next steps (PRECOS-2 and beyond) will focus on training crews to fill in these medical blanks and on getting more private companies to fully join the network.
In short, this paper doesn't claim to have "solved" emergency care in Ethiopia. Instead, it suggests that the first, most critical step—making the invisible visible—has been taken. By building a shared digital layer, the city finally has a baseline to measure its own performance. It found that help takes an average of 14.5 minutes, but sometimes takes 75 minutes, and that mothers are the most frequent users of the service. The authors propose that this "coordination-first" approach, where different rivals agree to play on the same team, is a replicable model for other cities. It's a story of turning a chaotic game of telephone into a coordinated orchestra, even if the musicians are still learning to read the sheet music.
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