Delivery of emergency medical services in Kathmandu, Nepal.

We describe the delivery of emergency medical services in the developing country of Nepal and identify areas of need and potential collaboration. We conducted interviews with emergency department directors and staff, analyzed ED patient records, and prospectively surveyed a convenience sample of patients visiting three Kathmandu, Nepal, EDs. The three principal EDs in Kathmandu have a collective yearly volume exceeding 100,000 visits. Injury is the reason for more than 30% of all visits; 27% of ED patients are admitted. Equipment and emergency laboratory tests essential to the practice of emergency medicine are often unavailable. Emergency physicians receive no formal training in emergency medicine, and continuing medical educational opportunities are limited. We determined that the three EDs in Kathmandu provide high-volume, high-acuteness care. Emergency physicians lack critical resources to manage the breadth of clinical problems encountered. A substantial emergency medical infrastructure exists in Kathmandu from which to address emerging problems. Injury is currently the single greatest threat to public health and may benefit from a multi-level international collaborative approach.